|
PR SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
HCPCS 36011
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$2,329.71 |
| Rate for Payer: Aetna Commercial |
$205.14
|
| Rate for Payer: Aetna Medicare |
$153.09
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$153.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,329.71
|
| Rate for Payer: BCN Commercial |
$1,185.05
|
| Rate for Payer: BCN Medicare Advantage |
$153.09
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$205.14
|
| Rate for Payer: Cofinity Commercial |
$220.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.09
|
| Rate for Payer: Healthscope Commercial |
$183.71
|
| Rate for Payer: Healthscope Whirlpool |
$183.71
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$160.74
|
| Rate for Payer: PACE SWMI |
$153.09
|
| Rate for Payer: PHP Medicare Advantage |
$153.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.58
|
| Rate for Payer: Priority Health Medicare |
$153.09
|
| Rate for Payer: Priority Health Narrow Network |
$242.58
|
| Rate for Payer: UHC Medicare Advantage |
$157.68
|
|
|
PR SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC
|
Professional
|
Both
|
$961.00
|
|
|
Service Code
|
HCPCS 36012
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$1,531.54 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Aetna Medicare |
$169.25
|
| Rate for Payer: BCBS Complete |
$113.39
|
| Rate for Payer: BCBS MAPPO |
$169.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,531.54
|
| Rate for Payer: BCN Commercial |
$1,227.56
|
| Rate for Payer: BCN Medicare Advantage |
$169.25
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cofinity Commercial |
$243.72
|
| Rate for Payer: Cofinity Commercial |
$226.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.25
|
| Rate for Payer: Healthscope Commercial |
$203.10
|
| Rate for Payer: Healthscope Whirlpool |
$203.10
|
| Rate for Payer: Meridian Medicaid |
$113.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.71
|
| Rate for Payer: PACE SWMI |
$169.25
|
| Rate for Payer: PHP Medicare Advantage |
$169.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.10
|
| Rate for Payer: Priority Health Medicare |
$169.25
|
| Rate for Payer: Priority Health Narrow Network |
$268.10
|
| Rate for Payer: UHC Medicare Advantage |
$174.33
|
|
|
PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,753.00
|
|
|
Service Code
|
HCPCS 36225
|
| Min. Negotiated Rate |
$205.55 |
| Max. Negotiated Rate |
$2,276.75 |
| Rate for Payer: Aetna Commercial |
$429.08
|
| Rate for Payer: Aetna Medicare |
$320.21
|
| Rate for Payer: BCBS Complete |
$215.83
|
| Rate for Payer: BCBS MAPPO |
$320.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.11
|
| Rate for Payer: BCN Commercial |
$2,276.75
|
| Rate for Payer: BCN Medicare Advantage |
$320.21
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Cofinity Commercial |
$461.10
|
| Rate for Payer: Cofinity Commercial |
$429.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.21
|
| Rate for Payer: Healthscope Commercial |
$384.25
|
| Rate for Payer: Healthscope Whirlpool |
$384.25
|
| Rate for Payer: Meridian Medicaid |
$215.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$336.22
|
| Rate for Payer: PACE SWMI |
$320.21
|
| Rate for Payer: PHP Medicare Advantage |
$320.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.96
|
| Rate for Payer: Priority Health Medicare |
$320.21
|
| Rate for Payer: Priority Health Narrow Network |
$506.96
|
| Rate for Payer: UHC Medicare Advantage |
$329.82
|
|
|
PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 36226
|
| Min. Negotiated Rate |
$231.32 |
| Max. Negotiated Rate |
$2,912.03 |
| Rate for Payer: Aetna Commercial |
$483.86
|
| Rate for Payer: Aetna Medicare |
$361.09
|
| Rate for Payer: BCBS Complete |
$242.89
|
| Rate for Payer: BCBS MAPPO |
$361.09
|
| Rate for Payer: BCBS Trust/PPO |
$726.41
|
| Rate for Payer: BCN Commercial |
$2,912.03
|
| Rate for Payer: BCN Medicare Advantage |
$361.09
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cofinity Commercial |
$519.97
|
| Rate for Payer: Cofinity Commercial |
$483.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.09
|
| Rate for Payer: Healthscope Commercial |
$433.31
|
| Rate for Payer: Healthscope Whirlpool |
$433.31
|
| Rate for Payer: Meridian Medicaid |
