|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$387.24 |
| Rate for Payer: Aetna Commercial |
$214.98
|
| Rate for Payer: Aetna Medicare |
$160.43
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS MAPPO |
$160.43
|
| Rate for Payer: BCBS Trust/PPO |
$387.24
|
| Rate for Payer: BCN Commercial |
$239.95
|
| Rate for Payer: BCN Medicare Advantage |
$160.43
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$231.02
|
| Rate for Payer: Cofinity Commercial |
$214.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.43
|
| Rate for Payer: Healthscope Commercial |
$192.52
|
| Rate for Payer: Healthscope Whirlpool |
$192.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$168.45
|
| Rate for Payer: PACE SWMI |
$160.43
|
| Rate for Payer: PHP Medicare Advantage |
$160.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.49
|
| Rate for Payer: Priority Health Medicare |
$160.43
|
| Rate for Payer: Priority Health Narrow Network |
$214.49
|
| Rate for Payer: UHC Medicare Advantage |
$165.24
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$167.51
|
| Rate for Payer: Aetna Medicare |
$125.01
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: BCBS MAPPO |
$125.01
|
| Rate for Payer: BCBS Trust/PPO |
$728.00
|
| Rate for Payer: BCN Commercial |
$187.65
|
| Rate for Payer: BCN Medicare Advantage |
$125.01
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$180.01
|
| Rate for Payer: Cofinity Commercial |
$167.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.01
|
| Rate for Payer: Healthscope Commercial |
$150.01
|
| Rate for Payer: Healthscope Whirlpool |
$150.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.26
|
| Rate for Payer: PACE SWMI |
$125.01
|
| Rate for Payer: PHP Medicare Advantage |
$125.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.75
|
| Rate for Payer: Priority Health Medicare |
$125.01
|
| Rate for Payer: Priority Health Narrow Network |
$167.75
|
| Rate for Payer: UHC Medicare Advantage |
$128.76
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$218.03 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$133.47
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS MAPPO |
$133.47
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$218.03
|
| Rate for Payer: BCN Medicare Advantage |
$133.47
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$178.85
|
| Rate for Payer: Cofinity Commercial |
$192.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.47
|
| Rate for Payer: Healthscope Commercial |
$160.17
|
| Rate for Payer: Healthscope Whirlpool |
$160.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.15
|
| Rate for Payer: PACE SWMI |
$133.47
|
| Rate for Payer: PHP Medicare Advantage |
$133.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$133.47
|
| Rate for Payer: UHC Medicare Advantage |
$137.48
|
|
|
PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX
|
Professional
|
Both
|
$4,561.00
|
|
|
Service Code
|
HCPCS 45112
|
| Min. Negotiated Rate |
$234.04 |
| Max. Negotiated Rate |
$3,192.70 |
| Rate for Payer: Aetna Commercial |
$2,385.94
|
| Rate for Payer: Aetna Medicare |
$1,780.55
|
| Rate for Payer: BCBS Complete |
$1,203.91
|
| Rate for Payer: BCBS MAPPO |
$1,780.55
|
| Rate for Payer: BCBS Trust/PPO |
$234.04
|
| Rate for Payer: BCN Commercial |
$2,621.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,780.55
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cofinity Commercial |
$2,563.99
|
| Rate for Payer: Cofinity Commercial |
$2,385.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,780.55
|
| Rate for Payer: Healthscope Commercial |
$2,136.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,136.66
|
| Rate for Payer: Meridian Medicaid |
$1,203.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,869.58
|
| Rate for Payer: PACE SWMI |
$1,780.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,780.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,146.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,192.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,153.89
|
| Rate for Payer: Priority Health Medicare |
$1,780.55
|
| Rate for Payer: Priority Health Narrow Network |
$3,153.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,833.97
|
|
|
PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST
|
Professional
|
Both
|
$4,632.00
|
|
|
Service Code
|
HCPCS 45110
|
| Min. Negotiated Rate |
$389.36 |
| Max. Negotiated Rate |
$3,242.40 |
| Rate for Payer: Aetna Commercial |
$2,400.34
|
| Rate for Payer: Aetna Medicare |
$1,791.30
|
| Rate for Payer: BCBS Complete |
$1,209.73
|
| Rate for Payer: BCBS MAPPO |
$1,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$389.36
|
| Rate for Payer: BCN Commercial |
$2,639.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,791.30
|
| Rate for Payer: Cash Price |
$3,705.60
|
| Rate for Payer: Cash Price |
$3,705.60
|
| Rate for Payer: Cofinity Commercial |
$2,400.34
|
| Rate for Payer: Cofinity Commercial |
