|
PR MD CERTIFICATION HHA PATIENT
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS G0180
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Aetna Commercial |
$72.48
|
| Rate for Payer: Aetna Medicare |
$54.09
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS MAPPO |
$54.09
|
| Rate for Payer: BCN Commercial |
$80.18
|
| Rate for Payer: BCN Medicare Advantage |
$54.09
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cofinity Commercial |
$77.89
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.09
|
| Rate for Payer: Healthscope Commercial |
$64.91
|
| Rate for Payer: Healthscope Whirlpool |
$64.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$64.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.25
|
| Rate for Payer: PACE SWMI |
$54.09
|
| Rate for Payer: PHP Medicare Advantage |
$54.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.94
|
| Rate for Payer: Priority Health Medicare |
$54.09
|
| Rate for Payer: Priority Health Narrow Network |
$73.94
|
| Rate for Payer: Railroad Medicare Medicare |
$54.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$54.09
|
| Rate for Payer: UHC Exchange |
$83.30
|
| Rate for Payer: UHCCP DNSP |
$54.09
|
|
|
PR MD INR TEST REVIE INTER MGMT
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0250
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$11.83
|
| Rate for Payer: Aetna Medicare |
$8.83
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$8.83
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$8.83
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Cofinity Commercial |
$11.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.83
|
| Rate for Payer: Healthscope Commercial |
$10.60
|
| Rate for Payer: Healthscope Whirlpool |
$10.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.71
|
| Rate for Payer: Nomi Health Commercial |
$10.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$8.83
|
| Rate for Payer: PHP Medicare Advantage |
$8.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.64
|
| Rate for Payer: Priority Health Medicare |
$8.83
|
| Rate for Payer: Priority Health Narrow Network |
$11.64
|
| Rate for Payer: Railroad Medicare Medicare |
$8.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.83
|
| Rate for Payer: UHC Exchange |
$14.76
|
| Rate for Payer: UHCCP DNSP |
$8.83
|
|
|
PR MD RECERTIFICATION HHA PT
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS G0179
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$63.51 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$42.05
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$42.05
|
| Rate for Payer: BCN Commercial |
$63.24
|
| Rate for Payer: BCN Medicare Advantage |
$42.05
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$60.55
|
| Rate for Payer: Cofinity Commercial |
$56.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.05
|
| Rate for Payer: Healthscope Commercial |
$50.46
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.26
|
| Rate for Payer: Nomi Health Commercial |
$50.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PACE SWMI |
$42.05
|
| Rate for Payer: PHP Medicare Advantage |
$42.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.32
|
| Rate for Payer: Priority Health Medicare |
$42.05
|
| Rate for Payer: Priority Health Narrow Network |
$58.32
|
| Rate for Payer: Railroad Medicare Medicare |
$42.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.05
|
| Rate for Payer: UHC Exchange |
$63.51
|
| Rate for Payer: UHCCP DNSP |
$42.05
|
|
|
PR MD SERVICE REQUIRED FOR PMD
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS G0372
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$10.16
|
| Rate for Payer: Aetna Medicare |
$7.58
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$7.58
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$7.58
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Cofinity Commercial |
$10.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.58
|
| Rate for Payer: Healthscope Commercial |
$9.10
|
| Rate for Payer: Healthscope Whirlpool |
$9.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.34
|
| Rate for Payer: Nomi Health Commercial |
$9.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.50
|
| Rate for Payer: PACE SWMI |
$7.58
|
| Rate for Payer: PHP Medicare Advantage |
$7.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.94
|
| Rate for Payer: Priority Health Medicare |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$11.94
