|
PR DISARTICULATION SHOULDER
|
Professional
|
Both
|
$2,056.00
|
|
|
Service Code
|
HCPCS 23920
|
| Min. Negotiated Rate |
$659.66 |
| Max. Negotiated Rate |
$1,969.28 |
| Rate for Payer: Aetna Commercial |
$1,359.62
|
| Rate for Payer: Aetna Medicare |
$1,014.64
|
| Rate for Payer: BCBS Complete |
$692.64
|
| Rate for Payer: BCBS MAPPO |
$1,014.64
|
| Rate for Payer: BCN Commercial |
$1,704.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,014.64
|
| Rate for Payer: Cash Price |
$1,644.80
|
| Rate for Payer: Cash Price |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$1,461.08
|
| Rate for Payer: Cofinity Commercial |
$1,359.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,014.64
|
| Rate for Payer: Healthscope Commercial |
$1,217.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,065.37
|
| Rate for Payer: Meridian Medicaid |
$692.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,116.10
|
| Rate for Payer: Nomi Health Commercial |
$1,217.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,542.00
|
| Rate for Payer: PACE SWMI |
$1,014.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,014.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,821.63
|
| Rate for Payer: Priority Health Medicare |
$1,014.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,821.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,014.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,969.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,014.64
|
| Rate for Payer: UHC Exchange |
$1,969.28
|
| Rate for Payer: UHC Medicaid |
$659.66
|
| Rate for Payer: UHCCP DNSP |
$1,014.64
|
| Rate for Payer: UHCCP Medicaid |
$659.66
|
|
|
PR DISARTICULATION THROUGH WRIST
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 25920
|
| Min. Negotiated Rate |
$444.74 |
| Max. Negotiated Rate |
$1,240.76 |
| Rate for Payer: Aetna Commercial |
$905.57
|
| Rate for Payer: Aetna Medicare |
$675.80
|
| Rate for Payer: BCBS Complete |
$466.98
|
| Rate for Payer: BCBS MAPPO |
$675.80
|
| Rate for Payer: BCN Commercial |
$1,112.49
|
| Rate for Payer: BCN Medicare Advantage |
$675.80
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$973.15
|
| Rate for Payer: Cofinity Commercial |
$905.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.80
|
| Rate for Payer: Healthscope Commercial |
$810.96
|
| Rate for Payer: Healthscope Whirlpool |
$810.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.59
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$743.38
|
| Rate for Payer: Nomi Health Commercial |
$810.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,106.25
|
| Rate for Payer: PACE SWMI |
$675.80
|
| Rate for Payer: PHP Medicare Advantage |
$675.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,189.22
|
| Rate for Payer: Priority Health Medicare |
$675.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.22
|
| Rate for Payer: Railroad Medicare Medicare |
$675.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,240.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$675.80
|
| Rate for Payer: UHC Exchange |
$1,240.76
|
| Rate for Payer: UHC Medicaid |
$444.74
|
| Rate for Payer: UHCCP DNSP |
$675.80
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
|
|
PR DISARTICULATION THRU WRIST RE-AMPUTATION
|
Professional
|
Both
|
$2,430.00
|
|
|
Service Code
|
HCPCS 25924
|
| Min. Negotiated Rate |
$434.73 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Aetna Commercial |
$885.16
|
| Rate for Payer: Aetna Medicare |
$660.57
|
| Rate for Payer: BCBS Complete |
$456.47
|
| Rate for Payer: BCBS MAPPO |
$660.57
|
| Rate for Payer: BCN Commercial |
$1,085.60
|
| Rate for Payer: BCN Medicare Advantage |
$660.57
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cofinity Commercial |
$951.22
|
| Rate for Payer: Cofinity Commercial |
$885.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$660.57
|
| Rate for Payer: Healthscope Commercial |
$792.68
|
| Rate for Payer: Healthscope Whirlpool |
$792.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$693.60
|
| Rate for Payer: Meridian Medicaid |
