|
PR PROCTOSGMDSC RIGID ABLATION LESION
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 45320
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$331.10 |
| Rate for Payer: Aetna Commercial |
$138.58
|
| Rate for Payer: Aetna Medicare |
$103.42
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS MAPPO |
$103.42
|
| Rate for Payer: BCBS Trust/PPO |
$223.95
|
| Rate for Payer: BCN Commercial |
$330.35
|
| Rate for Payer: BCN Medicare Advantage |
$103.42
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$148.92
|
| Rate for Payer: Cofinity Commercial |
$138.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.42
|
| Rate for Payer: Healthscope Commercial |
$124.10
|
| Rate for Payer: Healthscope Whirlpool |
$124.10
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.59
|
| Rate for Payer: PACE SWMI |
$103.42
|
| Rate for Payer: PHP Medicare Advantage |
$103.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.86
|
| Rate for Payer: Priority Health Medicare |
$103.42
|
| Rate for Payer: Priority Health Narrow Network |
$182.86
|
| Rate for Payer: UHC Medicare Advantage |
$106.52
|
|
|
PR PROCTOSGMDSC RIGID CONTROL BLEEDING
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 45317
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$325.46 |
| Rate for Payer: Aetna Commercial |
$144.56
|
| Rate for Payer: Aetna Medicare |
$107.88
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS MAPPO |
$107.88
|
| Rate for Payer: BCBS Trust/PPO |
$180.68
|
| Rate for Payer: BCN Commercial |
$325.46
|
| Rate for Payer: BCN Medicare Advantage |
$107.88
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$155.35
|
| Rate for Payer: Cofinity Commercial |
$144.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.88
|
| Rate for Payer: Healthscope Commercial |
$129.46
|
| Rate for Payer: Healthscope Whirlpool |
$129.46
|
| Rate for Payer: Meridian Medicaid |
$74.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$113.27
|
| Rate for Payer: PACE SWMI |
$107.88
|
| Rate for Payer: PHP Medicare Advantage |
$107.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Medicare |
$107.88
|
| Rate for Payer: Priority Health Narrow Network |
$191.68
|
| Rate for Payer: UHC Medicare Advantage |
$111.12
|
|
|
PR PROCTOSGMDSC RIGID DCMPRN VOLVULUS
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 45321
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$136.81
|
| Rate for Payer: Aetna Medicare |
$102.10
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS MAPPO |
$102.10
|
| Rate for Payer: BCBS Trust/PPO |
$202.87
|
| Rate for Payer: BCN Commercial |
$150.03
|
| Rate for Payer: BCN Medicare Advantage |
$102.10
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cofinity Commercial |
$147.02
|
| Rate for Payer: Cofinity Commercial |
$136.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.10
|
| Rate for Payer: Healthscope Commercial |
$122.52
|
| Rate for Payer: Healthscope Whirlpool |
$122.52
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.20
|
| Rate for Payer: PACE SWMI |
$102.10
|
| Rate for Payer: PHP Medicare Advantage |
$102.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.50
|
| Rate for Payer: Priority Health Medicare |
$102.10
|
| Rate for Payer: Priority Health Narrow Network |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$105.16
|
|
|
PR PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 45308
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$302.98 |
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Medicare |
$83.62
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$83.62
|
| Rate for Payer: BCBS Trust/PPO |
$76.60
|
| Rate for Payer: BCN Commercial |
$302.98
|
| Rate for Payer: BCN Medicare Advantage |
$83.62
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$120.41
|
| Rate for Payer: Cofinity Commercial |
$112.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.62
|
| Rate for Payer: Healthscope Commercial |
$100.34
|
| Rate for Payer: Healthscope Whirlpool |
$100.34
|
| Rate for Payer: Meridian Medicaid |
$56.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.80
|
| Rate for Payer: PACE SWMI |
$83.62
|
| Rate for Payer: PHP Medicare Advantage |
$83.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.18
|
| Rate for Payer: Priority Health Medicare |
$83.62
|
| Rate for Payer: Priority Health Narrow Network |
$148.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.13
|
|
|
PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 45309
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$676.75 |
| Rate for Payer: Aetna Commercial |
$118.74
|
| Rate for Payer: Aetna Medicare |
$88.61
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS MAPPO |
