|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
HCPCS 43251
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$775.45 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: Aetna Medicare |
$596.50
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS Trust/PPO |
$748.60
|
| Rate for Payer: BCN Commercial |
$729.10
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Meridian Medicaid |
$129.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.83
|
| Rate for Payer: Priority Health Narrow Network |
$344.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.35
|
| Rate for Payer: UHC Exchange |
$274.35
|
| Rate for Payer: UHCCP Medicaid |
$123.54
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$492.37 |
| Max. Negotiated Rate |
$1,423.83 |
| Rate for Payer: Aetna Commercial |
$754.20
|
| Rate for Payer: Aetna Medicare |
$918.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: ASR ASR |
$812.86
|
| Rate for Payer: ASR Commercial |
$812.86
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$686.24
|
| Rate for Payer: BCN Commercial |
$649.70
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$787.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$838.00
|
| Rate for Payer: Healthscope Whirlpool |
$812.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$918.60
|
| Rate for Payer: Mclaren Commercial |
$754.20
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.30
|
| Rate for Payer: Nomi Health Commercial |
$687.16
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$1,010.46
|
| Rate for Payer: PHP Medicaid |
$492.37
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$734.26
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$587.44
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$737.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$1,423.83
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP DNSP |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$544.70 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$754.20
|
| Rate for Payer: ASR ASR |
$812.86
|
| Rate for Payer: ASR Commercial |
$812.86
|
| Rate for Payer: BCBS Trust/PPO |
$682.89
|
| Rate for Payer: BCN Commercial |
$649.70
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$787.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.40
|
| Rate for Payer: Healthscope Commercial |
$838.00
|
| Rate for Payer: Healthscope Whirlpool |
$812.86
|
| Rate for Payer: Mclaren Commercial |
$754.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.30
|
| Rate for Payer: Nomi Health Commercial |
$687.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$737.44
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 43239
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$554.16 |
| Rate for Payer: Aetna Commercial |
$183.36
|
| Rate for Payer: Aetna Medicare |
$419.00
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$33.11
|
| Rate for Payer: BCN Commercial |
$554.16
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.61
|
| Rate for Payer: Priority Health Narrow Network |
$244.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.15
|
| Rate for Payer: UHC Exchange |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$87.33
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
43239
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$554.16 |
| Rate for Payer: Aetna Commercial |
$183.36
|
| Rate for Payer: Aetna Medicare |
$419.00
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$33.11
|
| Rate for Payer: BCN Commercial |
$554.16
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.61
|
| Rate for Payer: Priority Health Narrow Network |
$244.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.15
|
| Rate for Payer: UHC Exchange |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$87.33
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,153.00
|
|
|
Service Code
|
HCPCS 43255
|
| Min. Negotiated Rate |
$126.31 |
| Max. Negotiated Rate |
$935.09 |
| Rate for Payer: Aetna Commercial |
$266.36
|
| Rate for Payer: Aetna Medicare |
$576.50
|
| Rate for Payer: BCBS Complete |
$132.63
|
| Rate for Payer: BCBS Trust/PPO |
$935.09
|
| Rate for Payer: BCN Commercial |
$923.11
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Meridian Medicaid |
$132.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.00
|
| Rate for Payer: Priority Health Narrow Network |
$352.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.29
|
| Rate for Payer: UHC Exchange |
$356.29
|
| Rate for Payer: UHCCP Medicaid |
$126.31
|
|
|
PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$834.00
|
|
|
Service Code
|
HCPCS 43254
|
| Min. Negotiated Rate |
$169.97 |
| Max. Negotiated Rate |
$1,640.37 |
| Rate for Payer: Aetna Commercial |
$358.95
|
| Rate for Payer: Aetna Medicare |
$417.00
|
| Rate for Payer: BCBS Complete |
$178.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.37
|
| Rate for Payer: BCN Commercial |
$386.55
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Meridian Medicaid |
$178.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.30
|
| Rate for Payer: Priority Health Narrow Network |
$474.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.55
|
| Rate for Payer: UHC Exchange |
$372.55
|
| Rate for Payer: UHCCP Medicaid |
$169.97
|
|
|
PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 43240
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$772.20 |
| Rate for Payer: Aetna Commercial |
$521.19
|
| Rate for Payer: Aetna Medicare |
$594.00
|
| Rate for Payer: BCBS Complete |
$258.09
|
| Rate for Payer: BCBS Trust/PPO |
$41.74
|
| Rate for Payer: BCN Commercial |
$560.02
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Meridian Medicaid |
$258.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$688.47
|
| Rate for Payer: Priority Health Narrow Network |
$688.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.86
|
| Rate for Payer: UHC Exchange |
$500.86
|
| Rate for Payer: UHCCP Medicaid |
$245.80
|
|
|
PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 43253
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$1,676.30 |
| Rate for Payer: Aetna Commercial |
$348.83
|
| Rate for Payer: Aetna Medicare |
$402.00
|
| Rate for Payer: BCBS Complete |
$173.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.30
|
| Rate for Payer: BCN Commercial |
$376.28
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Meridian Medicaid |
$173.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$461.16
|
| Rate for Payer: Priority Health Narrow Network |
$461.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$358.61
|
| Rate for Payer: UHC Exchange |
$358.61
|
| Rate for Payer: UHCCP Medicaid |
$165.29
|
|
|
PR EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS G0403
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$1,763.47 |
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,763.47
|
| Rate for Payer: BCN Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.24
|
| Rate for Payer: Priority Health Narrow Network |
$20.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.09
|
| Rate for Payer: UHC Exchange |
$20.09
|
|