$456.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$726.63
|
| Rate for Payer: Nomi Health Commercial |
$792.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,822.50
|
| Rate for Payer: PACE SWMI |
$660.57
|
| Rate for Payer: PHP Medicare Advantage |
$660.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,160.47
|
| Rate for Payer: Priority Health Medicare |
$660.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,160.47
|
| Rate for Payer: Railroad Medicare Medicare |
$660.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,210.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$660.57
|
| Rate for Payer: UHC Exchange |
$1,210.54
|
| Rate for Payer: UHC Medicaid |
$434.73
|
| Rate for Payer: UHCCP DNSP |
$660.57
|
| Rate for Payer: UHCCP Medicaid |
$434.73
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC
|
Professional
|
Both
|
$5,918.00
|
|
|
Service Code
|
HCPCS 63075
|
| Min. Negotiated Rate |
$821.54 |
| Max. Negotiated Rate |
$4,438.50 |
| Rate for Payer: Aetna Commercial |
$1,711.80
|
| Rate for Payer: Aetna Medicare |
$1,277.46
|
| Rate for Payer: BCBS Complete |
$862.62
|
| Rate for Payer: BCBS MAPPO |
$1,277.46
|
| Rate for Payer: BCN Commercial |
$2,259.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,277.46
|
| Rate for Payer: Cash Price |
$4,734.40
|
| Rate for Payer: Cash Price |
$4,734.40
|
| Rate for Payer: Cofinity Commercial |
$1,839.54
|
| Rate for Payer: Cofinity Commercial |
$1,711.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,277.46
|
| Rate for Payer: Healthscope Commercial |
$1,532.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,532.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,341.33
|
| Rate for Payer: Meridian Medicaid |
$862.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,405.21
|
| Rate for Payer: Nomi Health Commercial |
$1,532.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,438.50
|
| Rate for Payer: PACE SWMI |
$1,277.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,277.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$821.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,389.35
|
| Rate for Payer: Priority Health Medicare |
$1,277.46
|
| Rate for Payer: Priority Health Narrow Network |
$2,389.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,277.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,381.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,277.46
|
| Rate for Payer: UHC Exchange |
$2,381.47
|
| Rate for Payer: UHC Medicaid |
$821.54
|
| Rate for Payer: UHCCP DNSP |
$1,277.46
|
| Rate for Payer: UHCCP Medicaid |
$821.54
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC
|
Professional
|
Both
|
$1,986.00
|
|
|
Service Code
|
HCPCS 63076
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,489.50 |
| Rate for Payer: Aetna Commercial |
$293.14
|
| Rate for Payer: Aetna Medicare |
$218.76
|
| Rate for Payer: BCBS Complete |
$145.37
|
| Rate for Payer: BCBS MAPPO |
$218.76
|
| Rate for Payer: BCN Commercial |
$401.00
|
| Rate for Payer: BCN Medicare Advantage |
$218.76
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cofinity Commercial |
$315.01
|
| Rate for Payer: Cofinity Commercial |
$293.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.76
|
| Rate for Payer: Healthscope Commercial |
$262.51
|
| Rate for Payer: Healthscope Whirlpool |
$262.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.70
|
| Rate for Payer: Meridian Medicaid |
$145.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.64
|
| Rate for Payer: Nomi Health Commercial |
$262.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.50
|
| Rate for Payer: PACE SWMI |
$218.76
|
| Rate for Payer: PHP Medicare Advantage |
$218.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$423.96
|
| Rate for Payer: Priority Health Medicare |
$218.76
|
| Rate for Payer: Priority Health Narrow Network |
$423.96
|
| Rate for Payer: Railroad Medicare Medicare |
$218.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.76
|
| Rate for Payer: UHC Exchange |
$437.99
|
| Rate for Payer: UHC Medicaid |
$138.45
|
| Rate for Payer: UHCCP DNSP |
$218.76
|
| Rate for Payer: UHCCP Medicaid |
