|
PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
HCPCS 43762
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$334.75 |
| Rate for Payer: Aetna Commercial |
$49.02
|
| Rate for Payer: Aetna Medicare |
$36.58
|
| Rate for Payer: BCBS Complete |
$24.82
|
| Rate for Payer: BCBS MAPPO |
$36.58
|
| Rate for Payer: BCBS Trust/PPO |
$210.26
|
| Rate for Payer: BCN Commercial |
$334.75
|
| Rate for Payer: BCN Medicare Advantage |
$36.58
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cofinity Commercial |
$49.02
|
| Rate for Payer: Cofinity Commercial |
$52.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.58
|
| Rate for Payer: Healthscope Commercial |
$43.90
|
| Rate for Payer: Healthscope Whirlpool |
$43.90
|
| Rate for Payer: Meridian Medicaid |
$24.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.41
|
| Rate for Payer: PACE SWMI |
$36.58
|
| Rate for Payer: PHP Medicare Advantage |
$36.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.09
|
| Rate for Payer: Priority Health Medicare |
$36.58
|
| Rate for Payer: Priority Health Narrow Network |
$64.09
|
| Rate for Payer: UHC Medicare Advantage |
$37.68
|
|
|
PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 43763
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$750.19 |
| Rate for Payer: Aetna Commercial |
$114.86
|
| Rate for Payer: Aetna Medicare |
$85.72
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$85.72
|
| Rate for Payer: BCBS Trust/PPO |
$750.19
|
| Rate for Payer: BCN Commercial |
$496.49
|
| Rate for Payer: BCN Medicare Advantage |
$85.72
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$123.44
|
| Rate for Payer: Cofinity Commercial |
$114.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.72
|
| Rate for Payer: Healthscope Commercial |
$102.86
|
| Rate for Payer: Healthscope Whirlpool |
$102.86
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.01
|
| Rate for Payer: PACE SWMI |
$85.72
|
| Rate for Payer: PHP Medicare Advantage |
$85.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.29
|
| Rate for Payer: Priority Health Medicare |
$85.72
|
| Rate for Payer: Priority Health Narrow Network |
$152.29
|
| Rate for Payer: UHC Medicare Advantage |
$88.29
|
|
|
PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 0201T
|
| Min. Negotiated Rate |
$237.73 |
| Max. Negotiated Rate |
$6,118.53 |
| Rate for Payer: Aetna Commercial |
$2,396.07
|
| Rate for Payer: BCBS Complete |
$249.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,600.00
|
| Rate for Payer: BCN Commercial |
$6,118.53
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Meridian Medicaid |
$249.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.20
|
|
|
PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL
|
Professional
|
Both
|
$2,272.00
|
|
|
Service Code
|
HCPCS 0200T
|
| Min. Negotiated Rate |
$64.33 |
| Max. Negotiated Rate |
$6,118.53 |
| Rate for Payer: Aetna Commercial |
$2,325.11
|
| Rate for Payer: BCBS Complete |
$249.62
|
| Rate for Payer: BCBS Trust/PPO |
$64.33
|
| Rate for Payer: BCN Commercial |
$6,118.53
|
| Rate for Payer: Cash Price |
$1,817.60
|
| Rate for Payer: Cash Price |
$1,817.60
|
| Rate for Payer: Meridian Medicaid |
$249.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,590.40
|
|
|
PR PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS
|
Professional
|
Both
|
$3,110.00
|
|
|
Service Code
|
HCPCS 27216
|
| Min. Negotiated Rate |
$571.69 |
| Max. Negotiated Rate |
$2,177.00 |
| Rate for Payer: Aetna Commercial |
$1,191.27
|
| Rate for Payer: BCBS Complete |
$600.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,616.07
|
| Rate for Payer: BCN Commercial |
$1,302.33
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Meridian Medicaid |
$600.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,177.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,360.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,360.88
|
|
|
PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,906.00
|
|
|
Service Code
|
HCPCS 25606
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$1,334.20 |
| Rate for Payer: Aetna Commercial |
$882.66
|
| Rate for Payer: Aetna Medicare |
$658.70
|
| Rate for Payer: BCBS Complete |
$458.03
|
| Rate for Payer: BCBS MAPPO |
$658.70
|
| Rate for Payer: BCBS Trust/PPO |
$72.38
|
| Rate for Payer: BCN Commercial |
$988.59
|
| Rate for Payer: BCN Medicare Advantage |
$658.70
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$948.53
|
| Rate for Payer: Cofinity Commercial |
$882.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.70
|
| Rate for Payer: Healthscope Commercial |
$790.44
|
| Rate for Payer: Healthscope Whirlpool |
$790.44
|
| Rate for Payer: Meridian Medicaid |
$458.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$691.64
|
| Rate for Payer: PACE SWMI |
$658.70
|
| Rate for Payer: PHP Medicare Advantage |
$658.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,033.05
|
| Rate for Payer: Priority Health Medicare |
