|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 90680
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$91.96
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.80
|
|
|
PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY
|
Professional
|
Both
|
$3,080.00
|
|
|
Service Code
|
HCPCS 33476
|
| Min. Negotiated Rate |
$684.68 |
| Max. Negotiated Rate |
$2,385.29 |
| Rate for Payer: Aetna Commercial |
$2,010.25
|
| Rate for Payer: Aetna Medicare |
$1,500.19
|
| Rate for Payer: BCBS Complete |
$1,008.44
|
| Rate for Payer: BCBS MAPPO |
$1,500.19
|
| Rate for Payer: BCBS Trust/PPO |
$684.68
|
| Rate for Payer: BCN Commercial |
$2,191.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,500.19
|
| Rate for Payer: Cash Price |
$2,464.00
|
| Rate for Payer: Cash Price |
$2,464.00
|
| Rate for Payer: Cofinity Commercial |
$2,160.27
|
| Rate for Payer: Cofinity Commercial |
$2,010.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,500.19
|
| Rate for Payer: Healthscope Commercial |
$1,800.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,800.23
|
| Rate for Payer: Meridian Medicaid |
$1,008.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,575.20
|
| Rate for Payer: PACE SWMI |
$1,500.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,500.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,156.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,385.29
|
| Rate for Payer: Priority Health Medicare |
$1,500.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,385.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,545.20
|
|
|
PR RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 92310
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$145.62
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.85
|
| Rate for Payer: Priority Health Narrow Network |
$67.85
|
|
|
PR RX&FTG CONTACT CORNEAL LENS EYES XCPT APHAKIA
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 92314
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$686.79 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCN Commercial |
$126.57
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.15
|
| Rate for Payer: Priority Health Narrow Network |
$40.15
|
|
|
PR RX RIB FRACTURE W EXTERN FIXATN
|
Professional
|
Both
|
$1,291.00
|
|
|
Service Code
|
HCPCS 21810
|
| Min. Negotiated Rate |
$516.40 |
| Max. Negotiated Rate |
$903.70 |
| Rate for Payer: BCBS Complete |
$516.40
|
| Rate for Payer: Cash Price |
$1,032.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.70
|
|
|
PR SACRAL NERVE STIM TEST LEAD
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS A4290
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$902.34 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$902.34
|
| Rate for Payer: BCN Commercial |
$22.50
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$1,715.00
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$1,200.50 |
| Rate for Payer: Aetna Commercial |
$1,064.08
|
| Rate for Payer: Aetna Medicare |
$794.09
|
| Rate for Payer: BCBS Complete |
$540.78
|
| Rate for Payer: BCBS MAPPO |
$794.09
|
| Rate for Payer: BCBS Trust/PPO |
$138.94
|
| Rate for Payer: BCN Commercial |
$1,174.29
|
| Rate for Payer: BCN Medicare Advantage |
$794.09
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cofinity Commercial |
$1,064.08
|
| Rate for Payer: Cofinity Commercial |
$1,143.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$794.09
|
| Rate for Payer: Healthscope Commercial |
$952.91
|
| Rate for Payer: Healthscope Whirlpool |
$952.91
|
| Rate for Payer: Meridian Medicaid |
$540.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$833.79
|
| Rate for Payer: PACE SWMI |
$794.09
|
| Rate for Payer: PHP Medicare Advantage |
$794.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,137.64
|
| Rate for Payer: Priority Health Medicare |
$794.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,137.64
|
| Rate for Payer: UHC Medicare Advantage |
$817.91
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$2,001.00
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$429.51 |
| Max. Negotiated Rate |
$1,400.70 |
| Rate for Payer: Aetna Commercial |
$1,005.83
|
| Rate for Payer: Aetna Medicare |
$750.62
|
| Rate for Payer: BCBS Complete |
$513.50
|
| Rate for Payer: BCBS MAPPO |
$750.62
|
| Rate for Payer: BCBS Trust/PPO |
$429.51
|
| Rate for Payer: BCN Commercial |
$1,111.74
|
| Rate for Payer: BCN Medicare Advantage |
$750.62
|
| Rate for Payer: Cash Price |
$1,600.80
|
| Rate for Payer: Cash Price |
$1,600.80
|
| Rate for Payer: Cofinity Commercial |
$1,080.89
|
| Rate for Payer: Cofinity Commercial |
$1,005.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.62
