|
PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL
|
Professional
|
Both
|
$7,567.00
|
|
|
Service Code
|
HCPCS 43314
|
| Min. Negotiated Rate |
$3,022.62 |
| Max. Negotiated Rate |
$4,918.55 |
| Rate for Payer: Aetna Commercial |
$4,050.31
|
| Rate for Payer: Aetna Medicare |
$3,022.62
|
| Rate for Payer: BCBS Complete |
$3,026.80
|
| Rate for Payer: BCBS MAPPO |
$3,022.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,022.62
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Cofinity Commercial |
$4,352.57
|
| Rate for Payer: Cofinity Commercial |
$4,050.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,022.62
|
| Rate for Payer: Healthscope Commercial |
$3,627.14
|
| Rate for Payer: Healthscope Whirlpool |
$3,627.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,173.75
|
| Rate for Payer: Nomi Health Commercial |
$3,627.14
|
| Rate for Payer: PACE SWMI |
$3,022.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,022.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,918.55
|
| Rate for Payer: Priority Health Medicare |
$3,022.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,022.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,022.62
|
| Rate for Payer: UHCCP DNSP |
$3,022.62
|
|
|
PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,072.00
|
|
|
Service Code
|
HCPCS 43300
|
| Min. Negotiated Rate |
$598.86 |
| Max. Negotiated Rate |
$1,346.80 |
| Rate for Payer: Aetna Commercial |
$802.47
|
| Rate for Payer: Aetna Medicare |
$598.86
|
| Rate for Payer: BCBS Complete |
$828.80
|
| Rate for Payer: BCBS MAPPO |
$598.86
|
| Rate for Payer: BCN Medicare Advantage |
$598.86
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cofinity Commercial |
$862.36
|
| Rate for Payer: Cofinity Commercial |
$802.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.86
|
| Rate for Payer: Healthscope Commercial |
$718.63
|
| Rate for Payer: Healthscope Whirlpool |
$718.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$628.80
|
| Rate for Payer: Nomi Health Commercial |
$718.63
|
| Rate for Payer: PACE SWMI |
$598.86
|
| Rate for Payer: PHP Medicare Advantage |
$598.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.80
|
| Rate for Payer: Priority Health Medicare |
$598.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$598.86
|
| Rate for Payer: UHC Medicare Advantage |
$598.86
|
| Rate for Payer: UHCCP DNSP |
$598.86
|
|
|
PR ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 43305
|
| Min. Negotiated Rate |
$925.20 |
| Max. Negotiated Rate |
$1,509.00 |
| Rate for Payer: Aetna Commercial |
$1,404.21
|
| Rate for Payer: Aetna Medicare |
$1,047.92
|
| Rate for Payer: BCBS Complete |
$925.20
|
| Rate for Payer: BCBS MAPPO |
$1,047.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.92
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,509.00
|
| Rate for Payer: Cofinity Commercial |
$1,404.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.92
|
| Rate for Payer: Healthscope Commercial |
$1,257.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.32
|
| Rate for Payer: Nomi Health Commercial |
$1,257.50
|
| Rate for Payer: PACE SWMI |
$1,047.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health Medicare |
$1,047.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,047.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.92
|
| Rate for Payer: UHCCP DNSP |
$1,047.92
|
|
|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$4,977.00
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$1,427.55 |
| Max. Negotiated Rate |
$3,235.05 |
| Rate for Payer: Aetna Commercial |
$1,912.92
|
| Rate for Payer: Aetna Medicare |
$1,427.55
|
| Rate for Payer: BCBS Complete |
$1,990.80
|
| Rate for Payer: BCBS MAPPO |
$1,427.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,427.55
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cofinity Commercial |
$2,055.67
|
| Rate for Payer: Cofinity Commercial |
$1,912.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,427.55
|
| Rate for Payer: Healthscope Commercial |
$1,713.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,713.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,498.93
|
| Rate for Payer: Nomi Health Commercial |
$1,713.06
|
| Rate for Payer: PACE SWMI |
$1,427.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,427.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,235.05
|
| Rate for Payer: Priority Health Medicare |
$1,427.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,427.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,427.55
|
| Rate for Payer: UHCCP DNSP |
$1,427.55
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$3,354.00
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$1,341.60 |
| Max. Negotiated Rate |
$2,200.77 |
| Rate for Payer: Aetna Commercial |
$2,047.94
|
| Rate for Payer: Aetna Medicare |
$1,528.31
|
| Rate for Payer: BCBS Complete |
$1,341.60
|
| Rate for Payer: BCBS MAPPO |
$1,528.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,528.31
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cofinity Commercial |
$2,200.77
|
| Rate for Payer: Cofinity Commercial |
$2,047.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,528.31
|
| Rate for Payer: Healthscope Commercial |
$1,833.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,833.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,604.73
|
| Rate for Payer: Nomi Health Commercial |
$1,833.97
|
| Rate for Payer: PACE SWMI |
$1,528.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,528.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,180.10