$2,579.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,791.30
|
| Rate for Payer: Healthscope Commercial |
$2,149.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,149.56
|
| Rate for Payer: Meridian Medicaid |
$1,209.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,880.86
|
| Rate for Payer: PACE SWMI |
$1,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,152.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,242.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,176.24
|
| Rate for Payer: Priority Health Medicare |
$1,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$3,176.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,845.04
|
|
|
PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS
|
Professional
|
Both
|
$4,895.00
|
|
|
Service Code
|
HCPCS 45120
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$3,426.50 |
| Rate for Payer: Aetna Commercial |
$2,132.82
|
| Rate for Payer: Aetna Medicare |
$1,591.66
|
| Rate for Payer: BCBS Complete |
$1,073.74
|
| Rate for Payer: BCBS MAPPO |
$1,591.66
|
| Rate for Payer: BCBS Trust/PPO |
$234.57
|
| Rate for Payer: BCN Commercial |
$2,334.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,591.66
|
| Rate for Payer: Cash Price |
$3,916.00
|
| Rate for Payer: Cash Price |
$3,916.00
|
| Rate for Payer: Cofinity Commercial |
$2,291.99
|
| Rate for Payer: Cofinity Commercial |
$2,132.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,591.66
|
| Rate for Payer: Healthscope Commercial |
$1,909.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,909.99
|
| Rate for Payer: Meridian Medicaid |
$1,073.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,671.24
|
| Rate for Payer: PACE SWMI |
$1,591.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,591.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,022.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,426.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,809.33
|
| Rate for Payer: Priority Health Medicare |
$1,591.66
|
| Rate for Payer: Priority Health Narrow Network |
$2,809.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,639.41
|
|
|
PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS
|
Professional
|
Both
|
$4,804.00
|
|
|
Service Code
|
HCPCS 45121
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$3,362.80 |
| Rate for Payer: Aetna Commercial |
$2,328.63
|
| Rate for Payer: Aetna Medicare |
$1,737.78
|
| Rate for Payer: BCBS Complete |
$1,171.71
|
| Rate for Payer: BCBS MAPPO |
$1,737.78
|
| Rate for Payer: BCBS Trust/PPO |
$188.07
|
| Rate for Payer: BCN Commercial |
$2,547.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,737.78
|
| Rate for Payer: Cash Price |
$3,843.20
|
| Rate for Payer: Cash Price |
$3,843.20
|
| Rate for Payer: Cofinity Commercial |
$2,328.63
|
| Rate for Payer: Cofinity Commercial |
$2,502.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,737.78
|
| Rate for Payer: Healthscope Commercial |
$2,085.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,085.34
|
| Rate for Payer: Meridian Medicaid |
$1,171.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,824.67
|
| Rate for Payer: PACE SWMI |
$1,737.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,737.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,115.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,362.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,065.10
|
| Rate for Payer: Priority Health Medicare |
$1,737.78
|
| Rate for Payer: Priority Health Narrow Network |
$3,065.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,789.91
|
|
|
PR PRCTECT PRTL RESCJ RECTUM TABDL APPR
|
Professional
|
Both
|
$1,934.00
|
|
|
Service Code
|
HCPCS 45111
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$1,896.21 |
| Rate for Payer: Aetna Commercial |
$1,432.81
|
| Rate for Payer: Aetna Medicare |
$1,069.26
|
| Rate for Payer: BCBS Complete |
$727.99
|
| Rate for Payer: BCBS MAPPO |
$1,069.26
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$1,575.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,069.26
|
| Rate for Payer: Cash Price |
$1,547.20
|
| Rate for Payer: Cash Price |
$1,547.20
|
| Rate for Payer: Cofinity Commercial |
$1,539.73
|
| Rate for Payer: Cofinity Commercial |
$1,432.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,069.26
|
| Rate for Payer: Healthscope Commercial |
$1,283.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,283.11
|
| Rate for Payer: Meridian Medicaid |
$727.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,122.72
|
| Rate for Payer: PACE SWMI |
$1,069.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,069.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$693.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,896.21
|
| Rate for Payer: Priority Health Medicare |
$1,069.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,896.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,101.34
|
|
|
PR PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH
|
Professional
|
Both
|
$3,195.00
|
|
|