|
| Rate for Payer: Healthscope Commercial |
$900.74
|
| Rate for Payer: Healthscope Whirlpool |
$900.74
|
| Rate for Payer: Meridian Medicaid |
$513.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$788.15
|
| Rate for Payer: PACE SWMI |
$750.62
|
| Rate for Payer: PHP Medicare Advantage |
$750.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,077.03
|
| Rate for Payer: Priority Health Medicare |
$750.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,077.03
|
| Rate for Payer: UHC Medicare Advantage |
$773.14
|
|
|
PR SALPINGOSTOMY
|
Professional
|
Both
|
$2,674.00
|
|
|
Service Code
|
HCPCS 58770
|
| Min. Negotiated Rate |
$209.21 |
| Max. Negotiated Rate |
$1,871.80 |
| Rate for Payer: Aetna Commercial |
$1,149.80
|
| Rate for Payer: Aetna Medicare |
$858.06
|
| Rate for Payer: BCBS Complete |
$581.04
|
| Rate for Payer: BCBS MAPPO |
$858.06
|
| Rate for Payer: BCBS Trust/PPO |
$209.21
|
| Rate for Payer: BCN Commercial |
$1,266.17
|
| Rate for Payer: BCN Medicare Advantage |
$858.06
|
| Rate for Payer: Cash Price |
$2,139.20
|
| Rate for Payer: Cash Price |
$2,139.20
|
| Rate for Payer: Cofinity Commercial |
$1,235.61
|
| Rate for Payer: Cofinity Commercial |
$1,149.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.06
|
| Rate for Payer: Healthscope Commercial |
$1,029.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,029.67
|
| Rate for Payer: Meridian Medicaid |
$581.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$900.96
|
| Rate for Payer: PACE SWMI |
$858.06
|
| Rate for Payer: PHP Medicare Advantage |
$858.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,871.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,226.65
|
| Rate for Payer: Priority Health Medicare |
$858.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,226.65
|
| Rate for Payer: UHC Medicare Advantage |
$883.80
|
|
|
PR SARSCOV2 VACC 10MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$214.83
|
|
|
Service Code
|
HCPCS 91319
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$150.38 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: BCBS Complete |
$85.93
|
| Rate for Payer: BCBS Trust/PPO |
$78.54
|
| Rate for Payer: Cash Price |
$171.86
|
| Rate for Payer: Cash Price |
$171.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.38
|
|
|
PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$320.85
|
|
|
Service Code
|
HCPCS 91320
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$224.60 |
| Rate for Payer: Aetna Commercial |
$131.10
|
| Rate for Payer: BCBS Complete |
$128.34
|
| Rate for Payer: BCBS Trust/PPO |
$125.00
|
| Rate for Payer: Cash Price |
$256.68
|
| Rate for Payer: Cash Price |
$256.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.60
|
|
|
PR SARSCOV2 VACC 3MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$160.44
|
|
|
Service Code
|
HCPCS 91318
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna Commercial |
$65.36
|
| Rate for Payer: BCBS Complete |
$64.18
|
| Rate for Payer: BCBS Trust/PPO |
$58.65
|
| Rate for Payer: Cash Price |
$128.35
|
| Rate for Payer: Cash Price |
$128.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.31
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$1,858.56 |
| Rate for Payer: Aetna Commercial |
$156.66
|
| Rate for Payer: Aetna Medicare |
$116.91
|
| Rate for Payer: BCBS Complete |
$78.73
|
| Rate for Payer: BCBS MAPPO |
$116.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.56
|
| Rate for Payer: BCN Commercial |
$126.11
|
| Rate for Payer: BCN Medicare Advantage |
$116.91
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$168.35
|
| Rate for Payer: Cofinity Commercial |
$156.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.91
|
| Rate for Payer: Healthscope Commercial |
$128.60
|
| Rate for Payer: Healthscope Whirlpool |
$128.60
|
| Rate for Payer: Meridian Medicaid |
$78.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$122.76
|
| Rate for Payer: PACE SWMI |
$116.91
|
| Rate for Payer: PHP Medicare Advantage |
$116.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.77
|
| Rate for Payer: Priority Health Medicare |
$116.91
|
| Rate for Payer: Priority Health Narrow Network |
$150.77
|
| Rate for Payer: UHC Medicare Advantage |
$120.42
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$2,072.52 |
| Rate for Payer: Aetna Commercial |
$104.13
|
| Rate for Payer: Aetna Medicare |
$77.71
|
| Rate for Payer: BCBS Complete |
$52.33
|
| Rate for Payer: BCBS MAPPO |
$77.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,072.52
|
| Rate for Payer: BCN Commercial |
$83.83
|
| Rate for Payer: BCN Medicare Advantage |
$77.71