$658.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,033.05
|
| Rate for Payer: UHC Medicare Advantage |
$678.46
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
HCPCS 36906
|
| Min. Negotiated Rate |
$316.52 |
| Max. Negotiated Rate |
$7,992.80 |
| Rate for Payer: Aetna Commercial |
$668.34
|
| Rate for Payer: Aetna Medicare |
$498.76
|
| Rate for Payer: BCBS Complete |
$332.35
|
| Rate for Payer: BCBS MAPPO |
$498.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.60
|
| Rate for Payer: BCN Commercial |
$7,992.80
|
| Rate for Payer: BCN Medicare Advantage |
$498.76
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cofinity Commercial |
$668.34
|
| Rate for Payer: Cofinity Commercial |
$718.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.76
|
| Rate for Payer: Healthscope Commercial |
$598.51
|
| Rate for Payer: Healthscope Whirlpool |
$598.51
|
| Rate for Payer: Meridian Medicaid |
$332.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$523.70
|
| Rate for Payer: PACE SWMI |
$498.76
|
| Rate for Payer: PHP Medicare Advantage |
$498.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$791.02
|
| Rate for Payer: Priority Health Medicare |
$498.76
|
| Rate for Payer: Priority Health Narrow Network |
$791.02
|
| Rate for Payer: UHC Medicare Advantage |
$513.72
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP
|
Professional
|
Both
|
$1,296.00
|
|
|
Service Code
|
HCPCS 36905
|
| Min. Negotiated Rate |
$274.13 |
| Max. Negotiated Rate |
$3,353.79 |
| Rate for Payer: Aetna Commercial |
$579.08
|
| Rate for Payer: Aetna Medicare |
$432.15
|
| Rate for Payer: BCBS Complete |
$287.84
|
| Rate for Payer: BCBS MAPPO |
$432.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,385.73
|
| Rate for Payer: BCN Commercial |
$3,353.79
|
| Rate for Payer: BCN Medicare Advantage |
$432.15
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cofinity Commercial |
$622.30
|
| Rate for Payer: Cofinity Commercial |
$579.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$432.15
|
| Rate for Payer: Healthscope Commercial |
$518.58
|
| Rate for Payer: Healthscope Whirlpool |
$518.58
|
| Rate for Payer: Meridian Medicaid |
$287.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$453.76
|
| Rate for Payer: PACE SWMI |
$432.15
|
| Rate for Payer: PHP Medicare Advantage |
$432.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$907.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.22
|
| Rate for Payer: Priority Health Medicare |
$432.15
|
| Rate for Payer: Priority Health Narrow Network |
$686.22
|
| Rate for Payer: UHC Medicare Advantage |
$445.11
|
|
|
PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 36904
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$2,663.30 |
| Rate for Payer: Aetna Commercial |
$482.28
|
| Rate for Payer: Aetna Medicare |
$359.91
|
| Rate for Payer: BCBS Complete |
$239.76
|
| Rate for Payer: BCBS MAPPO |
$359.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,699.01
|
| Rate for Payer: BCN Commercial |
$2,663.30
|
| Rate for Payer: BCN Medicare Advantage |
$359.91
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cofinity Commercial |
$518.27
|
| Rate for Payer: Cofinity Commercial |
$482.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.91
|
| Rate for Payer: Healthscope Commercial |
$431.89
|
| Rate for Payer: Healthscope Whirlpool |
$431.89
|
| Rate for Payer: Meridian Medicaid |
$239.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$377.91
|
| Rate for Payer: PACE SWMI |
$359.91
|
| Rate for Payer: PHP Medicare Advantage |
$359.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.79
|
| Rate for Payer: Priority Health Medicare |
$359.91
|
| Rate for Payer: Priority Health Narrow Network |
$570.79
|
| Rate for Payer: UHC Medicare Advantage |
$370.71
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS 22513
|
| Min. Negotiated Rate |
$219.77 |
| Max. Negotiated Rate |
$8,492.73 |
| Rate for Payer: Aetna Commercial |
$673.66
|
| Rate for Payer: Aetna Medicare |
$502.73
|
| Rate for Payer: BCBS Complete |
$340.17
|
| Rate for Payer: BCBS MAPPO |
$502.73
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: BCN Commercial |
$8,492.73
|
| Rate for Payer: BCN Medicare Advantage |
$502.73
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cofinity Commercial |
$723.93
|
| Rate for Payer: Cofinity Commercial |
$673.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.73
|
| Rate for Payer: Healthscope Commercial |
$603.28
|
| Rate for Payer: Healthscope Whirlpool |
$603.28
|
| Rate for Payer: Meridian Medicaid |
$340.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$527.87
|
| Rate for Payer: PACE SWMI |
$502.73
|
| Rate for Payer: PHP Medicare Advantage |
$502.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$773.63
|
| Rate for Payer: Priority Health Medicare |
$502.73
|
| Rate for Payer: Priority Health Narrow Network |
$773.63
|
| Rate for Payer: UHC Medicare Advantage |
$517.81