|
| Rate for Payer: Railroad Medicare Medicare |
$7.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.58
|
| Rate for Payer: UHC Exchange |
$14.72
|
| Rate for Payer: UHCCP DNSP |
$7.58
|
|
|
PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 90710
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$289.17 |
| Rate for Payer: Aetna Commercial |
$275.04
|
| Rate for Payer: BCBS Trust/PPO |
$289.17
|
| Rate for Payer: BCN Commercial |
$273.21
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.17
|
| Rate for Payer: UHC Exchange |
$289.17
|
|
|
PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 90707
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: BCBS Trust/PPO |
$95.20
|
| Rate for Payer: BCN Commercial |
$93.30
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.60
|
| Rate for Payer: UHC Exchange |
$96.60
|
|
|
PR MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 51798
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$11.73
|
| Rate for Payer: BCBS MAPPO |
$11.73
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: BCN Medicare Advantage |
$11.73
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.73
|
| Rate for Payer: Healthscope Commercial |
$14.08
|
| Rate for Payer: Healthscope Whirlpool |
$14.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.90
|
| Rate for Payer: Nomi Health Commercial |
$14.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PACE SWMI |
$11.73
|
| Rate for Payer: PHP Medicare Advantage |
$11.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.98
|
| Rate for Payer: Priority Health Medicare |
$11.73
|
| Rate for Payer: Priority Health Narrow Network |
$18.98
|
| Rate for Payer: Railroad Medicare Medicare |
$11.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.73
|
| Rate for Payer: UHC Exchange |
$16.72
|
| Rate for Payer: UHCCP DNSP |
$11.73
|
|
|
PR MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 53020
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$114.19
|
| Rate for Payer: Aetna Medicare |
$85.22
|
| Rate for Payer: BCBS Complete |
$57.70
|
| Rate for Payer: BCBS MAPPO |
$85.22
|
| Rate for Payer: BCN Commercial |
$143.92
|
| Rate for Payer: BCN Medicare Advantage |
$85.22
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cofinity Commercial |
$122.72
|
| Rate for Payer: Cofinity Commercial |
$114.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$102.26
|
| Rate for Payer: Healthscope Whirlpool |
$102.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.48
|
| Rate for Payer: Meridian Medicaid |
$57.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.74
|
| Rate for Payer: Nomi Health Commercial |
$102.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.00
|
| Rate for Payer: PACE SWMI |
$85.22
|
| Rate for Payer: PHP Medicare Advantage |
$85.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$156.77
|
| Rate for Payer: Priority Health Medicare |
$85.22
|
| Rate for Payer: Priority Health Narrow Network |
$156.77
|
| Rate for Payer: Railroad Medicare Medicare |
$85.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$85.22
|
| Rate for Payer: UHC Exchange |
$171.44
|
| Rate for Payer: UHC Medicaid |
$54.95
|
| Rate for Payer: UHCCP DNSP |
$85.22
|
| Rate for Payer: UHCCP Medicaid |
$54.95
|
|
|
PR MEATOTOMY CUTTING MEATUS SPX INFANT
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS 53025
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$82.46
|
| Rate for Payer: Aetna Medicare |
$61.54
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS MAPPO |
$61.54
|
| Rate for Payer: BCN Commercial |
$103.58
|
| Rate for Payer: BCN Medicare Advantage |
$61.54
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$88.62
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.54
|
| Rate for Payer: Healthscope Commercial |
$73.85
|
| Rate for Payer: Healthscope Whirlpool |
$73.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.62
|
| Rate for Payer: Meridian Medicaid |
$42.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.69
|
| Rate for Payer: Nomi Health Commercial |
$73.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.00
|
| Rate for Payer: PACE SWMI |
$61.54
|
| Rate for Payer: PHP Medicare Advantage |
$61.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$112.83
|
| Rate for Payer: Priority Health Medicare |
$61.54
|
| Rate for Payer: Priority Health Narrow Network |
$112.83
|