$88.61
|
| Rate for Payer: BCBS Trust/PPO |
$676.75
|
| Rate for Payer: BCN Commercial |
$311.78
|
| Rate for Payer: BCN Medicare Advantage |
$88.61
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$118.74
|
| Rate for Payer: Cofinity Commercial |
$127.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.61
|
| Rate for Payer: Healthscope Commercial |
$106.33
|
| Rate for Payer: Healthscope Whirlpool |
$106.33
|
| Rate for Payer: Meridian Medicaid |
$60.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.04
|
| Rate for Payer: PACE SWMI |
$88.61
|
| Rate for Payer: PHP Medicare Advantage |
$88.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.99
|
| Rate for Payer: Priority Health Medicare |
$88.61
|
| Rate for Payer: Priority Health Narrow Network |
$156.99
|
| Rate for Payer: UHC Medicare Advantage |
$91.27
|
|
|
PR PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 45315
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$1,137.43 |
| Rate for Payer: Aetna Commercial |
$140.41
|
| Rate for Payer: Aetna Medicare |
$104.78
|
| Rate for Payer: BCBS Complete |
$70.90
|
| Rate for Payer: BCBS MAPPO |
$104.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.43
|
| Rate for Payer: BCN Commercial |
$336.70
|
| Rate for Payer: BCN Medicare Advantage |
$104.78
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$140.41
|
| Rate for Payer: Cofinity Commercial |
$150.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.78
|
| Rate for Payer: Healthscope Commercial |
$125.74
|
| Rate for Payer: Healthscope Whirlpool |
$125.74
|
| Rate for Payer: Meridian Medicaid |
$70.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110.02
|
| Rate for Payer: PACE SWMI |
$104.78
|
| Rate for Payer: PHP Medicare Advantage |
$104.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.20
|
| Rate for Payer: Priority Health Medicare |
$104.78
|
| Rate for Payer: Priority Health Narrow Network |
$185.20
|
| Rate for Payer: UHC Medicare Advantage |
$107.92
|
|
|
PR PROCTOSGMDSC RIGID TNDSC STENT PLMT
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 45327
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$206.57 |
| Rate for Payer: Aetna Commercial |
$154.74
|
| Rate for Payer: Aetna Medicare |
$115.48
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS MAPPO |
$115.48
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: BCN Commercial |
$169.57
|
| Rate for Payer: BCN Medicare Advantage |
$115.48
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$154.74
|
| Rate for Payer: Cofinity Commercial |
$166.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.48
|
| Rate for Payer: Healthscope Commercial |
$138.58
|
| Rate for Payer: Healthscope Whirlpool |
$138.58
|
| Rate for Payer: Meridian Medicaid |
$78.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$121.25
|
| Rate for Payer: PACE SWMI |
$115.48
|
| Rate for Payer: PHP Medicare Advantage |
$115.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.03
|
| Rate for Payer: Priority Health Medicare |
$115.48
|
| Rate for Payer: Priority Health Narrow Network |
$204.03
|
| Rate for Payer: UHC Medicare Advantage |
$118.94
|
|
|
PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 45305
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$1,525.20 |
| Rate for Payer: Aetna Commercial |
$95.42
|
| Rate for Payer: Aetna Medicare |
$71.21
|
| Rate for Payer: BCBS Complete |
$48.75
|
| Rate for Payer: BCBS MAPPO |
$71.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,525.20
|
| Rate for Payer: BCN Commercial |
$267.80
|
| Rate for Payer: BCN Medicare Advantage |
$71.21
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$95.42
|
| Rate for Payer: Cofinity Commercial |
$102.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.21
|
| Rate for Payer: Healthscope Commercial |
$85.45
|
| Rate for Payer: Healthscope Whirlpool |
$85.45
|
| Rate for Payer: Meridian Medicaid |
$48.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$74.77
|
| Rate for Payer: PACE SWMI |
$71.21
|
| Rate for Payer: PHP Medicare Advantage |
$71.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.01
|
| Rate for Payer: Priority Health Medicare |
$71.21
|
| Rate for Payer: Priority Health Narrow Network |
$127.01
|
| Rate for Payer: UHC Medicare Advantage |
$73.35
|
|
|
PR PROCTOSGMDSC RIGID W/DILATION
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 45303
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$1,415.70 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Aetna Medicare |
$83.61
|
| Rate for Payer: BCBS Complete |
$57.26
|
| Rate for Payer: BCBS MAPPO |
$83.61
|
| Rate for Payer: BCBS Trust/PPO |
$520.38
|
| Rate for Payer: BCN Commercial |