$242.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$379.14
|
| Rate for Payer: PACE SWMI |
$361.09
|
| Rate for Payer: PHP Medicare Advantage |
$361.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$572.39
|
| Rate for Payer: Priority Health Medicare |
$361.09
|
| Rate for Payer: Priority Health Narrow Network |
$572.39
|
| Rate for Payer: UHC Medicare Advantage |
$371.92
|
|
|
PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 36227
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$1,296.45 |
| Rate for Payer: Aetna Commercial |
$159.31
|
| Rate for Payer: Aetna Medicare |
$118.89
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$118.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.45
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: BCN Medicare Advantage |
$118.89
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cofinity Commercial |
$159.31
|
| Rate for Payer: Cofinity Commercial |
$171.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.89
|
| Rate for Payer: Healthscope Commercial |
$142.67
|
| Rate for Payer: Healthscope Whirlpool |
$142.67
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.83
|
| Rate for Payer: PACE SWMI |
$118.89
|
| Rate for Payer: PHP Medicare Advantage |
$118.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.31
|
| Rate for Payer: Priority Health Medicare |
$118.89
|
| Rate for Payer: Priority Health Narrow Network |
$188.31
|
| Rate for Payer: UHC Medicare Advantage |
$122.46
|
|
|
PR SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
HCPCS 95806
|
| Min. Negotiated Rate |
$87.73 |
| Max. Negotiated Rate |
$410.49 |
| Rate for Payer: Aetna Commercial |
$117.56
|
| Rate for Payer: Aetna Commercial |
$117.56
|
| Rate for Payer: Aetna Medicare |
$87.73
|
| Rate for Payer: Aetna Medicare |
$87.73
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS Complete |
$222.40
|
| Rate for Payer: BCBS MAPPO |
$87.73
|
| Rate for Payer: BCBS MAPPO |
$87.73
|
| Rate for Payer: BCBS Trust/PPO |
$410.49
|
| Rate for Payer: BCBS Trust/PPO |
$410.49
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Medicare Advantage |
$87.73
|
| Rate for Payer: BCN Medicare Advantage |
$87.73
|
| Rate for Payer: Cash Price |
$444.80
|
| Rate for Payer: Cash Price |
$444.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$126.33
|
| Rate for Payer: Cofinity Commercial |
$117.56
|
| Rate for Payer: Cofinity Commercial |
$117.56
|
| Rate for Payer: Cofinity Commercial |
$126.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$105.28
|
| Rate for Payer: Healthscope Whirlpool |
$105.28
|
| Rate for Payer: Healthscope Whirlpool |
$105.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.12
|
| Rate for Payer: PACE SWMI |
$87.73
|
| Rate for Payer: PACE SWMI |
$87.73
|
| Rate for Payer: PHP Medicare Advantage |
$87.73
|
| Rate for Payer: PHP Medicare Advantage |
$87.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.06
|
| Rate for Payer: Priority Health Medicare |
$87.73
|
| Rate for Payer: Priority Health Medicare |
$87.73
|
| Rate for Payer: Priority Health Narrow Network |
$123.06
|
| Rate for Payer: Priority Health Narrow Network |
$123.06
|
| Rate for Payer: UHC Medicare Advantage |
$90.36
|
| Rate for Payer: UHC Medicare Advantage |
$90.36
|
|
|
PR SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 95807
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$1,022.00 |
| Rate for Payer: Aetna Commercial |
$484.02
|
| Rate for Payer: Aetna Commercial |
$484.02
|
| Rate for Payer: Aetna Medicare |
$361.21
|
| Rate for Payer: Aetna Medicare |
$361.21
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS Complete |
$584.00
|
| Rate for Payer: BCBS MAPPO |
$361.21
|
| Rate for Payer: BCBS MAPPO |
$361.21
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCN Commercial |
$453.53
|
| Rate for Payer: BCN Commercial |
$453.53
|
| Rate for Payer: BCN Medicare Advantage |
$361.21
|
| Rate for Payer: BCN Medicare Advantage |
$361.21
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$484.02
|
| Rate for Payer: Cofinity Commercial |
$520.14
|
| Rate for Payer: Cofinity Commercial |
$484.02
|
| Rate for Payer: Cofinity Commercial |
$520.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.21
|
| Rate for Payer: Healthscope Commercial |
$433.45
|
| Rate for Payer: Healthscope Commercial |
$433.45
|
| Rate for Payer: Healthscope Whirlpool |