$138.45
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC
|
Professional
|
Both
|
$5,863.00
|
|
|
Service Code
|
HCPCS 63077
|
| Min. Negotiated Rate |
$836.45 |
| Max. Negotiated Rate |
$4,397.25 |
| Rate for Payer: Aetna Commercial |
$1,737.50
|
| Rate for Payer: Aetna Medicare |
$1,296.64
|
| Rate for Payer: BCBS Complete |
$878.27
|
| Rate for Payer: BCBS MAPPO |
$1,296.64
|
| Rate for Payer: BCN Commercial |
$2,420.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,296.64
|
| Rate for Payer: Cash Price |
$4,690.40
|
| Rate for Payer: Cash Price |
$4,690.40
|
| Rate for Payer: Cofinity Commercial |
$1,867.16
|
| Rate for Payer: Cofinity Commercial |
$1,737.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,296.64
|
| Rate for Payer: Healthscope Commercial |
$1,555.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,555.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,361.47
|
| Rate for Payer: Meridian Medicaid |
$878.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,426.30
|
| Rate for Payer: Nomi Health Commercial |
$1,555.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,397.25
|
| Rate for Payer: PACE SWMI |
$1,296.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,296.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,559.40
|
| Rate for Payer: Priority Health Medicare |
$1,296.64
|
| Rate for Payer: Priority Health Narrow Network |
$2,559.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,296.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,661.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,296.64
|
| Rate for Payer: UHC Exchange |
$2,661.31
|
| Rate for Payer: UHC Medicaid |
$836.45
|
| Rate for Payer: UHCCP DNSP |
$1,296.64
|
| Rate for Payer: UHCCP Medicaid |
$836.45
|
|
|
PR DISCHRG MEDS RECONCILED W/CURRENT MED LIST
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS 1111F
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
|
|
PR DISEASE MANAGEMENT PROGRAM
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS S0315
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.75
|
|
|
PR DISEASE MGMT PER DIEM
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS S0317
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 42975
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.22 |
| Rate for Payer: Aetna Commercial |
$110.19
|
| Rate for Payer: Aetna Medicare |
$82.23
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS MAPPO |
$82.23
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: BCN Medicare Advantage |
$82.23
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$118.41
|
| Rate for Payer: Cofinity Commercial |
$110.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.23
|
| Rate for Payer: Healthscope Commercial |
$98.68
|
| Rate for Payer: Healthscope Whirlpool |
$98.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.34
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.45
|
| Rate for Payer: Nomi Health Commercial |
$98.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.50
|
| Rate for Payer: PACE SWMI |
$82.23
|
| Rate for Payer: PHP Medicare Advantage |
$82.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$177.17
|
| Rate for Payer: Priority Health Medicare |
$82.23
|
| Rate for Payer: Priority Health Narrow Network |
$177.17
|
| Rate for Payer: Railroad Medicare Medicare |
$82.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$82.23
|
| Rate for Payer: UHC Exchange |
$202.22
|
| Rate for Payer: UHC Medicaid |
$53.25
|
| Rate for Payer: UHCCP DNSP |
$82.23
|
| Rate for Payer: UHCCP Medicaid |
$53.25
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS V5160
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$484.34 |
| Rate for Payer: Aetna Commercial |
$289.59
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.34
|
| Rate for Payer: UHC Exchange |
$484.34
|
|
|
PR DISPENSING FEE, MONAURAL
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS V5241
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
|
|
PR DISP FEE CONTRALATERAL BINAU
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS V5240