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$111.90
|
| Rate for Payer: Cofinity Commercial |
$104.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.71
|
| Rate for Payer: Healthscope Commercial |
$85.48
|
| Rate for Payer: Healthscope Whirlpool |
$85.48
|
| Rate for Payer: Meridian Medicaid |
$52.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.60
|
| Rate for Payer: PACE SWMI |
$77.71
|
| Rate for Payer: PHP Medicare Advantage |
$77.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.23
|
| Rate for Payer: Priority Health Medicare |
$77.71
|
| Rate for Payer: Priority Health Narrow Network |
$100.23
|
| Rate for Payer: UHC Medicare Advantage |
$80.04
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$1,703.77 |
| Rate for Payer: Aetna Commercial |
$65.61
|
| Rate for Payer: Aetna Medicare |
$48.96
|
| Rate for Payer: BCBS Complete |
$32.88
|
| Rate for Payer: BCBS MAPPO |
$48.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: BCN Commercial |
$52.66
|
| Rate for Payer: BCN Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Cofinity Commercial |
$65.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$53.86
|
| Rate for Payer: Healthscope Whirlpool |
$53.86
|
| Rate for Payer: Meridian Medicaid |
$32.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.41
|
| Rate for Payer: PACE SWMI |
$48.96
|
| Rate for Payer: PHP Medicare Advantage |
$48.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.96
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health Narrow Network |
$62.96
|
| Rate for Payer: UHC Medicare Advantage |
$50.43
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$131.97 |
| Max. Negotiated Rate |
$500.83 |
| Rate for Payer: Aetna Commercial |
$200.13
|
| Rate for Payer: Aetna Medicare |
$149.35
|
| Rate for Payer: BCBS Complete |
$138.57
|
| Rate for Payer: BCBS MAPPO |
$149.35
|
| Rate for Payer: BCBS Trust/PPO |
$500.83
|
| Rate for Payer: BCN Commercial |
$221.37
|
| Rate for Payer: BCN Medicare Advantage |
$149.35
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$215.06
|
| Rate for Payer: Cofinity Commercial |
$200.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.35
|
| Rate for Payer: Healthscope Commercial |
$164.28
|
| Rate for Payer: Healthscope Whirlpool |
$164.28
|
| Rate for Payer: Meridian Medicaid |
$138.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.82
|
| Rate for Payer: PACE SWMI |
$149.35
|
| Rate for Payer: PHP Medicare Advantage |
$149.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.03
|
| Rate for Payer: Priority Health Medicare |
$149.35
|
| Rate for Payer: Priority Health Narrow Network |
$194.03
|
| Rate for Payer: UHC Medicare Advantage |
$153.83
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 15 MINUTES
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$2,410.10 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Aetna Medicare |
$72.40
|
| Rate for Payer: BCBS Complete |
$67.17
|
| Rate for Payer: BCBS MAPPO |
$72.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,410.10
|
| Rate for Payer: BCN Commercial |
$107.51
|
| Rate for Payer: BCN Medicare Advantage |
$72.40
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$97.02
|
| Rate for Payer: Cofinity Commercial |
$104.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$79.64
|
| Rate for Payer: Healthscope Whirlpool |
$79.64
|
| Rate for Payer: Meridian Medicaid |
$67.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.02
|
| Rate for Payer: PACE SWMI |
$72.40
|
| Rate for Payer: PHP Medicare Advantage |
$72.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.05
|
| Rate for Payer: Priority Health Medicare |
$72.40
|
| Rate for Payer: Priority Health Narrow Network |
$100.05
|
| Rate for Payer: UHC Medicare Advantage |
$74.57
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$323.85 |
| Rate for Payer: Aetna Commercial |
$138.97
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: BCBS Complete |
$97.12
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$323.85
|
| Rate for Payer: BCN Commercial |
$153.93
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$149.34
|
| Rate for Payer: Cofinity Commercial |
$138.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$114.08
|
| Rate for Payer: Healthscope Whirlpool |
$114.08
|
| Rate for Payer: Meridian Medicaid |
$97.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.88
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$131.88
|
| Rate for Payer: UHC Medicare Advantage |
$106.82
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$2,395.31 |
| Rate for Payer: Aetna Commercial |
$51.52
|
| Rate for Payer: Aetna Medicare |
$38.45
|
| Rate for Payer: BCBS Complete |
