|
PR PRO HEALTH PHYSICAL AGILITY TEST
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$54.27
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: Cash Price |
$56.00
|
| 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: Priority Health HMO/PPO/Tiered Network |
$198.06
|
| Rate for Payer: Priority Health Narrow Network |
$158.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: ASR ASR |
$24.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.38
|
| Rate for Payer: BCN Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Whirlpool |
$24.25
|
| Rate for Payer: Mclaren Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.00
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: ASR ASR |
$24.25
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.38
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Whirlpool |
$24.25
|
| Rate for Payer: Mclaren Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| 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 |
$22.00
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: ASR ASR |
$97.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$77.53
|
| Rate for Payer: BCN Commercial |
$77.53
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$94.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$100.00
|
| Rate for Payer: Healthscope Whirlpool |
$97.00
|
| Rate for Payer: Mclaren Commercial |
$90.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.00
|
| Rate for Payer: Priority Health Narrow Network |
$71.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.00
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: ASR ASR |
$97.00
|
| Rate for Payer: BCBS Trust/PPO |
$77.53
|
| Rate for Payer: BCN Commercial |
$77.53
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$94.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$100.00
|
| Rate for Payer: Healthscope Whirlpool |
$97.00
|
| Rate for Payer: Mclaren Commercial |
$90.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.00
|
|
|
PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 99359
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: Aetna Commercial |
$52.40
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$62.06
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.40
|
| Rate for Payer: Priority Health Narrow Network |
$54.40
|
|
|
PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 99358
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$165.90 |
| Rate for Payer: Aetna Commercial |
$109.68
|
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: BCBS Trust/PPO |
$147.73
|
| Rate for Payer: BCN Commercial |
$133.41
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.22
|
| Rate for Payer: Priority Health Narrow Network |
$115.22
|
|
|
PR PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY
|
Professional
|
Both
|
$2,718.00
|
|
|
Service Code
|
HCPCS 33960
|
| Min. Negotiated Rate |
$1,087.20 |
| Max. Negotiated Rate |
$1,902.60 |
| Rate for Payer: BCBS Complete |
$1,087.20
|
| Rate for Payer: Cash Price |
$2,174.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.60
|
|
|
PR PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 99418
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$1,631.44 |
| Rate for Payer: Aetna Commercial |
$38.86
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.44
|
| Rate for Payer: BCN Commercial |
$56.68
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.69
|
| Rate for Payer: Priority Health Narrow Network |
$49.69
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 99417
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$1,097.28 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,097.28
|
| Rate for Payer: BCN Commercial |
$44.96
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.12
|
| Rate for Payer: Priority Health Narrow Network |
$38.12
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING 1ST HOUR
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 99356
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: BCBS Complete |
$118.80
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.90
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 99357
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$109.90 |
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 99354
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 99355
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.00
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS G0316
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$1,295.39 |
| Rate for Payer: Aetna Commercial |
$40.00
|
| Rate for Payer: Aetna Medicare |
$29.85
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$29.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,295.39
|
| Rate for Payer: BCN Commercial |
$45.94
|
| Rate for Payer: BCN Medicare Advantage |
$29.85
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.85
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Healthscope Whirlpool |
$35.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.34
|
| Rate for Payer: PACE SWMI |
$29.85
|
| Rate for Payer: PHP Medicare Advantage |
$29.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.55
|
| Rate for Payer: Priority Health Medicare |
$29.85
|
| Rate for Payer: Priority Health Narrow Network |
$38.55
|
| Rate for Payer: UHC Medicare Advantage |
$30.75
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS G2212
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$1,127.92 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$30.46
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$30.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.92