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$415.22 |
| Rate for Payer: Aetna Commercial |
$248.26
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.22
|
| Rate for Payer: UHC Exchange |
$415.22
|
|
|
PR DISP FEE CONTRALATERAL MONAU
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS V5200
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$400.87 |
| Rate for Payer: Aetna Commercial |
$239.68
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$400.87
|
| Rate for Payer: UHC Exchange |
$400.87
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 38542
|
| Min. Negotiated Rate |
$299.48 |
| Max. Negotiated Rate |
$1,050.90 |
| Rate for Payer: Aetna Commercial |
$617.58
|
| Rate for Payer: Aetna Medicare |
$460.88
|
| Rate for Payer: BCBS Complete |
$314.45
|
| Rate for Payer: BCBS MAPPO |
$460.88
|
| Rate for Payer: BCN Commercial |
$789.79
|
| Rate for Payer: BCN Medicare Advantage |
$460.88
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cofinity Commercial |
$663.67
|
| Rate for Payer: Cofinity Commercial |
$617.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.88
|
| Rate for Payer: Healthscope Commercial |
$553.06
|
| Rate for Payer: Healthscope Whirlpool |
$553.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.92
|
| Rate for Payer: Meridian Medicaid |
$314.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$506.97
|
| Rate for Payer: Nomi Health Commercial |
$553.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.50
|
| Rate for Payer: PACE SWMI |
$460.88
|
| Rate for Payer: PHP Medicare Advantage |
$460.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,050.90
|
| Rate for Payer: Priority Health Medicare |
$460.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,050.90
|
| Rate for Payer: Railroad Medicare Medicare |
$460.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$903.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$460.88
|
| Rate for Payer: UHC Exchange |
$903.58
|
| Rate for Payer: UHC Medicaid |
$299.48
|
| Rate for Payer: UHCCP DNSP |
$460.88
|
| Rate for Payer: UHCCP Medicaid |
$299.48
|
|
|
PR DIS SITE TELE SVCS RHC/FQHC
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS G2025
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Aetna Commercial |
$95.30
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.28
|
| Rate for Payer: UHC Exchange |
$126.28
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 92587
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna Medicare |
$21.29
|
| Rate for Payer: BCBS MAPPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Medicare Advantage |
$21.29
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$30.66
|
| Rate for Payer: Cofinity Commercial |
$28.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.29
|
| Rate for Payer: Healthscope Commercial |
$25.55
|
| Rate for Payer: Healthscope Whirlpool |
$25.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.42
|
| Rate for Payer: Nomi Health Commercial |
$25.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.75
|
| Rate for Payer: PACE SWMI |
$21.29
|
| Rate for Payer: PHP Medicare Advantage |
$21.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.86
|
| Rate for Payer: Priority Health Medicare |
$21.29
|
| Rate for Payer: Priority Health Narrow Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$21.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.29
|
| Rate for Payer: UHC Exchange |
$35.32
|
| Rate for Payer: UHCCP DNSP |
$21.29
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 92588
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$53.85 |
| Rate for Payer: Aetna Commercial |
$43.60
|
| Rate for Payer: Aetna Medicare |
$32.54
|
| Rate for Payer: BCBS MAPPO |
$32.54
|
| Rate for Payer: BCN Commercial |
$49.80
|
| Rate for Payer: BCN Medicare Advantage |
$32.54
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$43.60
|
| Rate for Payer: Cofinity Commercial |
$46.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.54
|
| Rate for Payer: Healthscope Commercial |
$39.05
|
| Rate for Payer: Healthscope Whirlpool |
$39.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.79