Service Code
|
HCPCS 45114
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$3,185.05 |
| Rate for Payer: Aetna Commercial |
$2,423.23
|
| Rate for Payer: Aetna Medicare |
$1,808.38
|
| Rate for Payer: BCBS Complete |
$1,216.66
|
| Rate for Payer: BCBS MAPPO |
$1,808.38
|
| Rate for Payer: BCBS Trust/PPO |
$86.17
|
| Rate for Payer: BCN Commercial |
$2,647.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,808.38
|
| Rate for Payer: Cash Price |
$2,556.00
|
| Rate for Payer: Cash Price |
$2,556.00
|
| Rate for Payer: Cofinity Commercial |
$2,423.23
|
| Rate for Payer: Cofinity Commercial |
$2,604.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,808.38
|
| Rate for Payer: Healthscope Commercial |
$2,170.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,170.06
|
| Rate for Payer: Meridian Medicaid |
$1,216.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,898.80
|
| Rate for Payer: PACE SWMI |
$1,808.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,808.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,158.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,236.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,185.05
|
| Rate for Payer: Priority Health Medicare |
$1,808.38
|
| Rate for Payer: Priority Health Narrow Network |
$3,185.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,862.63
|
|
|
PR PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY
|
Professional
|
Both
|
$3,736.00
|
|
|
Service Code
|
HCPCS 45116
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$2,687.04 |
| Rate for Payer: Aetna Commercial |
$2,029.94
|
| Rate for Payer: Aetna Medicare |
$1,514.88
|
| Rate for Payer: BCBS Complete |
$1,026.77
|
| Rate for Payer: BCBS MAPPO |
$1,514.88
|
| Rate for Payer: BCBS Trust/PPO |
$187.02
|
| Rate for Payer: BCN Commercial |
$2,233.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,514.88
|
| Rate for Payer: Cash Price |
$2,988.80
|
| Rate for Payer: Cash Price |
$2,988.80
|
| Rate for Payer: Cofinity Commercial |
$2,181.43
|
| Rate for Payer: Cofinity Commercial |
$2,029.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,514.88
|
| Rate for Payer: Healthscope Commercial |
$1,817.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,817.86
|
| Rate for Payer: Meridian Medicaid |
$1,026.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,590.62
|
| Rate for Payer: PACE SWMI |
$1,514.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,514.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$977.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,615.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,687.04
|
| Rate for Payer: Priority Health Medicare |
$1,514.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,687.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.33
|
|
|
PR PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR
|
Professional
|
Both
|
$5,348.00
|
|
|
Service Code
|
HCPCS 45113
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$3,743.60 |
| Rate for Payer: Aetna Commercial |
$2,450.22
|
| Rate for Payer: Aetna Medicare |
$1,828.52
|
| Rate for Payer: BCBS Complete |
$1,237.68
|
| Rate for Payer: BCBS MAPPO |
$1,828.52
|
| Rate for Payer: BCBS Trust/PPO |
$234.57
|
| Rate for Payer: BCN Commercial |
$2,697.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,828.52
|
| Rate for Payer: Cash Price |
$4,278.40
|
| Rate for Payer: Cash Price |
$4,278.40
|
| Rate for Payer: Cofinity Commercial |
$2,633.07
|
| Rate for Payer: Cofinity Commercial |
$2,450.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,828.52
|
| Rate for Payer: Healthscope Commercial |
$2,194.22
|
| Rate for Payer: Healthscope Whirlpool |
$2,194.22
|
| Rate for Payer: Meridian Medicaid |
$1,237.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,919.95
|
| Rate for Payer: PACE SWMI |
$1,828.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,828.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,178.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,743.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,245.01
|
| Rate for Payer: Priority Health Medicare |
$1,828.52
|
| Rate for Payer: Priority Health Narrow Network |
$3,245.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,883.38
|
|
|
PR PRCTECT PRTL W/O ANAST PRNL APPR
|
Professional
|
Both
|
$2,987.00
|
|
|
Service Code
|
HCPCS 45123
|
| Min. Negotiated Rate |
$707.59 |
| Max. Negotiated Rate |
$2,090.90 |
| Rate for Payer: Aetna Commercial |
$1,474.16
|
| Rate for Payer: Aetna Medicare |
$1,100.12
|
| Rate for Payer: BCBS Complete |
$742.97
|
| Rate for Payer: BCBS MAPPO |
$1,100.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,046.11
|
| Rate for Payer: BCN Commercial |
$1,621.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,100.12
|
| Rate for Payer: Cash Price |
$2,389.60
|
| Rate for Payer: Cash Price |
$2,389.60
|
| Rate for Payer: Cofinity Commercial |
$1,474.16
|
| Rate for Payer: Cofinity Commercial |