$433.45
|
| Rate for Payer: Healthscope Whirlpool |
$433.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$379.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$379.27
|
| Rate for Payer: PACE SWMI |
$361.21
|
| Rate for Payer: PACE SWMI |
$361.21
|
| Rate for Payer: PHP Medicare Advantage |
$361.21
|
| Rate for Payer: PHP Medicare Advantage |
$361.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.76
|
| Rate for Payer: Priority Health Medicare |
$361.21
|
| Rate for Payer: Priority Health Medicare |
$361.21
|
| Rate for Payer: Priority Health Narrow Network |
$518.76
|
| Rate for Payer: Priority Health Narrow Network |
$518.76
|
| Rate for Payer: UHC Medicare Advantage |
$372.05
|
| Rate for Payer: UHC Medicare Advantage |
$372.05
|
|
|
PR SLING OPERATION STRESS INCONTINENCE
|
Professional
|
Both
|
$2,235.00
|
|
|
Service Code
|
HCPCS 57288
|
| Min. Negotiated Rate |
$477.55 |
| Max. Negotiated Rate |
$2,553.80 |
| Rate for Payer: Aetna Commercial |
$982.86
|
| Rate for Payer: Aetna Medicare |
$733.48
|
| Rate for Payer: BCBS Complete |
$501.43
|
| Rate for Payer: BCBS MAPPO |
$733.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,553.80
|
| Rate for Payer: BCN Commercial |
$1,508.40
|
| Rate for Payer: BCN Medicare Advantage |
$733.48
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cofinity Commercial |
$982.86
|
| Rate for Payer: Cofinity Commercial |
$1,056.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.48
|
| Rate for Payer: Healthscope Commercial |
$880.18
|
| Rate for Payer: Healthscope Whirlpool |
$880.18
|
| Rate for Payer: Meridian Medicaid |
$501.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$770.15
|
| Rate for Payer: PACE SWMI |
$733.48
|
| Rate for Payer: PHP Medicare Advantage |
$733.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,564.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,053.37
|
| Rate for Payer: Priority Health Medicare |
$733.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,053.37
|
| Rate for Payer: UHC Medicare Advantage |
$755.48
|
|
|
PR SLING OPRATION CORRJ MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,644.00
|
|
|
Service Code
|
HCPCS 53440
|
| Min. Negotiated Rate |
$479.25 |
| Max. Negotiated Rate |
$2,746.63 |
| Rate for Payer: Aetna Commercial |
$985.09
|
| Rate for Payer: Aetna Medicare |
$735.14
|
| Rate for Payer: BCBS Complete |
$503.21
|
| Rate for Payer: BCBS MAPPO |
$735.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,746.63
|
| Rate for Payer: BCN Commercial |
$1,085.84
|
| Rate for Payer: BCN Medicare Advantage |
$735.14
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Cofinity Commercial |
$1,058.60
|
| Rate for Payer: Cofinity Commercial |
$985.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.14
|
| Rate for Payer: Healthscope Commercial |
$882.17
|
| Rate for Payer: Healthscope Whirlpool |
$882.17
|
| Rate for Payer: Meridian Medicaid |
$503.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$771.90
|
| Rate for Payer: PACE SWMI |
$735.14
|
| Rate for Payer: PHP Medicare Advantage |
$735.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,200.67
|
| Rate for Payer: Priority Health Medicare |
$735.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,200.67
|
| Rate for Payer: UHC Medicare Advantage |
$757.19
|
|
|
PR SLINGS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCN Commercial |
$7.97
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$1,072.45 |
| Rate for Payer: Aetna Commercial |
$183.16
|
| Rate for Payer: Aetna Medicare |
$136.69
|
| Rate for Payer: BCBS Complete |
$94.60
|
| Rate for Payer: BCBS MAPPO |
$136.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.45
|
| Rate for Payer: BCN Commercial |
$289.29
|
| Rate for Payer: BCN Medicare Advantage |
$136.69
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$196.83
|
| Rate for Payer: Cofinity Commercial |
$183.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.69
|
| Rate for Payer: Healthscope Commercial |
$164.03
|
| Rate for Payer: Healthscope Whirlpool |
$164.03
|
| Rate for Payer: Meridian Medicaid |
$94.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.52
|
| Rate for Payer: PACE SWMI |
$136.69
|
| Rate for Payer: PHP Medicare Advantage |
$136.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.79
|
| Rate for Payer: Priority Health Medicare |