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS 22515
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$4,362.91 |
| Rate for Payer: Aetna Commercial |
$289.32
|
| Rate for Payer: Aetna Medicare |
$215.91
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$215.91
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$4,362.91
|
| Rate for Payer: BCN Medicare Advantage |
$215.91
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cofinity Commercial |
$310.91
|
| Rate for Payer: Cofinity Commercial |
$289.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.91
|
| Rate for Payer: Healthscope Commercial |
$259.09
|
| Rate for Payer: Healthscope Whirlpool |
$259.09
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.71
|
| Rate for Payer: PACE SWMI |
$215.91
|
| Rate for Payer: PHP Medicare Advantage |
$215.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.88
|
| Rate for Payer: Priority Health Medicare |
$215.91
|
| Rate for Payer: Priority Health Narrow Network |
$329.88
|
| Rate for Payer: UHC Medicare Advantage |
$222.39
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR
|
Professional
|
Both
|
$1,416.00
|
|
|
Service Code
|
HCPCS 22514
|
| Min. Negotiated Rate |
$302.03 |
| Max. Negotiated Rate |
$8,451.68 |
| Rate for Payer: Aetna Commercial |
$627.90
|
| Rate for Payer: Aetna Medicare |
$468.58
|
| Rate for Payer: BCBS Complete |
$317.13
|
| Rate for Payer: BCBS MAPPO |
$468.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,205.12
|
| Rate for Payer: BCN Commercial |
$8,451.68
|
| Rate for Payer: BCN Medicare Advantage |
$468.58
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cofinity Commercial |
$627.90
|
| Rate for Payer: Cofinity Commercial |
$674.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.58
|
| Rate for Payer: Healthscope Commercial |
$562.30
|
| Rate for Payer: Healthscope Whirlpool |
$562.30
|
| Rate for Payer: Meridian Medicaid |
$317.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$492.01
|
| Rate for Payer: PACE SWMI |
$468.58
|
| Rate for Payer: PHP Medicare Advantage |
$468.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.55
|
| Rate for Payer: Priority Health Medicare |
$468.58
|
| Rate for Payer: Priority Health Narrow Network |
$721.55
|
| Rate for Payer: UHC Medicare Advantage |
$482.64
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL
|
Professional
|
Both
|
$1,036.00
|
|
|
Service Code
|
HCPCS 22511
|
| Min. Negotiated Rate |
$190.19 |
| Max. Negotiated Rate |
$2,669.64 |
| Rate for Payer: Aetna Commercial |
$534.91
|
| Rate for Payer: Aetna Medicare |
$399.19
|
| Rate for Payer: BCBS Complete |
$270.16
|
| Rate for Payer: BCBS MAPPO |
$399.19
|
| Rate for Payer: BCBS Trust/PPO |
$190.19
|
| Rate for Payer: BCN Commercial |
$2,669.64
|
| Rate for Payer: BCN Medicare Advantage |
$399.19
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cofinity Commercial |
$534.91
|
| Rate for Payer: Cofinity Commercial |
$574.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.19
|
| Rate for Payer: Healthscope Commercial |
$479.03
|
| Rate for Payer: Healthscope Whirlpool |
$479.03
|
| Rate for Payer: Meridian Medicaid |
$270.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$419.15
|
| Rate for Payer: PACE SWMI |
$399.19
|
| Rate for Payer: PHP Medicare Advantage |
$399.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$257.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.31
|
| Rate for Payer: Priority Health Medicare |
$399.19
|
| Rate for Payer: Priority Health Narrow Network |
$614.31
|
| Rate for Payer: UHC Medicare Advantage |
$411.17
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC
|
Professional
|
Both
|
$3,354.00
|
|
|
Service Code
|
HCPCS 22510
|
| Min. Negotiated Rate |
$273.28 |
| Max. Negotiated Rate |
$2,683.33 |
| Rate for Payer: Aetna Commercial |
$570.57
|
| Rate for Payer: Aetna Medicare |
$425.80
|
| Rate for Payer: BCBS Complete |
$286.94
|
| Rate for Payer: BCBS MAPPO |
$425.80
|
| Rate for Payer: BCBS Trust/PPO |
$825.51
|
| Rate for Payer: BCN Commercial |
$2,683.33
|
| Rate for Payer: BCN Medicare Advantage |
$425.80
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cofinity Commercial |
$570.57
|
| Rate for Payer: Cofinity Commercial |
$613.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.80
|
| Rate for Payer: Healthscope Commercial |
$510.96
|
| Rate for Payer: Healthscope Whirlpool |
$510.96
|
| Rate for Payer: Meridian Medicaid |
$286.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$447.09
|
| Rate for Payer: PACE SWMI |
$425.80
|
| Rate for Payer: PHP Medicare Advantage |
$425.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,347.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$654.65
|
| Rate for Payer: Priority Health Medicare |
$425.80
|
| Rate for Payer: Priority Health Narrow Network |
$654.65
|
| Rate for Payer: UHC Medicare Advantage |
$438.57
|
|
|
PR PESSARY, NON RUBBER,ANY TYPE
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS A4562