|
| Rate for Payer: Priority Health Medicare |
$1,528.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,528.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,528.31
|
| Rate for Payer: UHCCP DNSP |
$1,528.31
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Medicare |
$9.15
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$9.15
|
| Rate for Payer: BCN Medicare Advantage |
$9.15
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$12.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$10.98
|
| Rate for Payer: Healthscope Whirlpool |
$10.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.61
|
| Rate for Payer: Nomi Health Commercial |
$10.98
|
| Rate for Payer: PACE SWMI |
$9.15
|
| Rate for Payer: PHP Medicare Advantage |
$9.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$9.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.15
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UHCCP DNSP |
$9.15
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 90962
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$275.36 |
| Rate for Payer: Aetna Commercial |
$256.23
|
| Rate for Payer: Aetna Medicare |
$191.22
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$191.22
|
| Rate for Payer: BCN Medicare Advantage |
$191.22
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$275.36
|
| Rate for Payer: Cofinity Commercial |
$256.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.22
|
| Rate for Payer: Healthscope Commercial |
$229.46
|
| Rate for Payer: Healthscope Whirlpool |
$229.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.78
|
| Rate for Payer: Nomi Health Commercial |
$229.46
|
| Rate for Payer: PACE SWMI |
$191.22
|
| Rate for Payer: PHP Medicare Advantage |
$191.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Medicare |
$191.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.22
|
| Rate for Payer: UHC Medicare Advantage |
$191.22
|
| Rate for Payer: UHCCP DNSP |
$191.22
|
|
|
PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 90961
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$400.45 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$278.09
|
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Healthscope Commercial |
$333.71
|
| Rate for Payer: Healthscope Whirlpool |
$333.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
| Rate for Payer: Priority Health Medicare |
$278.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UHCCP DNSP |
$278.09
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 90960
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$482.99 |
| Rate for Payer: Aetna Commercial |
$449.45
|
| Rate for Payer: Aetna Medicare |
$335.41
|
| Rate for Payer: BCBS Complete |
$196.80
|
| Rate for Payer: BCBS MAPPO |
$335.41
|
| Rate for Payer: BCN Medicare Advantage |
$335.41
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$482.99
|
| Rate for Payer: Cofinity Commercial |
$449.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.41
|
| Rate for Payer: Healthscope Commercial |
$402.49
|
| Rate for Payer: Healthscope Whirlpool |
$402.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.18
|
| Rate for Payer: Nomi Health Commercial |
$402.49
|
| Rate for Payer: PACE SWMI |
$335.41
|
| Rate for Payer: PHP Medicare Advantage |
$335.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health Medicare |
$335.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.41
|
| Rate for Payer: UHC Medicare Advantage |
$335.41
|
| Rate for Payer: UHCCP DNSP |
$335.41
|
|
|
PR ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 90966
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$400.45 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$278.09
|
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Healthscope Commercial |
$333.71
|
| Rate for Payer: Healthscope Whirlpool |
$333.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health Medicare |
$278.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UHCCP DNSP |
$278.09
|
|
|
PR ESW BY PHYS W/ANES INVG LAT HUMERL EPICONDYLE
|
Professional
|
Both
|
$2,655.00
|
|
|
Service Code
|
HCPCS 0102T
|
| Min. Negotiated Rate |
$1,062.00 |
| Max. Negotiated Rate |
$1,725.75 |
| Rate for Payer: Aetna Medicare |
$1,327.50
|
| Rate for Payer: BCBS Complete |
$1,062.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.75
|
|
|
PR ETHMOIDECTOMY INTRANASAL ANTERIOR
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 31200
|
| Min. Negotiated Rate |
$570.42 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Aetna Commercial |
$764.36
|
| Rate for Payer: Aetna Medicare |
$570.42
|
| Rate for Payer: BCBS Complete |
$1,020.00
|
| Rate for Payer: BCBS MAPPO |
$570.42
|
| Rate for Payer: BCN Medicare Advantage |
$570.42
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$821.40
|
| Rate for Payer: Cofinity Commercial |
$764.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.42
|
| Rate for Payer: Healthscope Commercial |
$684.50
|
| Rate for Payer: Healthscope Whirlpool |
$684.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.94
|
| Rate for Payer: Nomi Health Commercial |
$684.50
|
| Rate for Payer: PACE SWMI |
$570.42
|
| Rate for Payer: PHP Medicare Advantage |
$570.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: Priority Health Medicare |
$570.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.42
|
| Rate for Payer: UHC Medicare Advantage |
$570.42
|
| Rate for Payer: UHCCP DNSP |
$570.42
|
|
|