$136.69
|
| Rate for Payer: Priority Health Narrow Network |
$224.79
|
| Rate for Payer: UHC Medicare Advantage |
$140.79
|
|
|
PR SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 95800
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$545.73 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$140.28
|
| Rate for Payer: Aetna Medicare |
$140.28
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS MAPPO |
$140.28
|
| Rate for Payer: BCBS MAPPO |
$140.28
|
| Rate for Payer: BCBS Trust/PPO |
$545.73
|
| Rate for Payer: BCBS Trust/PPO |
$545.73
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Medicare Advantage |
$140.28
|
| Rate for Payer: BCN Medicare Advantage |
$140.28
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$187.98
|
| Rate for Payer: Cofinity Commercial |
$202.00
|
| Rate for Payer: Cofinity Commercial |
$187.98
|
| Rate for Payer: Cofinity Commercial |
$202.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.28
|
| Rate for Payer: Healthscope Commercial |
$168.34
|
| Rate for Payer: Healthscope Commercial |
$168.34
|
| Rate for Payer: Healthscope Whirlpool |
$168.34
|
| Rate for Payer: Healthscope Whirlpool |
$168.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.29
|
| Rate for Payer: PACE SWMI |
$140.28
|
| Rate for Payer: PACE SWMI |
$140.28
|
| Rate for Payer: PHP Medicare Advantage |
$140.28
|
| Rate for Payer: PHP Medicare Advantage |
$140.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.87
|
| Rate for Payer: Priority Health Medicare |
$140.28
|
| Rate for Payer: Priority Health Medicare |
$140.28
|
| Rate for Payer: Priority Health Narrow Network |
$199.87
|
| Rate for Payer: Priority Health Narrow Network |
$199.87
|
| Rate for Payer: UHC Medicare Advantage |
$144.49
|
| Rate for Payer: UHC Medicare Advantage |
$144.49
|
|
|
PR SMOKE/TOBACCO COUNSELNG 3-10
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0375
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$517.72 |
| Rate for Payer: Aetna Commercial |
$78.64
|
| Rate for Payer: Aetna Medicare |
$58.69
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$58.69
|
| Rate for Payer: BCBS Trust/PPO |
$517.72
|
| Rate for Payer: BCN Commercial |
$167.13
|
| Rate for Payer: BCN Medicare Advantage |
$58.69
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$84.51
|
| Rate for Payer: Cofinity Commercial |
$78.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.69
|
| Rate for Payer: Healthscope Commercial |
$70.43
|
| Rate for Payer: Healthscope Whirlpool |
$70.43
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.62
|
| Rate for Payer: PACE SWMI |
$58.69
|
| Rate for Payer: PHP Medicare Advantage |
$58.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.93
|
| Rate for Payer: Priority Health Medicare |
$58.69
|
| Rate for Payer: Priority Health Narrow Network |
$71.93
|
| Rate for Payer: UHC Medicare Advantage |
$60.45
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$561.29 |
| Rate for Payer: Aetna Commercial |
$126.98
|
| Rate for Payer: Aetna Medicare |
$94.76
|
| Rate for Payer: BCBS Complete |
$63.29
|
| Rate for Payer: BCBS MAPPO |
$94.76
|
| Rate for Payer: BCBS Trust/PPO |
$561.29
|
| Rate for Payer: BCN Commercial |
$259.49
|
| Rate for Payer: BCN Medicare Advantage |
$94.76
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$136.45
|
| Rate for Payer: Cofinity Commercial |
$126.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.76
|
| Rate for Payer: Healthscope Commercial |
$113.71
|
| Rate for Payer: Healthscope Whirlpool |
$113.71
|
| Rate for Payer: Meridian Medicaid |
$63.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.50
|
| Rate for Payer: PACE SWMI |
$94.76
|
| Rate for Payer: PHP Medicare Advantage |
$94.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.50
|
| Rate for Payer: Priority Health Medicare |
$94.76
|
| Rate for Payer: Priority Health Narrow Network |
$115.50
|
| Rate for Payer: UHC Medicare Advantage |
$97.60
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$73.70 |
| Max. Negotiated Rate |
$525.42 |
| Rate for Payer: Aetna Commercial |
$156.23
|
| Rate for Payer: Aetna Medicare |
$116.59
|
| Rate for Payer: BCBS Complete |
$77.38
|
| Rate for Payer: BCBS MAPPO |
$116.59
|
| Rate for Payer: BCBS Trust/PPO |
$525.42
|
| Rate for Payer: BCN Commercial |
$301.51
|
| Rate for Payer: BCN Medicare Advantage |