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCN Commercial |
$56.07
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
PR PESSARY RUBBER, ANY TYPE
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS A4561
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$19.09
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCN Commercial |
$22.57
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
PR PHALANGECTOMY TOE EACH TOE
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28150
|
| Min. Negotiated Rate |
$180.41 |
| Max. Negotiated Rate |
$1,132.15 |
| Rate for Payer: Aetna Commercial |
$363.45
|
| Rate for Payer: Aetna Medicare |
$271.23
|
| Rate for Payer: BCBS Complete |
$189.43
|
| Rate for Payer: BCBS MAPPO |
$271.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.15
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: BCN Medicare Advantage |
$271.23
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$363.45
|
| Rate for Payer: Cofinity Commercial |
$390.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.23
|
| Rate for Payer: Healthscope Commercial |
$325.48
|
| Rate for Payer: Healthscope Whirlpool |
$325.48
|
| Rate for Payer: Meridian Medicaid |
$189.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$284.79
|
| Rate for Payer: PACE SWMI |
$271.23
|
| Rate for Payer: PHP Medicare Advantage |
$271.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.83
|
| Rate for Payer: Priority Health Medicare |
$271.23
|
| Rate for Payer: Priority Health Narrow Network |
$423.83
|
| Rate for Payer: UHC Medicare Advantage |
$279.37
|
|
|
PR PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 90863
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$1,062.41 |
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.41
|
| Rate for Payer: BCN Commercial |
$70.30
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.86
|
| Rate for Payer: Priority Health Narrow Network |
$41.86
|
|
|
PR PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX
|
Professional
|
Both
|
$1,413.00
|
|
|
Service Code
|
HCPCS 42950
|
| Min. Negotiated Rate |
$510.35 |
| Max. Negotiated Rate |
$1,414.67 |
| Rate for Payer: Aetna Commercial |
$1,037.71
|
| Rate for Payer: Aetna Medicare |
$774.41
|
| Rate for Payer: BCBS Complete |
$535.87
|
| Rate for Payer: BCBS MAPPO |
$774.41
|
| Rate for Payer: BCBS Trust/PPO |
$665.13
|
| Rate for Payer: BCN Commercial |
$1,175.76
|
| Rate for Payer: BCN Medicare Advantage |
$774.41
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cofinity Commercial |
$1,037.71
|
| Rate for Payer: Cofinity Commercial |
$1,115.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.41
|
| Rate for Payer: Healthscope Commercial |
$929.29
|
| Rate for Payer: Healthscope Whirlpool |
$929.29
|
| Rate for Payer: Meridian Medicaid |
$535.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$813.13
|
| Rate for Payer: PACE SWMI |
$774.41
|
| Rate for Payer: PHP Medicare Advantage |
$774.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$989.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,414.67
|
| Rate for Payer: Priority Health Medicare |
$774.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,414.67
|
| Rate for Payer: UHC Medicare Advantage |
$797.64
|
|
|
PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 99195
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$587.47 |
| Rate for Payer: Aetna Commercial |
$120.41
|
| Rate for Payer: Aetna Medicare |
$89.86
|
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: BCBS MAPPO |
$89.86
|
| Rate for Payer: BCBS Trust/PPO |
$587.47
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: BCN Medicare Advantage |
$89.86
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Cofinity Commercial |
$120.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.86
|
| Rate for Payer: Healthscope Commercial |
$107.83
|
| Rate for Payer: Healthscope Whirlpool |
$107.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$94.35
|
| Rate for Payer: PACE SWMI |
$89.86
|
| Rate for Payer: PHP Medicare Advantage |
$89.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.25
|
| Rate for Payer: Priority Health Medicare |
$89.86
|
| Rate for Payer: Priority Health Narrow Network |
$130.25
|
| Rate for Payer: UHC Medicare Advantage |
$92.56
|
|
|
PR PHTFAC ARMS
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00079
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR PHTFAC CHEST/SHLD
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 00077
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
|
|
PR PHTFAC FACE & NECK/ FL ARMS
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00076
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR PHTFAC FL LEGS
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 00080
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
|
|
PR PHTFAC HANDS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00078
|
|
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
|
|