$1,584.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,100.12
|
| Rate for Payer: Healthscope Commercial |
$1,320.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.14
|
| Rate for Payer: Meridian Medicaid |
$742.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,155.13
|
| Rate for Payer: PACE SWMI |
$1,100.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,100.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$707.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,090.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,951.49
|
| Rate for Payer: Priority Health Medicare |
$1,100.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,951.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.12
|
|
|
PR PREDNISONE IR OR DR ORAL 1MG
|
Professional
|
Both
|
$0.50
|
|
|
Service Code
|
HCPCS J7512
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS MAPPO |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.01
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.01
|
| Rate for Payer: PACE SWMI |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.35
|
| Rate for Payer: Priority Health Medicare |
$0.01
|
| Rate for Payer: UHC Medicare Advantage |
$0.01
|
|
|
PR PREDNISONE ORAL
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J7506
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
|
|
PR PREPARE FECAL MICROBIOTA FOR INSTILLATION
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 44705
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$96.49
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS Trust/PPO |
$252.00
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Meridian Medicaid |
$47.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.83
|
| Rate for Payer: Priority Health Narrow Network |
$125.83
|
|
|
PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 49013
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$794.36 |
| Rate for Payer: Aetna Commercial |
$608.20
|
| Rate for Payer: Aetna Medicare |
$453.88
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS MAPPO |
$453.88
|
| Rate for Payer: BCBS Trust/PPO |
$562.11
|
| Rate for Payer: BCN Commercial |
$660.20
|
| Rate for Payer: BCN Medicare Advantage |
$453.88
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$653.59
|
| Rate for Payer: Cofinity Commercial |
$608.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.88
|
| Rate for Payer: Healthscope Commercial |
$544.66
|
| Rate for Payer: Healthscope Whirlpool |
$544.66
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$476.57
|
| Rate for Payer: PACE SWMI |
$453.88
|
| Rate for Payer: PHP Medicare Advantage |
$453.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$794.36
|
| Rate for Payer: Priority Health Medicare |
$453.88
|
| Rate for Payer: Priority Health Narrow Network |
$794.36
|
| Rate for Payer: UHC Medicare Advantage |
$467.50
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 15004
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$576.64 |
| Rate for Payer: Aetna Commercial |
$342.25
|
| Rate for Payer: Aetna Medicare |
$255.41
|
| Rate for Payer: BCBS Complete |
$172.43
|
| Rate for Payer: BCBS MAPPO |
$255.41
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$576.64
|
| Rate for Payer: BCN Medicare Advantage |
$255.41
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$367.79
|
| Rate for Payer: Cofinity Commercial |
$342.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.41
|
| Rate for Payer: Healthscope Commercial |
$306.49
|
| Rate for Payer: Healthscope Whirlpool |
$306.49
|
| Rate for Payer: Meridian Medicaid |
$172.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.18
|
| Rate for Payer: PACE SWMI |
$255.41
|
| Rate for Payer: PHP Medicare Advantage |
$255.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.91
|
| Rate for Payer: Priority Health Medicare |
$255.41
|
| Rate for Payer: Priority Health Narrow Network |
$316.91
|
| Rate for Payer: UHC Medicare Advantage |
$263.07
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 15005
|
| Min. Negotiated Rate |
$56.66 |
| Max. Negotiated Rate |
$206.12 |
| Rate for Payer: Aetna Commercial |
$118.42
|
| Rate for Payer: Aetna Medicare |
$88.37
|
| Rate for Payer: BCBS Complete |
$59.49
|
| Rate for Payer: BCBS MAPPO |
$88.37
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$169.57
|
| Rate for Payer: BCN Medicare Advantage |
$88.37
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$118.42
|
| Rate for Payer: Cofinity Commercial |
$127.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.37
|
| Rate for Payer: Healthscope Commercial |
$106.04
|
| Rate for Payer: Healthscope Whirlpool |
$106.04
|
| Rate for Payer: Meridian Medicaid |
$59.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.79
|
| Rate for Payer: PACE SWMI |
$88.37
|
| Rate for Payer: PHP Medicare Advantage |
$88.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.92
|
| Rate for Payer: Priority Health Medicare |
$88.37
|
| Rate for Payer: Priority Health Narrow Network |
$108.92
|