$1,415.70
|
| Rate for Payer: BCN Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$112.04
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.61
|
| Rate for Payer: Healthscope Commercial |
$100.33
|
| Rate for Payer: Healthscope Whirlpool |
$100.33
|
| Rate for Payer: Meridian Medicaid |
$57.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.79
|
| Rate for Payer: PACE SWMI |
$83.61
|
| Rate for Payer: PHP Medicare Advantage |
$83.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.75
|
| Rate for Payer: Priority Health Medicare |
$83.61
|
| Rate for Payer: Priority Health Narrow Network |
$148.75
|
| Rate for Payer: UHC Medicare Advantage |
$86.12
|
|
|
PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 45307
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$854.26 |
| Rate for Payer: Aetna Commercial |
$132.74
|
| Rate for Payer: Aetna Medicare |
$99.06
|
| Rate for Payer: BCBS Complete |
$67.32
|
| Rate for Payer: BCBS MAPPO |
$99.06
|
| Rate for Payer: BCBS Trust/PPO |
$854.26
|
| Rate for Payer: BCN Commercial |
$316.66
|
| Rate for Payer: BCN Medicare Advantage |
$99.06
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$142.65
|
| Rate for Payer: Cofinity Commercial |
$132.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.06
|
| Rate for Payer: Healthscope Commercial |
$118.87
|
| Rate for Payer: Healthscope Whirlpool |
$118.87
|
| Rate for Payer: Meridian Medicaid |
$67.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$104.01
|
| Rate for Payer: PACE SWMI |
$99.06
|
| Rate for Payer: PHP Medicare Advantage |
$99.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.21
|
| Rate for Payer: Priority Health Medicare |
$99.06
|
| Rate for Payer: Priority Health Narrow Network |
$175.21
|
| Rate for Payer: UHC Medicare Advantage |
$102.03
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 95115
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$432.68 |
| Rate for Payer: Aetna Commercial |
$12.49
|
| Rate for Payer: Aetna Medicare |
$9.32
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$9.32
|
| Rate for Payer: BCBS Trust/PPO |
$432.68
|
| Rate for Payer: BCN Commercial |
$14.66
|
| Rate for Payer: BCN Medicare Advantage |
$9.32
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.32
|
| Rate for Payer: Healthscope Commercial |
$11.18
|
| Rate for Payer: Healthscope Whirlpool |
$11.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.79
|
| Rate for Payer: PACE SWMI |
$9.32
|
| Rate for Payer: PHP Medicare Advantage |
$9.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.72
|
| Rate for Payer: Priority Health Medicare |
$9.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.72
|
| Rate for Payer: UHC Medicare Advantage |
$9.60
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 95117
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$446.94 |
| Rate for Payer: Aetna Commercial |
$14.55
|
| Rate for Payer: Aetna Medicare |
$10.86
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$10.86
|
| Rate for Payer: BCBS Trust/PPO |
$446.94
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.86
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$15.64
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.86
|
| Rate for Payer: Healthscope Commercial |
$13.03
|
| Rate for Payer: Healthscope Whirlpool |
$13.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.40
|
| Rate for Payer: PACE SWMI |
$10.86
|
| Rate for Payer: PHP Medicare Advantage |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.65
|
| Rate for Payer: Priority Health Medicare |
$10.86
|
| Rate for Payer: Priority Health Narrow Network |
$16.65
|
| Rate for Payer: UHC Medicare Advantage |
$11.19
|
|
|
PR PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 0389T
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 93280
|
| Min. Negotiated Rate |
$75.96 |
| Max. Negotiated Rate |
$707.92 |
| Rate for Payer: Aetna Commercial |
$101.79
|
| Rate for Payer: Aetna Medicare |
$75.96
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$75.96
|
| Rate for Payer: BCBS Trust/PPO |
$707.92
|
| Rate for Payer: BCN Commercial |
$116.31
|
| Rate for Payer: BCN Medicare Advantage |
$75.96
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$101.79
|
| Rate for Payer: Cofinity Commercial |
$109.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.96
|
| Rate for Payer: Healthscope Commercial |
$91.15
|
| Rate for Payer: Healthscope Whirlpool |
$91.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.76
|
| Rate for Payer: PACE SWMI |
$75.96
|
| Rate for Payer: PHP Medicare Advantage |
$75.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.54
|
| Rate for Payer: Priority Health Medicare |