$116.59
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cofinity Commercial |
$167.89
|
| Rate for Payer: Cofinity Commercial |
$156.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.59
|
| Rate for Payer: Healthscope Commercial |
$139.91
|
| Rate for Payer: Healthscope Whirlpool |
$139.91
|
| Rate for Payer: Meridian Medicaid |
$77.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$122.42
|
| Rate for Payer: PACE SWMI |
$116.59
|
| Rate for Payer: PHP Medicare Advantage |
$116.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.22
|
| Rate for Payer: Priority Health Medicare |
$116.59
|
| Rate for Payer: Priority Health Narrow Network |
$142.22
|
| Rate for Payer: UHC Medicare Advantage |
$120.09
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$62.27 |
| Rate for Payer: Aetna Commercial |
$39.50
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCN Commercial |
$62.27
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$25.37
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$25.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,605.50
|
| Rate for Payer: BCN Commercial |
$40.07
|
| Rate for Payer: BCN Medicare Advantage |
$25.37
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.37
|
| Rate for Payer: Healthscope Commercial |
$30.44
|
| Rate for Payer: Healthscope Whirlpool |
$30.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.64
|
| Rate for Payer: PACE SWMI |
$25.37
|
| Rate for Payer: PHP Medicare Advantage |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.83
|
| Rate for Payer: Priority Health Medicare |
$25.37
|
| Rate for Payer: Priority Health Narrow Network |
$36.83
|
| Rate for Payer: UHC Medicare Advantage |
$26.13
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$1,742.33 |
| Rate for Payer: Aetna Commercial |
$52.61
|
| Rate for Payer: Aetna Medicare |
$39.26
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS MAPPO |
$39.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,742.33
|
| Rate for Payer: BCN Commercial |
$62.06
|
| Rate for Payer: BCN Medicare Advantage |
$39.26
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$56.53
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.26
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Healthscope Whirlpool |
$47.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.22
|
| Rate for Payer: PACE SWMI |
$39.26
|
| Rate for Payer: PHP Medicare Advantage |
$39.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.05
|
| Rate for Payer: Priority Health Medicare |
$39.26
|
| Rate for Payer: Priority Health Narrow Network |
$57.05
|
| Rate for Payer: UHC Medicare Advantage |
$40.44
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$1,543.16 |
| Rate for Payer: Aetna Commercial |
$210.02
|
| Rate for Payer: Aetna Medicare |
$156.73
|
| Rate for Payer: BCBS Complete |
$106.24
|
| Rate for Payer: BCBS MAPPO |
$156.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: BCN Commercial |
$425.15
|
| Rate for Payer: BCN Medicare Advantage |
$156.73
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$225.69
|
| Rate for Payer: Cofinity Commercial |
$210.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.73
|
| Rate for Payer: Healthscope Commercial |
$188.08
|
| Rate for Payer: Healthscope Whirlpool |
$188.08
|
| Rate for Payer: Meridian Medicaid |
$106.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$164.57
|
| Rate for Payer: PACE SWMI |
$156.73
|
| Rate for Payer: PHP Medicare Advantage |
$156.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$278.71
|
| Rate for Payer: Priority Health Medicare |
$156.73
|
| Rate for Payer: Priority Health Narrow Network |
$278.71
|
| Rate for Payer: UHC Medicare Advantage |
$161.43
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$1,480.00
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$479.04 |
| Max. Negotiated Rate |
$1,315.89 |
| Rate for Payer: Aetna Commercial |
$989.36
|
| Rate for Payer: Aetna Medicare |
$738.33
|
| Rate for Payer: BCBS Complete |
$502.99
|
| Rate for Payer: BCBS MAPPO |
$738.33
|
| Rate for Payer: BCBS Trust/PPO |
$714.79
|
| Rate for Payer: BCN Commercial |
$1,093.66
|
| Rate for Payer: BCN Medicare Advantage |
$738.33
|
| Rate for Payer: Cash Price |
$1,184.00
|
| Rate for Payer: Cash Price |
$1,184.00
|
| Rate for Payer: Cofinity Commercial |
$989.36
|