$36.31
|
| Rate for Payer: BCBS MAPPO |
$38.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,395.31
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: BCN Medicare Advantage |
$38.45
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$55.37
|
| Rate for Payer: Cofinity Commercial |
$51.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.45
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Healthscope Whirlpool |
$42.30
|
| Rate for Payer: Meridian Medicaid |
$36.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.37
|
| Rate for Payer: PACE SWMI |
$38.45
|
| Rate for Payer: PHP Medicare Advantage |
$38.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.12
|
| Rate for Payer: Priority Health Medicare |
$38.45
|
| Rate for Payer: Priority Health Narrow Network |
$50.12
|
| Rate for Payer: UHC Medicare Advantage |
$39.60
|
|
|
PR SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 99224
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$58.10 |
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
|
|
PR SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 99225
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$102.90 |
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.90
|
|
|
PR SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99226
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
|
|
PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 99493
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$687.85 |
| Rate for Payer: Aetna Commercial |
$132.87
|
| Rate for Payer: Aetna Medicare |
$99.16
|
| Rate for Payer: BCBS Complete |
$68.22
|
| Rate for Payer: BCBS MAPPO |
$99.16
|
| Rate for Payer: BCBS Trust/PPO |
$687.85
|
| Rate for Payer: BCN Commercial |
$154.35
|
| Rate for Payer: BCN Medicare Advantage |
$99.16
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$132.87
|
| Rate for Payer: Cofinity Commercial |
$142.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.16
|
| Rate for Payer: Healthscope Commercial |
$109.08
|
| Rate for Payer: Healthscope Whirlpool |
$109.08
|
| Rate for Payer: Meridian Medicaid |
$68.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$104.12
|
| Rate for Payer: PACE SWMI |
$99.16
|
| Rate for Payer: PHP Medicare Advantage |
$99.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.29
|
| Rate for Payer: Priority Health Medicare |
$99.16
|
| Rate for Payer: Priority Health Narrow Network |
$154.29
|
| Rate for Payer: UHC Medicare Advantage |
$102.13
|
|
|
PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Professional
|
Both
|
$2,223.00
|
|
|
Service Code
|
HCPCS 49185
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$1,875.55 |
| Rate for Payer: Aetna Commercial |
$155.33
|
| Rate for Payer: Aetna Medicare |
$115.92
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$115.92
|
| Rate for Payer: BCBS Trust/PPO |
$585.36
|
| Rate for Payer: BCN Commercial |
$1,875.55
|
| Rate for Payer: BCN Medicare Advantage |
$115.92
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cofinity Commercial |
$166.92
|
| Rate for Payer: Cofinity Commercial |
$155.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$139.10
|
| Rate for Payer: Healthscope Whirlpool |
$139.10
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$121.72
|
| Rate for Payer: PACE SWMI |
$115.92
|
| Rate for Payer: PHP Medicare Advantage |
$115.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,556.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.62
|
| Rate for Payer: Priority Health Medicare |
$115.92
|
| Rate for Payer: Priority Health Narrow Network |
$204.62
|
| Rate for Payer: UHC Medicare Advantage |
$119.40
|
|
|
PR SCREENING PAP SMEAR BY PHYS
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS P3001
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$2,624.07 |
| Rate for Payer: Aetna Commercial |
$29.25
|
| Rate for Payer: Aetna Medicare |
$21.83
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS MAPPO |
$21.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,624.07
|
| Rate for Payer: BCN Commercial |
$33.23
|
| Rate for Payer: BCN Medicare Advantage |
$21.83
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$31.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.83
|
| Rate for Payer: Healthscope Commercial |
$26.20
|
| Rate for Payer: Healthscope Whirlpool |
$26.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.92
|
| Rate for Payer: PACE SWMI |
$21.83
|
| Rate for Payer: PHP Medicare Advantage |
$21.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.10
|
| Rate for Payer: Priority Health Medicare |
$21.83
|
| Rate for Payer: UHC Medicare Advantage |
$22.48
|
|