|
| Rate for Payer: Nomi Health Commercial |
$39.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: PACE SWMI |
$32.54
|
| Rate for Payer: PHP Medicare Advantage |
$32.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.93
|
| Rate for Payer: Priority Health Medicare |
$32.54
|
| Rate for Payer: Priority Health Narrow Network |
$45.93
|
| Rate for Payer: Railroad Medicare Medicare |
$32.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.54
|
| Rate for Payer: UHC Exchange |
$53.85
|
| Rate for Payer: UHCCP DNSP |
$32.54
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR
|
Professional
|
Both
|
$2,510.00
|
|
|
Service Code
|
HCPCS 43130
|
| Min. Negotiated Rate |
$455.61 |
| Max. Negotiated Rate |
$1,882.50 |
| Rate for Payer: Aetna Commercial |
$943.11
|
| Rate for Payer: Aetna Medicare |
$703.81
|
| Rate for Payer: BCBS Complete |
$478.39
|
| Rate for Payer: BCBS MAPPO |
$703.81
|
| Rate for Payer: BCN Commercial |
$1,192.67
|
| Rate for Payer: BCN Medicare Advantage |
$703.81
|
| Rate for Payer: Cash Price |
$2,008.00
|
| Rate for Payer: Cash Price |
$2,008.00
|
| Rate for Payer: Cofinity Commercial |
$943.11
|
| Rate for Payer: Cofinity Commercial |
$1,013.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.81
|
| Rate for Payer: Healthscope Commercial |
$844.57
|
| Rate for Payer: Healthscope Whirlpool |
$844.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$739.00
|
| Rate for Payer: Meridian Medicaid |
$478.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$774.19
|
| Rate for Payer: Nomi Health Commercial |
$844.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,882.50
|
| Rate for Payer: PACE SWMI |
$703.81
|
| Rate for Payer: PHP Medicare Advantage |
$703.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,453.19
|
| Rate for Payer: Priority Health Medicare |
$703.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,453.19
|
| Rate for Payer: Railroad Medicare Medicare |
$703.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,380.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.81
|
| Rate for Payer: UHC Exchange |
$1,380.32
|
| Rate for Payer: UHC Medicaid |
$455.61
|
| Rate for Payer: UHCCP DNSP |
$703.81
|
| Rate for Payer: UHCCP Medicaid |
$455.61
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR
|
Professional
|
Both
|
$3,262.00
|
|
|
Service Code
|
HCPCS 43135
|
| Min. Negotiated Rate |
$885.44 |
| Max. Negotiated Rate |
$2,647.89 |
| Rate for Payer: Aetna Commercial |
$1,860.23
|
| Rate for Payer: Aetna Medicare |
$1,388.23
|
| Rate for Payer: BCBS Complete |
$929.71
|
| Rate for Payer: BCBS MAPPO |
$1,388.23
|
| Rate for Payer: BCN Commercial |
$2,173.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,388.23
|
| Rate for Payer: Cash Price |
$2,609.60
|
| Rate for Payer: Cash Price |
$2,609.60
|
| Rate for Payer: Cofinity Commercial |
$1,999.05
|
| Rate for Payer: Cofinity Commercial |
$1,860.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,388.23
|
| Rate for Payer: Healthscope Commercial |
$1,665.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,665.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,457.64
|
| Rate for Payer: Meridian Medicaid |
$929.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,527.05
|
| Rate for Payer: Nomi Health Commercial |
$1,665.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,446.50
|
| Rate for Payer: PACE SWMI |
$1,388.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,388.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$885.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,647.89
|
| Rate for Payer: Priority Health Medicare |
$1,388.23
|
| Rate for Payer: Priority Health Narrow Network |
$2,647.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,388.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,619.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,388.23
|
| Rate for Payer: UHC Exchange |
$2,619.36
|
| Rate for Payer: UHC Medicaid |
$885.44
|
| Rate for Payer: UHCCP DNSP |
$1,388.23
|
| Rate for Payer: UHCCP Medicaid |
$885.44
|
|
|
PR DIVISION ABERRANT VESSEL VASCULAR RING