| Rate for Payer: Cofinity Commercial |
$1,063.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$738.33
|
| Rate for Payer: Healthscope Commercial |
$886.00
|
| Rate for Payer: Healthscope Whirlpool |
$886.00
|
| Rate for Payer: Meridian Medicaid |
$502.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$775.25
|
| Rate for Payer: PACE SWMI |
$738.33
|
| Rate for Payer: PHP Medicare Advantage |
$738.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,036.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,315.89
|
| Rate for Payer: Priority Health Medicare |
$738.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,315.89
|
| Rate for Payer: UHC Medicare Advantage |
$760.48
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$430.47 |
| Max. Negotiated Rate |
$1,183.59 |
| Rate for Payer: Aetna Commercial |
$887.84
|
| Rate for Payer: Aetna Medicare |
$662.57
|
| Rate for Payer: BCBS Complete |
$451.99
|
| Rate for Payer: BCBS MAPPO |
$662.57
|
| Rate for Payer: BCBS Trust/PPO |
$477.58
|
| Rate for Payer: BCN Commercial |
$983.71
|
| Rate for Payer: BCN Medicare Advantage |
$662.57
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$887.84
|
| Rate for Payer: Cofinity Commercial |
$954.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.57
|
| Rate for Payer: Healthscope Commercial |
$795.08
|
| Rate for Payer: Healthscope Whirlpool |
$795.08
|
| Rate for Payer: Meridian Medicaid |
$451.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$695.70
|
| Rate for Payer: PACE SWMI |
$662.57
|
| Rate for Payer: PHP Medicare Advantage |
$662.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,183.59
|
| Rate for Payer: Priority Health Medicare |
$662.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,183.59
|
| Rate for Payer: UHC Medicare Advantage |
$682.45
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$1,851.00
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$1,606.34 |
| Rate for Payer: Aetna Commercial |
$1,210.53
|
| Rate for Payer: Aetna Medicare |
$903.38
|
| Rate for Payer: BCBS Complete |
$612.13
|
| Rate for Payer: BCBS MAPPO |
$903.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.81
|
| Rate for Payer: BCN Commercial |
$1,335.07
|
| Rate for Payer: BCN Medicare Advantage |
$903.38
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cofinity Commercial |
$1,210.53
|
| Rate for Payer: Cofinity Commercial |
$1,300.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.38
|
| Rate for Payer: Healthscope Commercial |
$1,084.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,084.06
|
| Rate for Payer: Meridian Medicaid |
$612.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$948.55
|
| Rate for Payer: PACE SWMI |
$903.38
|
| Rate for Payer: PHP Medicare Advantage |
$903.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$582.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,606.34
|
| Rate for Payer: Priority Health Medicare |
$903.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,606.34
|
| Rate for Payer: UHC Medicare Advantage |
$930.48
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$2,644.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$165.93 |
| Max. Negotiated Rate |
$1,850.80 |
| Rate for Payer: Aetna Commercial |
$349.03
|
| Rate for Payer: Aetna Medicare |
$260.47
|
| Rate for Payer: BCBS Complete |
$174.23
|
| Rate for Payer: BCBS MAPPO |
$260.47
|
| Rate for Payer: BCBS Trust/PPO |
$538.34
|
| Rate for Payer: BCN Commercial |
$379.70
|
| Rate for Payer: BCN Medicare Advantage |
$260.47
|
| Rate for Payer: Cash Price |
$2,115.20
|
| Rate for Payer: Cash Price |
$2,115.20
|
| Rate for Payer: Cofinity Commercial |
$375.08
|
| Rate for Payer: Cofinity Commercial |
$349.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.47
|
| Rate for Payer: Healthscope Commercial |
$312.56
|
| Rate for Payer: Healthscope Whirlpool |
$312.56
|
| Rate for Payer: Meridian Medicaid |
$174.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$273.49
|
| Rate for Payer: PACE SWMI |
$260.47
|
| Rate for Payer: PHP Medicare Advantage |
$260.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,850.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$562.81
|
| Rate for Payer: Priority Health Medicare |
$260.47
|
| Rate for Payer: Priority Health Narrow Network |
$562.81
|
| Rate for Payer: UHC Medicare Advantage |
$268.28
|
|
