|
PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV
|
Professional
|
Both
|
$3,558.00
|
|
|
Service Code
|
HCPCS 43640
|
| Min. Negotiated Rate |
$762.75 |
| Max. Negotiated Rate |
$2,490.60 |
| Rate for Payer: Aetna Commercial |
$1,589.35
|
| Rate for Payer: Aetna Medicare |
$1,186.08
|
| Rate for Payer: BCBS Complete |
$800.89
|
| Rate for Payer: BCBS MAPPO |
$1,186.08
|
| Rate for Payer: BCBS Trust/PPO |
$864.30
|
| Rate for Payer: BCN Commercial |
$1,740.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,186.08
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cofinity Commercial |
$1,707.96
|
| Rate for Payer: Cofinity Commercial |
$1,589.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,186.08
|
| Rate for Payer: Healthscope Commercial |
$1,423.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,423.30
|
| Rate for Payer: Meridian Medicaid |
$800.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,245.38
|
| Rate for Payer: PACE SWMI |
$1,186.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,186.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,490.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,094.36
|
| Rate for Payer: Priority Health Medicare |
$1,186.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,094.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,221.66
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 34845
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,929.49 |
| Rate for Payer: Aetna Commercial |
$2,344.71
|
| Rate for Payer: BCBS Complete |
$1,424.60
|
| Rate for Payer: BCBS Trust/PPO |
$660.38
|
| Rate for Payer: BCN Commercial |
$1,812.17
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Meridian Medicaid |
$1,424.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,356.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,929.49
|
| Rate for Payer: Priority Health Narrow Network |
$2,929.49
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 34846
|
| Min. Negotiated Rate |
$1,492.43 |
| Max. Negotiated Rate |
$3,102.91 |
| Rate for Payer: Aetna Commercial |
$2,496.07
|
| Rate for Payer: BCBS Complete |
$1,567.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,564.30
|
| Rate for Payer: BCN Commercial |
$2,013.51
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Meridian Medicaid |
$1,567.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,492.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,100.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,102.91
|
| Rate for Payer: Priority Health Narrow Network |
$3,102.91
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 34847
|
| Min. Negotiated Rate |
$1,628.11 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,642.90
|
| Rate for Payer: BCBS Complete |
$1,709.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,672.07
|
| Rate for Payer: BCN Commercial |
$2,416.22
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Meridian Medicaid |
$1,709.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,628.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,500.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,284.31
|
| Rate for Payer: Priority Health Narrow Network |
$3,284.31
|
|
|
PR VISCO GEL SPACER - LARGE
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00039
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
|
|
PR VISCO GEL SPACER - MEDIUM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00038
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
|
|
PR VISCO GEL SPACER - SMALL
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00037
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
|
|
PR VISION EXAM
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
PR VISION EXAM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.50
|
| Rate for Payer: Priority Health Narrow Network |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 95930
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$187.60 |
| Rate for Payer: Aetna Commercial |
$83.47
|
| Rate for Payer: Aetna Medicare |
$62.29
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS MAPPO |
$62.29
|
| Rate for Payer: BCBS Trust/PPO |
$64.98
|
| Rate for Payer: BCN Commercial |
$96.76
|
| Rate for Payer: BCN Medicare Advantage |
$62.29
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$89.70
|
| Rate for Payer: Cofinity Commercial |
$83.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.29
|
| Rate for Payer: Healthscope Commercial |
$74.75
|
| Rate for Payer: Healthscope Whirlpool |
$74.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.40
|
| Rate for Payer: PACE SWMI |
$62.29
|
| Rate for Payer: PHP Medicare Advantage |
$62.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.93
|
| Rate for Payer: Priority Health Medicare |
$62.29
|
| Rate for Payer: Priority Health Narrow Network |
$88.93
|
| Rate for Payer: UHC Medicare Advantage |
$64.16
|
|
|
PR VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 92083
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$1,352.98 |