PR ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$1,534.00
|
|
|
Service Code
|
HCPCS 31201
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$1,043.42 |
| Rate for Payer: Aetna Commercial |
$970.96
|
| Rate for Payer: Aetna Medicare |
$724.60
|
| Rate for Payer: BCBS Complete |
$613.60
|
| Rate for Payer: BCBS MAPPO |
$724.60
|
| Rate for Payer: BCN Medicare Advantage |
$724.60
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cofinity Commercial |
$970.96
|
| Rate for Payer: Cofinity Commercial |
$1,043.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.60
|
| Rate for Payer: Healthscope Commercial |
$869.52
|
| Rate for Payer: Healthscope Whirlpool |
$869.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$760.83
|
| Rate for Payer: Nomi Health Commercial |
$869.52
|
| Rate for Payer: PACE SWMI |
$724.60
|
| Rate for Payer: PHP Medicare Advantage |
$724.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.10
|
| Rate for Payer: Priority Health Medicare |
$724.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$724.60
|
| Rate for Payer: UHC Medicare Advantage |
$724.60
|
| Rate for Payer: UHCCP DNSP |
$724.60
|
|
|
PR ETONOGESTREL IMPLANT SYSTEM
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS J7307
|
| Min. Negotiated Rate |
$545.20 |
| Max. Negotiated Rate |
$885.95 |
| Rate for Payer: Aetna Medicare |
$681.50
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
|
|
PR EUFLEXXA INJ PER DOSE
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS J7323
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$191.75 |
| Rate for Payer: Aetna Commercial |
$150.68
|
| Rate for Payer: Aetna Medicare |
$112.45
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: BCBS MAPPO |
$112.45
|
| Rate for Payer: BCN Medicare Advantage |
$112.45
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Commercial |
$161.93
|
| Rate for Payer: Cofinity Commercial |
$150.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.45
|
| Rate for Payer: Healthscope Commercial |
$134.94
|
| Rate for Payer: Healthscope Whirlpool |
$134.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.07
|
| Rate for Payer: Nomi Health Commercial |
$134.94
|
| Rate for Payer: PACE SWMI |
$112.45
|
| Rate for Payer: PHP Medicare Advantage |
$112.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
| Rate for Payer: Priority Health Medicare |
$112.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.45
|
| Rate for Payer: UHC Medicare Advantage |
$112.45
|
| Rate for Payer: UHCCP DNSP |
$112.45
|
|
|
PR EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 11740
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: Aetna Medicare |
$30.49
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$30.49
|
| Rate for Payer: BCN Medicare Advantage |
$30.49
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$43.91
|
| Rate for Payer: Cofinity Commercial |
$40.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.49
|
| Rate for Payer: Healthscope Commercial |
$36.59
|
| Rate for Payer: Healthscope Whirlpool |
$36.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.01
|
| Rate for Payer: Nomi Health Commercial |
$36.59
|
| Rate for Payer: PACE SWMI |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$30.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$30.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.49
|
| Rate for Payer: UHC Medicare Advantage |
$30.49
|
| Rate for Payer: UHCCP DNSP |
$30.49
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 92626
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$93.52
|
| Rate for Payer: Aetna Medicare |
$69.79
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$69.79
|
| Rate for Payer: BCN Medicare Advantage |
$69.79
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$100.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.79
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Healthscope Whirlpool |
$83.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.28
|
| Rate for Payer: Nomi Health Commercial |
$83.75
|
| Rate for Payer: PACE SWMI |
$69.79
|
| Rate for Payer: PHP Medicare Advantage |
$69.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$69.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.79
|
| Rate for Payer: UHC Medicare Advantage |
$69.79
|
| Rate for Payer: UHCCP DNSP |
$69.79
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 92627
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$16.36
|
| Rate for Payer: BCN Medicare Advantage |
$16.36
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$21.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.36
|
| Rate for Payer: Healthscope Commercial |
$19.63
|
| Rate for Payer: Healthscope Whirlpool |
$19.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.18
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PACE SWMI |
$16.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health Medicare |
$16.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.36
|
| Rate for Payer: UHC Medicare Advantage |
$16.36
|
| Rate for Payer: UHCCP DNSP |
$16.36
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 92620
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$99.83
|
| Rate for Payer: Aetna Medicare |
$74.50
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$74.50
|
| Rate for Payer: BCN Medicare Advantage |
$74.50
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Healthscope Whirlpool |
$89.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.22
|
| Rate for Payer: Nomi Health Commercial |
$89.40
|
| Rate for Payer: PACE SWMI |