| Rate for Payer: Railroad Medicare Medicare |
$61.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$61.54
|
| Rate for Payer: UHC Exchange |
$118.70
|
| Rate for Payer: UHC Medicaid |
$40.04
|
| Rate for Payer: UHCCP DNSP |
$61.54
|
| Rate for Payer: UHCCP Medicaid |
$40.04
|
|
|
PR MEDIASTINOSCOPY INCL BIOPSIES WHEN PERFORMED
|
Professional
|
Both
|
$2,310.00
|
|
|
Service Code
|
HCPCS 39400
|
| Min. Negotiated Rate |
$924.00 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: BCBS Complete |
$924.00
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,732.50
|
|
|
PR MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
HCPCS 39401
|
| Min. Negotiated Rate |
$186.59 |
| Max. Negotiated Rate |
$749.25 |
| Rate for Payer: Aetna Commercial |
$391.36
|
| Rate for Payer: Aetna Medicare |
$292.06
|
| Rate for Payer: BCBS Complete |
$195.92
|
| Rate for Payer: BCBS MAPPO |
$292.06
|
| Rate for Payer: BCN Commercial |
$457.15
|
| Rate for Payer: BCN Medicare Advantage |
$292.06
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cofinity Commercial |
$391.36
|
| Rate for Payer: Cofinity Commercial |
$420.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.06
|
| Rate for Payer: Healthscope Commercial |
$350.47
|
| Rate for Payer: Healthscope Whirlpool |
$350.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.66
|
| Rate for Payer: Meridian Medicaid |
$195.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$321.27
|
| Rate for Payer: Nomi Health Commercial |
$350.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$749.25
|
| Rate for Payer: PACE SWMI |
$292.06
|
| Rate for Payer: PHP Medicare Advantage |
$292.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$491.60
|
| Rate for Payer: Priority Health Medicare |
$292.06
|
| Rate for Payer: Priority Health Narrow Network |
$491.60
|
| Rate for Payer: Railroad Medicare Medicare |
$292.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$548.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$292.06
|
| Rate for Payer: UHC Exchange |
$548.73
|
| Rate for Payer: UHC Medicaid |
$186.59
|
| Rate for Payer: UHCCP DNSP |
$292.06
|
| Rate for Payer: UHCCP Medicaid |
$186.59
|
|
|
PR MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 39402
|
| Min. Negotiated Rate |
$240.90 |
| Max. Negotiated Rate |
$718.52 |
| Rate for Payer: Aetna Commercial |
$506.71
|
| Rate for Payer: Aetna Medicare |
$378.14
|
| Rate for Payer: BCBS Complete |
$252.94
|
| Rate for Payer: BCBS MAPPO |
$378.14
|
| Rate for Payer: BCN Commercial |
$596.08
|
| Rate for Payer: BCN Medicare Advantage |
$378.14
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cofinity Commercial |
$544.52
|
| Rate for Payer: Cofinity Commercial |
$506.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.14
|
| Rate for Payer: Healthscope Commercial |
$453.77
|
| Rate for Payer: Healthscope Whirlpool |
$453.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.05
|
| Rate for Payer: Meridian Medicaid |
$252.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$415.95
|
| Rate for Payer: Nomi Health Commercial |
$453.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$652.50
|
| Rate for Payer: PACE SWMI |
$378.14
|
| Rate for Payer: PHP Medicare Advantage |
$378.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$641.02
|
| Rate for Payer: Priority Health Medicare |
$378.14
|
| Rate for Payer: Priority Health Narrow Network |
$641.02
|
| Rate for Payer: Railroad Medicare Medicare |
$378.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$378.14
|
| Rate for Payer: UHC Exchange |
$718.52
|
| Rate for Payer: UHC Medicaid |
$240.90
|
| Rate for Payer: UHCCP DNSP |
$378.14
|
| Rate for Payer: UHCCP Medicaid |
$240.90
|
|
|
PR MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR
|
Professional
|
Both
|
$2,625.00
|
|
|
Service Code
|
HCPCS 39000
|
| Min. Negotiated Rate |
$313.75 |
| Max. Negotiated Rate |
$1,968.75 |
| Rate for Payer: Aetna Commercial |
$646.99
|
| Rate for Payer: Aetna Medicare |
$482.83
|
| Rate for Payer: BCBS Complete |
$329.44
|
| Rate for Payer: BCBS MAPPO |
$482.83
|
| Rate for Payer: BCN Commercial |
$757.42
|
| Rate for Payer: BCN Medicare Advantage |
$482.83
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cofinity Commercial |
$695.28
|
| Rate for Payer: Cofinity Commercial |
$646.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.83
|
| Rate for Payer: Healthscope Commercial |
$579.40
|