| Rate for Payer: Aetna Commercial |
$79.11
|
| Rate for Payer: Aetna Medicare |
$59.04
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS MAPPO |
$59.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,352.98
|
| Rate for Payer: BCN Commercial |
$90.89
|
| Rate for Payer: BCN Medicare Advantage |
$59.04
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$79.11
|
| Rate for Payer: Cofinity Commercial |
$85.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.04
|
| Rate for Payer: Healthscope Commercial |
$70.85
|
| Rate for Payer: Healthscope Whirlpool |
$70.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.99
|
| Rate for Payer: PACE SWMI |
$59.04
|
| Rate for Payer: PHP Medicare Advantage |
$59.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.34
|
| Rate for Payer: Priority Health Medicare |
$59.04
|
| Rate for Payer: Priority Health Narrow Network |
$91.34
|
| Rate for Payer: UHC Medicare Advantage |
$60.81
|
|
|
PR VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 92081
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$1,007.47 |
| Rate for Payer: Aetna Commercial |
$42.32
|
| Rate for Payer: Aetna Medicare |
$31.58
|
| Rate for Payer: BCBS Complete |
$30.40
|
| Rate for Payer: BCBS MAPPO |
$31.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.47
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Medicare Advantage |
$31.58
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$45.48
|
| Rate for Payer: Cofinity Commercial |
$42.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$37.90
|
| Rate for Payer: Healthscope Whirlpool |
$37.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.16
|
| Rate for Payer: PACE SWMI |
$31.58
|
| Rate for Payer: PHP Medicare Advantage |
$31.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.75
|
| Rate for Payer: Priority Health Medicare |
$31.58
|
| Rate for Payer: Priority Health Narrow Network |
$39.75
|
| Rate for Payer: UHC Medicare Advantage |
$32.53
|
|
|
PR VISUAL REINFORCEMENT AUDIOMETRY
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 92579
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$2,273.80 |
| Rate for Payer: Aetna Commercial |
$48.48
|
| Rate for Payer: Aetna Medicare |
$36.18
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$36.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,273.80
|
| Rate for Payer: BCN Commercial |
$65.48
|
| Rate for Payer: BCN Medicare Advantage |
$36.18
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.10
|
| Rate for Payer: Cofinity Commercial |
$48.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$43.42
|
| Rate for Payer: Healthscope Whirlpool |
$43.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.99
|
| Rate for Payer: PACE SWMI |
$36.18
|
| Rate for Payer: PHP Medicare Advantage |
$36.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.41
|
| Rate for Payer: Priority Health Medicare |
$36.18
|
| Rate for Payer: Priority Health Narrow Network |
$49.41
|
| Rate for Payer: UHC Medicare Advantage |
$37.27
|
|
|
PR VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 94150
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$1,708.52 |
| Rate for Payer: Aetna Commercial |
$26.29
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.52
|
| Rate for Payer: BCN Commercial |
$36.16
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.24
|
| Rate for Payer: Priority Health Narrow Network |
$33.24
|
|
|
PR VITAMIN B12 INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3420
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.31
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$1.31
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Medicare Advantage |
$1.31
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| Rate for Payer: Healthscope Whirlpool |
$1.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$1.31
|
| Rate for Payer: UHC Medicare Advantage |
$1.35
|
|
|
PR VITAMIN K PHYTONADIONE INJ
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3430
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$2.87
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: BCN Medicare Advantage |
$2.87
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$3.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.87
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Healthscope Whirlpool |
$3.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.02
|
| Rate for Payer: PACE SWMI |
$2.87
|
| Rate for Payer: PHP Medicare Advantage |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$2.87
|
| Rate for Payer: UHC Medicare Advantage |
$2.96
|
|
|
PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING
|
Professional
|
Both
|
$5,023.80
|
|
|
Service Code
|
HCPCS 33427
|
| Min. Negotiated Rate |
$359.24 |
| Max. Negotiated Rate |
$3,796.58 |
| Rate for Payer: Aetna Commercial |
$3,209.31
|
| Rate for Payer: Aetna Medicare |
$2,395.01
|
| Rate for Payer: BCBS Complete |
$1,602.68
|
| Rate for Payer: BCBS MAPPO |
$2,395.01