|
PR EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0405
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$1,397.35 |
| Rate for Payer: Aetna Commercial |
$11.04
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,397.35
|
| Rate for Payer: BCN Commercial |
$11.73
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.30
|
| Rate for Payer: Priority Health Narrow Network |
$11.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.86
|
| Rate for Payer: UHC Exchange |
$8.86
|
|
|
PR EKG TRACING FOR INITIAL PREV
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0404
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$2,970.10 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,970.10
|
| Rate for Payer: BCN Commercial |
$9.29
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.94
|
| Rate for Payer: Priority Health Narrow Network |
$8.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.22
|
| Rate for Payer: UHC Exchange |
$11.22
|
|
|
PR ELASTIC GARMENT/COVERING
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS A4466
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 95983
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$205.51 |
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS Trust/PPO |
$205.51
|
| Rate for Payer: BCN Commercial |
$72.82
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.04
|
| Rate for Payer: Priority Health Narrow Network |
$66.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.44
|
| Rate for Payer: UHC Exchange |
$55.44
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 95984
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$269.43 |
| Rate for Payer: Aetna Commercial |
$48.95
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Trust/PPO |
$269.43
|
| Rate for Payer: BCN Commercial |
$63.04
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.90
|
| Rate for Payer: Priority Health Narrow Network |
$57.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.48
|
| Rate for Payer: UHC Exchange |
$48.48
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
|
|
PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 95977
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$154.26 |
| Rate for Payer: Aetna Commercial |
$58.47
|
| Rate for Payer: Aetna Medicare |
$55.00
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS Trust/PPO |
$154.26
|
| Rate for Payer: BCN Commercial |
$76.23
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.20
|
| Rate for Payer: Priority Health Narrow Network |
$69.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.46
|
| Rate for Payer: UHC Exchange |
$58.46
|
| Rate for Payer: UHCCP Medicaid |
$31.74
|
|
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 95972
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$168.53 |
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna Medicare |
$239.50
|
| Rate for Payer: BCBS Complete |
$26.39
|
| Rate for Payer: BCBS Complete |
$26.39
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: BCN Commercial |
$82.09
|
| Rate for Payer: BCN Commercial |
$82.09
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$26.39
|
| Rate for Payer: Meridian Medicaid |
$26.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.82
|
| Rate for Payer: Priority Health Narrow Network |
$53.82
|
| Rate for Payer: Priority Health Narrow Network |
$53.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.89
|
| Rate for Payer: UHC Exchange |
$80.89
|
| Rate for Payer: UHC Exchange |
$80.89
|
| Rate for Payer: UHCCP Medicaid |
$25.13
|
| Rate for Payer: UHCCP Medicaid |
$25.13
|
|
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 95970
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: BCN Commercial |
$27.36
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Meridian Medicaid |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.43
|
| Rate for Payer: Priority Health Narrow Network |
$24.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.90
|
| Rate for Payer: UHC Exchange |
$23.90
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
|
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 95971
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$475.47 |
| Rate for Payer: Aetna Commercial |
$44.17
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS Trust/PPO |
$475.47
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.02
|
| Rate for Payer: Priority Health Narrow Network |
$52.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.35
|
| Rate for Payer: UHC Exchange |
$42.35
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
|
|
PR ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 95976
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$140.93 |
| Rate for Payer: Aetna Commercial |
$43.64
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: BCBS Complete |
$24.82
|
| Rate for Payer: BCBS Trust/PPO |
$140.93
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Meridian Medicaid |
$24.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.02
|
| Rate for Payer: Priority Health Narrow Network |
$52.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.86
|
| Rate for Payer: UHC Exchange |
$43.86
|
| Rate for Payer: UHCCP Medicaid |
$23.64
|
|
|
PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
HCPCS 95974
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$623.35 |
| Rate for Payer: Aetna Medicare |
$479.50
|
| Rate for Payer: BCBS Complete |
$383.60
|
| Rate for Payer: Cash Price |
$767.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.35
|
|
|
PR ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 95973
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
|
|
PR ELEC STIM OTHER THAN WOUND
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS G0283
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$367.70 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: BCN Commercial |
$11.75
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.99
|
| Rate for Payer: Priority Health Narrow Network |
$11.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.60
|
| Rate for Payer: UHC Exchange |
$12.60
|
|
|
PR ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 62368
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Aetna Commercial |
$45.55
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: BCN Commercial |
$64.02
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Meridian Medicaid |
$22.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.00
|
| Rate for Payer: Priority Health Narrow Network |
$58.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.95
|
| Rate for Payer: UHC Exchange |
$44.95
|
| Rate for Payer: UHCCP Medicaid |
$21.73
|
|
|
PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 62367
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$31.85
|
| Rate for Payer: Aetna Medicare |
$191.50
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.08
|
| Rate for Payer: Priority Health Narrow Network |
$42.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.11
|
| Rate for Payer: UHC Exchange |
$29.11
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