| Rate for Payer: Healthscope Whirlpool |
$579.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$506.97
|
| Rate for Payer: Meridian Medicaid |
$329.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$531.11
|
| Rate for Payer: Nomi Health Commercial |
$579.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,968.75
|
| Rate for Payer: PACE SWMI |
$482.83
|
| Rate for Payer: PHP Medicare Advantage |
$482.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$814.52
|
| Rate for Payer: Priority Health Medicare |
$482.83
|
| Rate for Payer: Priority Health Narrow Network |
$814.52
|
| Rate for Payer: Railroad Medicare Medicare |
$482.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$482.83
|
| Rate for Payer: UHC Exchange |
$872.96
|
| Rate for Payer: UHC Medicaid |
$313.75
|
| Rate for Payer: UHCCP DNSP |
$482.83
|
| Rate for Payer: UHCCP Medicaid |
$313.75
|
|
|
PR MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR
|
Professional
|
Both
|
$5,404.00
|
|
|
Service Code
|
HCPCS 39010
|
| Min. Negotiated Rate |
$486.07 |
| Max. Negotiated Rate |
$4,053.00 |
| Rate for Payer: Aetna Commercial |
$1,012.93
|
| Rate for Payer: Aetna Medicare |
$755.92
|
| Rate for Payer: BCBS Complete |
$510.37
|
| Rate for Payer: BCBS MAPPO |
$755.92
|
| Rate for Payer: BCN Commercial |
$1,175.24
|
| Rate for Payer: BCN Medicare Advantage |
$755.92
|
| Rate for Payer: Cash Price |
$4,323.20
|
| Rate for Payer: Cash Price |
$4,323.20
|
| Rate for Payer: Cofinity Commercial |
$1,088.52
|
| Rate for Payer: Cofinity Commercial |
$1,012.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$755.92
|
| Rate for Payer: Healthscope Commercial |
$907.10
|
| Rate for Payer: Healthscope Whirlpool |
$907.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$793.72
|
| Rate for Payer: Meridian Medicaid |
$510.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$831.51
|
| Rate for Payer: Nomi Health Commercial |
$907.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,053.00
|
| Rate for Payer: PACE SWMI |
$755.92
|
| Rate for Payer: PHP Medicare Advantage |
$755.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$486.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,263.82
|
| Rate for Payer: Priority Health Medicare |
$755.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,263.82
|
| Rate for Payer: Railroad Medicare Medicare |
$755.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,393.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$755.92
|
| Rate for Payer: UHC Exchange |
$1,393.31
|
| Rate for Payer: UHC Medicaid |
$486.07
|
| Rate for Payer: UHCCP DNSP |
$755.92
|
| Rate for Payer: UHCCP Medicaid |
$486.07
|
|
|
PR MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 97802
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: Aetna Medicare |
$25.70
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS MAPPO |
$25.70
|
| Rate for Payer: BCN Commercial |
$48.30
|
| Rate for Payer: BCN Medicare Advantage |
$25.70
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$34.44
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$30.84
|
| Rate for Payer: Healthscope Whirlpool |
$30.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.27
|
| Rate for Payer: Nomi Health Commercial |
$30.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
| Rate for Payer: PACE SWMI |
$25.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40.91
|
| Rate for Payer: Priority Health Medicare |
$25.70
|
| Rate for Payer: Priority Health Narrow Network |
$40.91
|
| Rate for Payer: Railroad Medicare Medicare |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.70
|
| Rate for Payer: UHC Exchange |
$53.76
|
| Rate for Payer: UHCCP DNSP |
$25.70
|
|
|
PR MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 97803
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$45.39 |
| Rate for Payer: Aetna Commercial |
$28.82
|
| Rate for Payer: Aetna Medicare |
$21.51
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$21.51
|
| Rate for Payer: BCN Commercial |
$40.83
|
| Rate for Payer: BCN Medicare Advantage |
$21.51
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$28.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.51
|
| Rate for Payer: Healthscope Commercial |
$25.81
|
| Rate for Payer: Healthscope Whirlpool |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.66
|
| Rate for Payer: Nomi Health Commercial |
$25.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE SWMI |