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: BCN Commercial |
$3,487.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,395.01
|
| Rate for Payer: Cash Price |
$4,019.04
|
| Rate for Payer: Cash Price |
$4,019.04
|
| Rate for Payer: Cofinity Commercial |
$3,448.81
|
| Rate for Payer: Cofinity Commercial |
$3,209.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,395.01
|
| Rate for Payer: Healthscope Commercial |
$2,874.01
|
| Rate for Payer: Healthscope Whirlpool |
$2,874.01
|
| Rate for Payer: Meridian Medicaid |
$1,602.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,514.76
|
| Rate for Payer: PACE SWMI |
$2,395.01
|
| Rate for Payer: PHP Medicare Advantage |
$2,395.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,526.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,516.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,796.58
|
| Rate for Payer: Priority Health Medicare |
$2,395.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,796.58
|
| Rate for Payer: UHC Medicare Advantage |
$2,466.86
|
|
|
PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING
|
Professional
|
Both
|
$8,728.00
|
|
|
Service Code
|
HCPCS 33426
|
| Min. Negotiated Rate |
$951.47 |
| Max. Negotiated Rate |
$6,109.60 |
| Rate for Payer: Aetna Commercial |
$3,137.40
|
| Rate for Payer: Aetna Medicare |
$2,341.34
|
| Rate for Payer: BCBS Complete |
$1,567.34
|
| Rate for Payer: BCBS MAPPO |
$2,341.34
|
| Rate for Payer: BCBS Trust/PPO |
$951.47
|
| Rate for Payer: BCN Commercial |
$3,410.48
|
| Rate for Payer: BCN Medicare Advantage |
$2,341.34
|
| Rate for Payer: Cash Price |
$6,982.40
|
| Rate for Payer: Cash Price |
$6,982.40
|
| Rate for Payer: Cofinity Commercial |
$3,371.53
|
| Rate for Payer: Cofinity Commercial |
$3,137.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,341.34
|
| Rate for Payer: Healthscope Commercial |
$2,809.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,809.61
|
| Rate for Payer: Meridian Medicaid |
$1,567.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,458.41
|
| Rate for Payer: PACE SWMI |
$2,341.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,341.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,492.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,712.54
|
| Rate for Payer: Priority Health Medicare |
$2,341.34
|
| Rate for Payer: Priority Health Narrow Network |
$3,712.54
|
| Rate for Payer: UHC Medicare Advantage |
$2,411.58
|
|
|
PR VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 36400
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$2,334.03 |
| Rate for Payer: Aetna Commercial |
$25.00
|
| Rate for Payer: Aetna Medicare |
$18.66
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS MAPPO |
$18.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,334.03
|
| Rate for Payer: BCN Commercial |
$40.07
|
| Rate for Payer: BCN Medicare Advantage |
$18.66
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$22.39
|
| Rate for Payer: Healthscope Whirlpool |
$22.39
|
| Rate for Payer: Meridian Medicaid |
$12.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.59
|
| Rate for Payer: PACE SWMI |
$18.66
|
| Rate for Payer: PHP Medicare Advantage |
$18.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.79
|
| Rate for Payer: Priority Health Medicare |
$18.66
|
| Rate for Payer: Priority Health Narrow Network |
$29.79
|
| Rate for Payer: UHC Medicare Advantage |
$19.22
|
|
|
PR VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 36410
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$1,232.00 |
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS MAPPO |
$8.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.00
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Medicare Advantage |
$8.99
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.99
|
| Rate for Payer: Healthscope Commercial |
$10.79
|
| Rate for Payer: Healthscope Whirlpool |
$10.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.44
|
| Rate for Payer: PACE SWMI |
$8.99
|
| Rate for Payer: PHP Medicare Advantage |
$8.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.36
|
| Rate for Payer: Priority Health Medicare |
$8.99
|
| Rate for Payer: Priority Health Narrow Network |
$14.36
|
| Rate for Payer: UHC Medicare Advantage |
$9.26
|
|
|
PR VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 51797
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$3,594.55 |
| Rate for Payer: Aetna Commercial |
$242.94
|
| Rate for Payer: Aetna Medicare |
$181.30
|
| Rate for Payer: BCBS Complete |
$203.20
|
| Rate for Payer: BCBS MAPPO |
$181.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,594.55
|
| Rate for Payer: BCN Commercial |
$282.46
|
| Rate for Payer: BCN Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cofinity Commercial |
$261.07
|
| Rate for Payer: Cofinity Commercial |
$242.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.30
|
| Rate for Payer: Healthscope Commercial |
$217.56
|
| Rate for Payer: Healthscope Whirlpool |