| Rate for Payer: UHC Medicare Advantage |
$91.02
|
|
|
PR PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
HCPCS 15002
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$505.78 |
| Rate for Payer: Aetna Commercial |
$288.52
|
| Rate for Payer: Aetna Medicare |
$215.31
|
| Rate for Payer: BCBS Complete |
$146.04
|
| Rate for Payer: BCBS MAPPO |
$215.31
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$505.78
|
| Rate for Payer: BCN Medicare Advantage |
$215.31
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cofinity Commercial |
$310.05
|
| Rate for Payer: Cofinity Commercial |
$288.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.31
|
| Rate for Payer: Healthscope Commercial |
$258.37
|
| Rate for Payer: Healthscope Whirlpool |
$258.37
|
| Rate for Payer: Meridian Medicaid |
$146.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.08
|
| Rate for Payer: PACE SWMI |
$215.31
|
| Rate for Payer: PHP Medicare Advantage |
$215.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.18
|
| Rate for Payer: Priority Health Medicare |
$215.31
|
| Rate for Payer: Priority Health Narrow Network |
$267.18
|
| Rate for Payer: UHC Medicare Advantage |
$221.77
|
|
|
PR PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 15003
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$138.90 |
| Rate for Payer: Aetna Commercial |
$60.02
|
| Rate for Payer: Aetna Medicare |
$44.79
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS MAPPO |
$44.79
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$101.65
|
| Rate for Payer: BCN Medicare Advantage |
$44.79
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$60.02
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.03
|
| Rate for Payer: PACE SWMI |
$44.79
|
| Rate for Payer: PHP Medicare Advantage |
$44.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.08
|
| Rate for Payer: Priority Health Medicare |
$44.79
|
| Rate for Payer: Priority Health Narrow Network |
$55.08
|
| Rate for Payer: UHC Medicare Advantage |
$46.13
|
|
|
PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 94640
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$255.17 |
| Rate for Payer: Aetna Commercial |
$11.24
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$8.39
|
| Rate for Payer: BCBS Trust/PPO |
$255.17
|
| Rate for Payer: BCN Commercial |
$13.19
|
| Rate for Payer: BCN Medicare Advantage |
$8.39
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$12.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.39
|
| Rate for Payer: Healthscope Commercial |
$10.07
|
| Rate for Payer: Healthscope Whirlpool |
$10.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.81
|
| Rate for Payer: PACE SWMI |
$8.39
|
| Rate for Payer: PHP Medicare Advantage |
$8.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.13
|
| Rate for Payer: Priority Health Medicare |
$8.39
|
| Rate for Payer: Priority Health Narrow Network |
$12.13
|
| Rate for Payer: UHC Medicare Advantage |
$8.64
|
|
|
PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 MIN
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 99401
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$1,234.11 |
| Rate for Payer: Aetna Commercial |
$25.12
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.11
|
| Rate for Payer: BCN Commercial |
$56.19
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.41
|
| Rate for Payer: Priority Health Narrow Network |
$30.41
|
|
|
PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 MIN
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99402
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$1,381.50 |
| Rate for Payer: Aetna Commercial |
$51.32
|
| Rate for Payer: BCBS Complete |
$31.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,381.50
|
| Rate for Payer: BCN Commercial |
$90.89
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Meridian Medicaid |
$31.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.82
|
| Rate for Payer: Priority Health Narrow Network |
$60.82
|
|
|
PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 99403
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$393.06 |
| Rate for Payer: Aetna Commercial |
$76.44
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS Trust/PPO |
$393.06
|
| Rate for Payer: BCN Commercial |
$125.10
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Meridian Medicaid |
$47.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.23
|
| Rate for Payer: Priority Health Narrow Network |
$91.23
|
|
|
PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 99404
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$805.13 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: BCBS Complete |
$63.29
|
| Rate for Payer: BCBS Trust/PPO |
$805.13
|
| Rate for Payer: BCN Commercial |
$159.31
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Meridian Medicaid |
$63.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.21
|
| Rate for Payer: Priority Health Narrow Network |
$121.21
|
|