$21.51
|
| Rate for Payer: PHP Medicare Advantage |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.63
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: Priority Health Narrow Network |
$34.63
|
| Rate for Payer: Railroad Medicare Medicare |
$21.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.51
|
| Rate for Payer: UHC Exchange |
$45.39
|
| Rate for Payer: UHCCP DNSP |
$21.51
|
|
|
PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 97804
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$25.21 |
| Rate for Payer: Aetna Commercial |
$16.19
|
| Rate for Payer: Aetna Medicare |
$12.08
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$12.08
|
| Rate for Payer: BCN Commercial |
$22.91
|
| Rate for Payer: BCN Medicare Advantage |
$12.08
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$16.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.08
|
| Rate for Payer: Healthscope Commercial |
$14.50
|
| Rate for Payer: Healthscope Whirlpool |
$14.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.29
|
| Rate for Payer: Nomi Health Commercial |
$14.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: PACE SWMI |
$12.08
|
| Rate for Payer: PHP Medicare Advantage |
$12.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.57
|
| Rate for Payer: Priority Health Medicare |
$12.08
|
| Rate for Payer: Priority Health Narrow Network |
$19.57
|
| Rate for Payer: Railroad Medicare Medicare |
$12.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.08
|
| Rate for Payer: UHC Exchange |
$25.21
|
| Rate for Payer: UHCCP DNSP |
$12.08
|
|
|
PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 93463
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Aetna Commercial |
$110.28
|
| Rate for Payer: Aetna Medicare |
$82.30
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$82.30
|
| Rate for Payer: BCN Commercial |
$142.92
|
| Rate for Payer: BCN Medicare Advantage |
$82.30
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$110.28
|
| Rate for Payer: Cofinity Commercial |
$118.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.30
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Healthscope Whirlpool |
$98.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.42
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.53
|
| Rate for Payer: Nomi Health Commercial |
$98.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PACE SWMI |
$82.30
|
| Rate for Payer: PHP Medicare Advantage |
$82.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$135.83
|
| Rate for Payer: Priority Health Medicare |
$82.30
|
| Rate for Payer: Priority Health Narrow Network |
$135.83
|
| Rate for Payer: Railroad Medicare Medicare |
$82.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$82.30
|
| Rate for Payer: UHC Exchange |
$160.44
|
| Rate for Payer: UHC Medicaid |
$52.82
|
| Rate for Payer: UHCCP DNSP |
$82.30
|
| Rate for Payer: UHCCP Medicaid |
$52.82
|
|
|
PR MEDICATION THERAPY EACH ADDITIONAL 15 MIN
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 99607
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$45.29 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.75
|
|
|
PR MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 99606
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$33.89 |
| Rate for Payer: Aetna Commercial |
$33.89
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
|
|
PR MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 99605
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$67.55 |
| Rate for Payer: Aetna Commercial |
$67.55
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.50
|
|
|
PR MEDROXYPROGESTERONE ACETATE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1050
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.48
|
|
|
PR MEDROXYPROGESTERONE INJ
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J1051
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
|
|
PR MEDRXYPROGESTER ACETATE INJ
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS J1055
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.00
|
|
|
PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 90734
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$166.75 |
| Rate for Payer: Aetna Commercial |
$151.33
|
| Rate for Payer: BCBS Trust/PPO |
$166.75
|
| Rate for Payer: BCN Commercial |
$163.95
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.75
|
| Rate for Payer: UHC Exchange |
$166.75
|
|