$74.50
|
| Rate for Payer: PHP Medicare Advantage |
$74.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$74.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.50
|
| Rate for Payer: UHC Medicare Advantage |
$74.50
|
| Rate for Payer: UHCCP DNSP |
$74.50
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 92621
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna Medicare |
$17.59
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$17.59
|
| Rate for Payer: BCN Medicare Advantage |
$17.59
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$25.33
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Healthscope Whirlpool |
$21.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.47
|
| Rate for Payer: Nomi Health Commercial |
$21.11
|
| Rate for Payer: PACE SWMI |
$17.59
|
| Rate for Payer: PHP Medicare Advantage |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health Medicare |
$17.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.59
|
| Rate for Payer: UHC Medicare Advantage |
$17.59
|
| Rate for Payer: UHCCP DNSP |
$17.59
|
|
|
PR EVAL OF ORTHOTIC/PROSTH USE, EA 15 MIN
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 97762
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
|
|
PR EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 92523
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$310.35 |
| Rate for Payer: Aetna Commercial |
$288.80
|
| Rate for Payer: Aetna Medicare |
$215.52
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$215.52
|
| Rate for Payer: BCN Medicare Advantage |
$215.52
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$310.35
|
| Rate for Payer: Cofinity Commercial |
$288.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.52
|
| Rate for Payer: Healthscope Commercial |
$258.62
|
| Rate for Payer: Healthscope Whirlpool |
$258.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.30
|
| Rate for Payer: Nomi Health Commercial |
$258.62
|
| Rate for Payer: PACE SWMI |
$215.52
|
| Rate for Payer: PHP Medicare Advantage |
$215.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$215.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.52
|
| Rate for Payer: UHC Medicare Advantage |
$215.52
|
| Rate for Payer: UHCCP DNSP |
$215.52
|
|
|
PR EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 92521
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$181.32 |
| Rate for Payer: Aetna Commercial |
$168.73
|
| Rate for Payer: Aetna Medicare |
$125.92
|
| Rate for Payer: BCBS Complete |
$84.40
|
| Rate for Payer: BCBS MAPPO |
$125.92
|
| Rate for Payer: BCN Medicare Advantage |
$125.92
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$181.32
|
| Rate for Payer: Cofinity Commercial |
$168.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.92
|
| Rate for Payer: Healthscope Commercial |
$151.10
|
| Rate for Payer: Healthscope Whirlpool |
$151.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.22
|
| Rate for Payer: Nomi Health Commercial |
$151.10
|
| Rate for Payer: PACE SWMI |
$125.92
|
| Rate for Payer: PHP Medicare Advantage |
$125.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.15
|
| Rate for Payer: Priority Health Medicare |
$125.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.92
|
| Rate for Payer: UHC Medicare Advantage |
$125.92
|
| Rate for Payer: UHCCP DNSP |
$125.92
|
|
|
PR EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 92522
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$151.27 |
| Rate for Payer: Aetna Commercial |
$140.77
|
| Rate for Payer: Aetna Medicare |
$105.05
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$105.05
|
| Rate for Payer: BCN Medicare Advantage |
$105.05
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$151.27
|
| Rate for Payer: Cofinity Commercial |
$140.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.05
|
| Rate for Payer: Healthscope Commercial |
$126.06
|
| Rate for Payer: Healthscope Whirlpool |
$126.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.30
|
| Rate for Payer: Nomi Health Commercial |
$126.06
|
| Rate for Payer: PACE SWMI |
$105.05
|
| Rate for Payer: PHP Medicare Advantage |
$105.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$105.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.05
|
| Rate for Payer: UHC Medicare Advantage |
$105.05
|
| Rate for Payer: UHCCP DNSP |
$105.05
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST
|
Professional
|
Both
|
$1,105.00
|
|
|
Service Code
|
HCPCS 61650
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$828.37 |
| Rate for Payer: Aetna Commercial |
$770.85
|
| Rate for Payer: Aetna Medicare |
$575.26
|
| Rate for Payer: BCBS Complete |
$442.00
|
| Rate for Payer: BCBS MAPPO |
$575.26
|
| Rate for Payer: BCN Medicare Advantage |
$575.26
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cofinity Commercial |
$828.37
|
| Rate for Payer: Cofinity Commercial |
$770.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.26
|
| Rate for Payer: Healthscope Commercial |
$690.31
|
| Rate for Payer: Healthscope Whirlpool |
$690.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.02
|
| Rate for Payer: Nomi Health Commercial |
$690.31
|
| Rate for Payer: PACE SWMI |
$575.26
|
| Rate for Payer: PHP Medicare Advantage |
$575.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$718.25
|
| Rate for Payer: Priority Health Medicare |
$575.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.26
|
| Rate for Payer: UHC Medicare Advantage |
$575.26
|
| Rate for Payer: UHCCP DNSP |
$575.26
|
|