$217.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$190.36
|
| Rate for Payer: PACE SWMI |
$181.30
|
| Rate for Payer: PHP Medicare Advantage |
$181.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.33
|
| Rate for Payer: Priority Health Medicare |
$181.30
|
| Rate for Payer: Priority Health Narrow Network |
$312.33
|
| Rate for Payer: UHC Medicare Advantage |
$186.74
|
|
|
PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 92540
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$1,769.28 |
| Rate for Payer: Aetna Commercial |
$140.47
|
| Rate for Payer: Aetna Medicare |
$104.83
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$104.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.28
|
| Rate for Payer: BCN Commercial |
$158.33
|
| Rate for Payer: BCN Medicare Advantage |
$104.83
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$140.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.83
|
| Rate for Payer: Healthscope Commercial |
$125.80
|
| Rate for Payer: Healthscope Whirlpool |
$125.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110.07
|
| Rate for Payer: PACE SWMI |
$104.83
|
| Rate for Payer: PHP Medicare Advantage |
$104.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.52
|
| Rate for Payer: Priority Health Medicare |
$104.83
|
| Rate for Payer: Priority Health Narrow Network |
$145.52
|
| Rate for Payer: UHC Medicare Advantage |
$107.97
|
|
|
PR VULVECTOMY RADICAL PARTIAL
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 56630
|
| Min. Negotiated Rate |
$619.19 |
| Max. Negotiated Rate |
$1,855.92 |
| Rate for Payer: Aetna Commercial |
$1,270.37
|
| Rate for Payer: Aetna Medicare |
$948.04
|
| Rate for Payer: BCBS Complete |
$650.15
|
| Rate for Payer: BCBS MAPPO |
$948.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,855.92
|
| Rate for Payer: BCN Commercial |
$1,408.37
|
| Rate for Payer: BCN Medicare Advantage |
$948.04
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$1,270.37
|
| Rate for Payer: Cofinity Commercial |
$1,365.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$948.04
|
| Rate for Payer: Healthscope Commercial |
$1,137.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,137.65
|
| Rate for Payer: Meridian Medicaid |
$650.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$995.44
|
| Rate for Payer: PACE SWMI |
$948.04
|
| Rate for Payer: PHP Medicare Advantage |
$948.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,364.41
|
| Rate for Payer: Priority Health Medicare |
$948.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,364.41
|
| Rate for Payer: UHC Medicare Advantage |
$976.48
|
|
|
PR VULVECTOMY SIMPLE PARTIAL
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 56620
|
| Min. Negotiated Rate |
$379.35 |
| Max. Negotiated Rate |
$1,725.43 |
| Rate for Payer: Aetna Commercial |
$769.94
|
| Rate for Payer: Aetna Medicare |
$574.58
|
| Rate for Payer: BCBS Complete |
$398.32
|
| Rate for Payer: BCBS MAPPO |
$574.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.43
|
| Rate for Payer: BCN Commercial |
$862.52
|
| Rate for Payer: BCN Medicare Advantage |
$574.58
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$827.40
|
| Rate for Payer: Cofinity Commercial |
$769.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$574.58
|
| Rate for Payer: Healthscope Commercial |
$689.50
|
| Rate for Payer: Healthscope Whirlpool |
$689.50
|
| Rate for Payer: Meridian Medicaid |
$398.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$603.31
|
| Rate for Payer: PACE SWMI |
$574.58
|
| Rate for Payer: PHP Medicare Advantage |
$574.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$379.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,078.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$835.59
|
| Rate for Payer: Priority Health Medicare |
$574.58
|
| Rate for Payer: Priority Health Narrow Network |
$835.59
|
| Rate for Payer: UHC Medicare Advantage |
$591.82
|
|
|
PR WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 11765
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$267.10 |
| Rate for Payer: Aetna Commercial |
$119.03
|
| Rate for Payer: Aetna Medicare |
$88.83
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS MAPPO |
$88.83
|
| Rate for Payer: BCBS Trust/PPO |
$267.10
|
| Rate for Payer: BCN Commercial |
$194.37
|
| Rate for Payer: BCN Medicare Advantage |
$88.83
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Cofinity Commercial |
$119.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.83
|
| Rate for Payer: Healthscope Commercial |
$106.60
|
| Rate for Payer: Healthscope Whirlpool |
$106.60
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.27
|
| Rate for Payer: PACE SWMI |
$88.83
|
| Rate for Payer: PHP Medicare Advantage |
$88.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.62
|
| Rate for Payer: Priority Health Medicare |
$88.83
|
| Rate for Payer: Priority Health Narrow Network |
$112.62
|
| Rate for Payer: UHC Medicare Advantage |
$91.49
|
|