|
| Rate for Payer: BCN Commercial |
$38.06
|
| Rate for Payer: BCN Medicare Advantage |
$30.46
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$40.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$36.55
|
| Rate for Payer: Healthscope Whirlpool |
$36.55
|
| Rate for Payer: Meridian Medicaid |
$20.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.98
|
| Rate for Payer: PACE SWMI |
$30.46
|
| Rate for Payer: PHP Medicare Advantage |
$30.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.02
|
| Rate for Payer: Priority Health Medicare |
$30.46
|
| Rate for Payer: Priority Health Narrow Network |
$32.02
|
| Rate for Payer: UHC Medicare Advantage |
$31.37
|
|
|
PR PROMETHAZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J2550
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$3.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.15
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$4.53
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Healthscope Whirlpool |
$3.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.30
|
| Rate for Payer: PACE SWMI |
$3.15
|
| Rate for Payer: PHP Medicare Advantage |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health Medicare |
$3.15
|
| Rate for Payer: UHC Medicare Advantage |
$3.24
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 25490
|
| Min. Negotiated Rate |
$710.52 |
| Max. Negotiated Rate |
$3,253.04 |
| Rate for Payer: Aetna Commercial |
$952.10
|
| Rate for Payer: Aetna Medicare |
$710.52
|
| Rate for Payer: BCBS Complete |
$882.80
|
| Rate for Payer: BCBS MAPPO |
$710.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.04
|
| Rate for Payer: BCN Commercial |
$1,060.92
|
| Rate for Payer: BCN Medicare Advantage |
$710.52
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cofinity Commercial |
$952.10
|
| Rate for Payer: Cofinity Commercial |
$1,023.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$710.52
|
| Rate for Payer: Healthscope Commercial |
$852.62
|
| Rate for Payer: Healthscope Whirlpool |
$852.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$746.05
|
| Rate for Payer: PACE SWMI |
$710.52
|
| Rate for Payer: PHP Medicare Advantage |
$710.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,108.62
|
| Rate for Payer: Priority Health Medicare |
$710.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,108.62
|
| Rate for Payer: UHC Medicare Advantage |
$731.84
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR
|
Professional
|
Both
|
$2,727.00
|
|
|
Service Code
|
HCPCS 27495
|
| Min. Negotiated Rate |
$1,090.80 |
| Max. Negotiated Rate |
$1,908.90 |
| Rate for Payer: Aetna Commercial |
$1,492.76
|
| Rate for Payer: Aetna Medicare |
$1,114.00
|
| Rate for Payer: BCBS Complete |
$1,090.80
|
| Rate for Payer: BCBS MAPPO |
$1,114.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,264.22
|
| Rate for Payer: BCN Commercial |
$1,655.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,114.00
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cofinity Commercial |
$1,604.16
|
| Rate for Payer: Cofinity Commercial |
$1,492.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,114.00
|
| Rate for Payer: Healthscope Commercial |
$1,336.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,336.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,169.70
|
| Rate for Payer: PACE SWMI |
$1,114.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,114.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,729.57
|
| Rate for Payer: Priority Health Medicare |
$1,114.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,729.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,147.42
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA
|
Professional
|
Both
|
$2,106.00
|
|
|
Service Code
|
HCPCS 27745
|
| Min. Negotiated Rate |
$744.75 |
| Max. Negotiated Rate |
$2,619.31 |
| Rate for Payer: Aetna Commercial |
$997.96
|
| Rate for Payer: Aetna Medicare |
$744.75
|
| Rate for Payer: BCBS Complete |
$842.40
|
| Rate for Payer: BCBS MAPPO |
$744.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,619.31
|
| Rate for Payer: BCN Commercial |
$1,110.77
|
| Rate for Payer: BCN Medicare Advantage |
$744.75
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cofinity Commercial |
$997.96
|
| Rate for Payer: Cofinity Commercial |
$1,072.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.75
|
| Rate for Payer: Healthscope Commercial |
$893.70
|
| Rate for Payer: Healthscope Whirlpool |
$893.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$781.99
|
| Rate for Payer: PACE SWMI |
$744.75
|
| Rate for Payer: PHP Medicare Advantage |
$744.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,474.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,160.71
|
| Rate for Payer: Priority Health Medicare |
$744.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,160.71
|
| Rate for Payer: UHC Medicare Advantage |
$767.09
|
|
|
PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR
|
Professional
|
Both
|
$2,001.18
|
|
|
Service Code
|
HCPCS 27187
|
| Min. Negotiated Rate |
$800.47 |
| Max. Negotiated Rate |
$2,727.08 |
| Rate for Payer: Aetna Commercial |
$1,315.68
|
| Rate for Payer: Aetna Medicare |
$981.85
|
| Rate for Payer: BCBS Complete |
$800.47
|
| Rate for Payer: BCBS MAPPO |
$981.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,727.08
|
| Rate for Payer: BCN Commercial |
$1,461.15
|
| Rate for Payer: BCN Medicare Advantage |
$981.85
|
| Rate for Payer: Cash Price |
$1,600.94
|
| Rate for Payer: Cash Price |
$1,600.94
|
| Rate for Payer: Cofinity Commercial |