$75.96
|
| Rate for Payer: Priority Health Narrow Network |
$112.54
|
| Rate for Payer: UHC Medicare Advantage |
$78.24
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 93281
|
| Min. Negotiated Rate |
$81.26 |
| Max. Negotiated Rate |
$1,457.58 |
| Rate for Payer: Aetna Commercial |
$108.89
|
| Rate for Payer: Aetna Medicare |
$81.26
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS MAPPO |
$81.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.58
|
| Rate for Payer: BCN Commercial |
$124.13
|
| Rate for Payer: BCN Medicare Advantage |
$81.26
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$108.89
|
| Rate for Payer: Cofinity Commercial |
$117.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.26
|
| Rate for Payer: Healthscope Commercial |
$97.51
|
| Rate for Payer: Healthscope Whirlpool |
$97.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.32
|
| Rate for Payer: PACE SWMI |
$81.26
|
| Rate for Payer: PHP Medicare Advantage |
$81.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.10
|
| Rate for Payer: Priority Health Medicare |
$81.26
|
| Rate for Payer: Priority Health Narrow Network |
$120.10
|
| Rate for Payer: UHC Medicare Advantage |
$83.70
|
|
|
PR PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 93623
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$1,642.40 |
| Rate for Payer: Aetna Commercial |
$217.76
|
| Rate for Payer: Aetna Commercial |
$217.76
|
| Rate for Payer: BCBS Complete |
$95.20
|
| Rate for Payer: BCBS Complete |
$130.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,500.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,500.37
|
| Rate for Payer: BCN Commercial |
$1,642.40
|
| Rate for Payer: BCN Commercial |
$1,642.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.68
|
| Rate for Payer: Priority Health Narrow Network |
$153.68
|
| Rate for Payer: Priority Health Narrow Network |
$153.68
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$177.52 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.52
|
| Rate for Payer: Priority Health Narrow Network |
$142.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
PR PRO HEALTH FIT FOR DUTY EXAM
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: ASR ASR |
$218.25
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS Trust/PPO |
$174.44
|
| Rate for Payer: BCN Commercial |
$174.44
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$211.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Healthscope Whirlpool |
$218.25
|
| Rate for Payer: Mclaren Commercial |
$202.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.75
|
| Rate for Payer: Priority Health Narrow Network |
$159.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.00
|
|
|
PR PRO HEALTH FIT FOR DUTY EXAM
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: ASR ASR |
$218.25
|
| Rate for Payer: BCBS Trust/PPO |
$174.44
|
| Rate for Payer: BCN Commercial |
$174.44
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$211.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Healthscope Whirlpool |
$218.25
|
| Rate for Payer: Mclaren Commercial |
$202.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.00
|
|
|
PR PRO HEALTH LIFT TEST
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$177.52 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.52
|
| Rate for Payer: Priority Health Narrow Network |
$142.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
PR PRO HEALTH LIFT TEST
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
PR PRO HEALTH NURSE VISIT
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: ASR ASR |
$31.04
|
| Rate for Payer: BCBS Trust/PPO |
$24.81
|
| Rate for Payer: BCN Commercial |
$24.81
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$30.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$32.00
|
| Rate for Payer: Healthscope Whirlpool |
$31.04
|
| Rate for Payer: Mclaren Commercial |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.16
|
|
|
PR PRO HEALTH NURSE VISIT
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: ASR ASR |
$31.04
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$24.81
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$24.81
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$30.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$32.00
|
| Rate for Payer: Healthscope Whirlpool |
$31.04
|
| Rate for Payer: Mclaren Commercial |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.16
|
|
|
PR PRO HEALTH PHYSICAL AGILITY TEST
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: BCBS Trust/PPO |
$54.27
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.90
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