|
Professional
|
Both
|
$4,360.00
|
|
|
Service Code
|
HCPCS 33802
|
| Min. Negotiated Rate |
$666.69 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$1,392.37
|
| Rate for Payer: Aetna Medicare |
$1,039.08
|
| Rate for Payer: BCBS Complete |
$700.02
|
| Rate for Payer: BCBS MAPPO |
$1,039.08
|
| Rate for Payer: BCN Commercial |
$1,612.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,039.08
|
| Rate for Payer: Cash Price |
$3,488.00
|
| Rate for Payer: Cash Price |
$3,488.00
|
| Rate for Payer: Cofinity Commercial |
$1,496.28
|
| Rate for Payer: Cofinity Commercial |
$1,392.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,039.08
|
| Rate for Payer: Healthscope Commercial |
$1,246.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,246.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,091.03
|
| Rate for Payer: Meridian Medicaid |
$700.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,142.99
|
| Rate for Payer: Nomi Health Commercial |
$1,246.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,270.00
|
| Rate for Payer: PACE SWMI |
$1,039.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,039.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$666.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,734.00
|
| Rate for Payer: Priority Health Medicare |
$1,039.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,734.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,039.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,920.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,039.08
|
| Rate for Payer: UHC Exchange |
$1,920.84
|
| Rate for Payer: UHC Medicaid |
$666.69
|
| Rate for Payer: UHCCP DNSP |
$1,039.08
|
| Rate for Payer: UHCCP Medicaid |
$666.69
|
|
|
PR DIVISION PLANTAR FASCIA & MUSCLE SPX
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 28250
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$1,012.50 |
| Rate for Payer: Aetna Commercial |
$504.23
|
| Rate for Payer: Aetna Medicare |
$376.29
|
| Rate for Payer: BCBS Complete |
$258.98
|
| Rate for Payer: BCBS MAPPO |
$376.29
|
| Rate for Payer: BCN Commercial |
$629.95
|
| Rate for Payer: BCN Medicare Advantage |
$376.29
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$541.86
|
| Rate for Payer: Cofinity Commercial |
$504.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.29
|
| Rate for Payer: Healthscope Commercial |
$451.55
|
| Rate for Payer: Healthscope Whirlpool |
$451.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.10
|
| Rate for Payer: Meridian Medicaid |
$258.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$413.92
|
| Rate for Payer: Nomi Health Commercial |
$451.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,012.50
|
| Rate for Payer: PACE SWMI |
$376.29
|
| Rate for Payer: PHP Medicare Advantage |
$376.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$673.39
|
| Rate for Payer: Priority Health Medicare |
$376.29
|
| Rate for Payer: Priority Health Narrow Network |
$673.39
|
| Rate for Payer: Railroad Medicare Medicare |
$376.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$706.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$376.29
|
| Rate for Payer: UHC Exchange |
$706.37
|
| Rate for Payer: UHC Medicaid |
$246.65
|
| Rate for Payer: UHCCP DNSP |
$376.29
|
| Rate for Payer: UHCCP Medicaid |
$246.65
|
|
|
PR DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB
|
Professional
|
Both
|
$1,153.00
|
|
|
Service Code
|
HCPCS 21705
|
| Min. Negotiated Rate |
$315.24 |
| Max. Negotiated Rate |
$958.36 |
| Rate for Payer: Aetna Commercial |
$666.41
|
| Rate for Payer: Aetna Medicare |
$497.32
|
| Rate for Payer: BCBS Complete |
$331.00
|
| Rate for Payer: BCBS MAPPO |
$497.32
|
| Rate for Payer: BCN Commercial |
$792.29
|
| Rate for Payer: BCN Medicare Advantage |
$497.32
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Cofinity Commercial |
$716.14
|
| Rate for Payer: Cofinity Commercial |
$666.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.32
|
| Rate for Payer: Healthscope Commercial |
$596.78
|
| Rate for Payer: Healthscope Whirlpool |