$1,413.86
|
| Rate for Payer: Cofinity Commercial |
$1,315.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.85
|
| Rate for Payer: Healthscope Commercial |
$1,178.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,178.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,030.94
|
| Rate for Payer: PACE SWMI |
$981.85
|
| Rate for Payer: PHP Medicare Advantage |
$981.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,526.85
|
| Rate for Payer: Priority Health Medicare |
$981.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,526.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,011.31
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT
|
Professional
|
Both
|
$2,531.00
|
|
|
Service Code
|
HCPCS 24498
|
| Min. Negotiated Rate |
$557.36 |
| Max. Negotiated Rate |
$1,771.70 |
| Rate for Payer: Aetna Commercial |
$1,147.00
|
| Rate for Payer: Aetna Medicare |
$855.97
|
| Rate for Payer: BCBS Complete |
$1,012.40
|
| Rate for Payer: BCBS MAPPO |
$855.97
|
| Rate for Payer: BCBS Trust/PPO |
$557.36
|
| Rate for Payer: BCN Commercial |
$1,274.47
|
| Rate for Payer: BCN Medicare Advantage |
$855.97
|
| Rate for Payer: Cash Price |
$2,024.80
|
| Rate for Payer: Cash Price |
$2,024.80
|
| Rate for Payer: Cofinity Commercial |
$1,232.60
|
| Rate for Payer: Cofinity Commercial |
$1,147.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.97
|
| Rate for Payer: Healthscope Commercial |
$1,027.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,027.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$898.77
|
| Rate for Payer: PACE SWMI |
$855.97
|
| Rate for Payer: PHP Medicare Advantage |
$855.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,331.78
|
| Rate for Payer: Priority Health Medicare |
$855.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,331.78
|
| Rate for Payer: UHC Medicare Advantage |
$881.65
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS
|
Professional
|
Both
|
$2,049.00
|
|
|
Service Code
|
HCPCS 23491
|
| Min. Negotiated Rate |
$185.93 |
| Max. Negotiated Rate |
$1,557.48 |
| Rate for Payer: Aetna Commercial |
$1,342.34
|
| Rate for Payer: Aetna Medicare |
$1,001.75
|
| Rate for Payer: BCBS Complete |
$819.60
|
| Rate for Payer: BCBS MAPPO |
$1,001.75
|
| Rate for Payer: BCBS Trust/PPO |
$185.93
|
| Rate for Payer: BCN Commercial |
$1,490.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,001.75
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Cofinity Commercial |
$1,342.34
|
| Rate for Payer: Cofinity Commercial |
$1,442.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,001.75
|
| Rate for Payer: Healthscope Commercial |
$1,202.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,202.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,051.84
|
| Rate for Payer: PACE SWMI |
$1,001.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,001.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,557.48
|
| Rate for Payer: Priority Health Medicare |
$1,001.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,557.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,031.80
|
|
|
PR PROSTATE CA SCREENING; DRE
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS G0102
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$1,420.07 |
| Rate for Payer: Aetna Commercial |
$11.56
|
| Rate for Payer: Aetna Medicare |
$8.63
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$8.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.07
|
| Rate for Payer: BCN Commercial |
$33.72
|
| Rate for Payer: BCN Medicare Advantage |
$8.63
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$12.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.63
|
| Rate for Payer: Healthscope Commercial |
$10.36
|
| Rate for Payer: Healthscope Whirlpool |
$10.36
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.06
|
| Rate for Payer: PACE SWMI |
$8.63
|
| Rate for Payer: PHP Medicare Advantage |
$8.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.14
|
| Rate for Payer: Priority Health Medicare |
$8.63
|
| Rate for Payer: Priority Health Narrow Network |
$11.14
|
| Rate for Payer: UHC Medicare Advantage |
$8.89
|
|
|
PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC
|
Professional
|
Both
|
$3,585.00
|
|
|
Service Code
|
HCPCS 55815
|
| Min. Negotiated Rate |
$1,112.29 |
| Max. Negotiated Rate |
$2,793.65 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Medicare |
$1,717.39
|
| Rate for Payer: BCBS Complete |
$1,167.90
|
| Rate for Payer: BCBS MAPPO |
$1,717.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.22
|
| Rate for Payer: BCN Commercial |
$2,526.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,717.39
|
| Rate for Payer: Cash Price |
$2,868.00
|
| Rate for Payer: Cash Price |
$2,868.00
|
| Rate for Payer: Cofinity Commercial |
$2,473.04
|
| Rate for Payer: Cofinity Commercial |
$2,301.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,717.39
|
| Rate for Payer: Healthscope Commercial |
$2,060.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,060.87
|
| Rate for Payer: Meridian Medicaid |
$1,167.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,803.26
|
| Rate for Payer: PACE SWMI |
$1,717.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,717.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,112.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,509.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,793.65
|
| Rate for Payer: Priority Health Medicare |
$1,717.39
|
| Rate for Payer: Priority Health Narrow Network |
$2,793.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,768.91
|
|