$596.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$522.19
|
| Rate for Payer: Meridian Medicaid |
$331.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$547.05
|
| Rate for Payer: Nomi Health Commercial |
$596.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$864.75
|
| Rate for Payer: PACE SWMI |
$497.32
|
| Rate for Payer: PHP Medicare Advantage |
$497.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$846.93
|
| Rate for Payer: Priority Health Medicare |
$497.32
|
| Rate for Payer: Priority Health Narrow Network |
$846.93
|
| Rate for Payer: Railroad Medicare Medicare |
$497.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$958.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$497.32
|
| Rate for Payer: UHC Exchange |
$958.36
|
| Rate for Payer: UHC Medicaid |
$315.24
|
| Rate for Payer: UHCCP DNSP |
$497.32
|
| Rate for Payer: UHCCP Medicaid |
$315.24
|
|
|
PR DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB
|
Professional
|
Both
|
$1,595.00
|
|
|
Service Code
|
HCPCS 21700
|
| Min. Negotiated Rate |
$211.94 |
| Max. Negotiated Rate |
$1,196.25 |
| Rate for Payer: Aetna Commercial |
$445.71
|
| Rate for Payer: Aetna Medicare |
$332.62
|
| Rate for Payer: BCBS Complete |
$222.54
|
| Rate for Payer: BCBS MAPPO |
$332.62
|
| Rate for Payer: BCN Commercial |
$531.34
|
| Rate for Payer: BCN Medicare Advantage |
$332.62
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cofinity Commercial |
$478.97
|
| Rate for Payer: Cofinity Commercial |
$445.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.62
|
| Rate for Payer: Healthscope Commercial |
$399.14
|
| Rate for Payer: Healthscope Whirlpool |
$399.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.25
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$365.88
|
| Rate for Payer: Nomi Health Commercial |
$399.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,196.25
|
| Rate for Payer: PACE SWMI |
$332.62
|
| Rate for Payer: PHP Medicare Advantage |
$332.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$568.00
|
| Rate for Payer: Priority Health Medicare |
$332.62
|
| Rate for Payer: Priority Health Narrow Network |
$568.00
|
| Rate for Payer: Railroad Medicare Medicare |
$332.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$636.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$332.62
|
| Rate for Payer: UHC Exchange |
$636.91
|
| Rate for Payer: UHC Medicaid |
$211.94
|
| Rate for Payer: UHCCP DNSP |
$332.62
|
| Rate for Payer: UHCCP Medicaid |
$211.94
|
|
|
PR DIVISION STRICTURE RECTUM
|
Professional
|
Both
|
$1,421.00
|
|
|
Service Code
|
HCPCS 45150
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$1,065.75 |
| Rate for Payer: Aetna Commercial |
$548.41
|
| Rate for Payer: Aetna Medicare |
$409.26
|
| Rate for Payer: BCBS Complete |
$280.01
|
| Rate for Payer: BCBS MAPPO |
$409.26
|
| Rate for Payer: BCN Commercial |
$644.38
|
| Rate for Payer: BCN Medicare Advantage |
$409.26
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cofinity Commercial |
$589.33
|
| Rate for Payer: Cofinity Commercial |
$548.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$409.26
|
| Rate for Payer: Healthscope Commercial |
$491.11
|
| Rate for Payer: Healthscope Whirlpool |
$491.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$429.72
|
| Rate for Payer: Meridian Medicaid |
$280.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$450.19
|
| Rate for Payer: Nomi Health Commercial |
$491.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,065.75
|
| Rate for Payer: PACE SWMI |
$409.26
|
| Rate for Payer: PHP Medicare Advantage |
$409.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$785.14
|
| Rate for Payer: Priority Health Medicare |
$409.26
|
| Rate for Payer: Priority Health Narrow Network |
$785.14
|
| Rate for Payer: Railroad Medicare Medicare |
$409.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$736.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$409.26
|
| Rate for Payer: UHC Exchange |
$736.84
|
| Rate for Payer: UHC Medicaid |
$266.68
|
| Rate for Payer: UHCCP DNSP |
$409.26
|
| Rate for Payer: UHCCP Medicaid |
$266.68
|
|
