|
PR WEDGE RESCJ/BISCTJ OVARY UNI/BI
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 58920
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$1,323.70 |
| Rate for Payer: Aetna Commercial |
$952.04
|
| Rate for Payer: Aetna Medicare |
$710.48
|
| Rate for Payer: BCBS Complete |
$482.19
|
| Rate for Payer: BCBS MAPPO |
$710.48
|
| Rate for Payer: BCBS Trust/PPO |
$165.36
|
| Rate for Payer: BCN Commercial |
$1,050.17
|
| Rate for Payer: BCN Medicare Advantage |
$710.48
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$952.04
|
| Rate for Payer: Cofinity Commercial |
$1,023.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$710.48
|
| Rate for Payer: Healthscope Commercial |
$852.58
|
| Rate for Payer: Healthscope Whirlpool |
$852.58
|
| Rate for Payer: Meridian Medicaid |
$482.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$746.00
|
| Rate for Payer: PACE SWMI |
$710.48
|
| Rate for Payer: PHP Medicare Advantage |
$710.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,323.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,017.39
|
| Rate for Payer: Priority Health Medicare |
$710.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,017.39
|
| Rate for Payer: UHC Medicare Advantage |
$731.79
|
|
|
PR WEDGING CAST EXCEPT CLUBFOOT CASTS
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 29740
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$1,753.43 |
| Rate for Payer: Aetna Commercial |
$90.97
|
| Rate for Payer: Aetna Medicare |
$67.89
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS MAPPO |
$67.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.43
|
| Rate for Payer: BCN Commercial |
$144.65
|
| Rate for Payer: BCN Medicare Advantage |
$67.89
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$90.97
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.89
|
| Rate for Payer: Healthscope Commercial |
$81.47
|
| Rate for Payer: Healthscope Whirlpool |
$81.47
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.28
|
| Rate for Payer: PACE SWMI |
$67.89
|
| Rate for Payer: PHP Medicare Advantage |
$67.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.69
|
| Rate for Payer: Priority Health Medicare |
$67.89
|
| Rate for Payer: Priority Health Narrow Network |
$104.69
|
| Rate for Payer: UHC Medicare Advantage |
$69.93
|
|
|
PR WESTONE MUSICIAN EAR PLUGS
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 00591
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
|
|
PR WET MOUNTS/ W PREPARATIONS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS Q0111
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$703.47 |
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna Medicare |
$17.31
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$17.31
|
| Rate for Payer: BCBS Trust/PPO |
$703.47
|
| Rate for Payer: BCN Commercial |
$12.01
|
| Rate for Payer: BCN Medicare Advantage |
$17.31
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$24.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$20.77
|
| Rate for Payer: Healthscope Whirlpool |
$20.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.18
|
| Rate for Payer: PACE SWMI |
$17.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health Medicare |
$17.31
|
| Rate for Payer: UHC Medicare Advantage |
$17.83
|
|
|
PR WHFO, RIGID W/O JOINTS
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS L3808
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$307.83 |
| Rate for Payer: Aetna Commercial |
$195.26
|
| Rate for Payer: BCBS Complete |
$130.40
|
| Rate for Payer: BCN Commercial |
$307.83
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.20
|
|
|
PR WHFO W/O JOINTS PRE CST
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS L3807
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: BCBS Complete |
$91.60
|
| Rate for Payer: BCN Commercial |
$216.07
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.30
|
|
|
PR WHO COCK-UP NONMOLDE PRE OTS
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS L3908
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$40.19
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCN Commercial |
$63.36
|
| 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 WHO W/NONTORSION JNT(S) CF
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS L3905
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$856.95 |
| Rate for Payer: Aetna Commercial |
$543.58
|
| Rate for Payer: BCBS Complete |
$363.20
|
| Rate for Payer: BCN Commercial |
$856.95
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.60
|
|
|
PR WHO W/O JOINTS CF
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS L3906
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$437.92 |
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: BCN Commercial |
$437.92
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.80
|
|
|
PR WINDOWING CAST
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 29730
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$1,134.26 |
| Rate for Payer: Aetna Commercial |
$58.53
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS MAPPO |
$43.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.26
|
| Rate for Payer: BCN Commercial |
$93.34
|
| Rate for Payer: BCN Medicare Advantage |
$43.68
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$58.53
|
| Rate for Payer: Cofinity Commercial |
$62.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.68
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Healthscope Whirlpool |
$52.42
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.86
|
| Rate for Payer: PACE SWMI |
$43.68
|
| Rate for Payer: PHP Medicare Advantage |
$43.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.40
|
| Rate for Payer: Priority Health Medicare |
$43.68
|
| Rate for Payer: Priority Health Narrow Network |
$67.40
|
| Rate for Payer: UHC Medicare Advantage |
$44.99
|
|
|
PR WORK HARDENING/CONDITIONING 1ST 2 HR
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 97545
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$187.39 |
| Rate for Payer: Aetna Commercial |
$119.94
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$187.39
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
|
|
PR WORK HARDENING/CONDITIONING EACH HOUR
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 97546
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$328.07 |
| Rate for Payer: Aetna Commercial |
$47.77
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS Trust/PPO |
$328.07
|
| Rate for Payer: BCN Commercial |
$93.43
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
|
|
PR WORK RELATED/MED DBLT XM TREATING PHYS
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99455
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$165.89 |
| Rate for Payer: Aetna Commercial |
$84.95
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$165.89
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
|
|
PR WOUND CLOSURE BY ADHESIVE
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS G0168
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$19.90
|
| Rate for Payer: Aetna Medicare |
$14.85
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS MAPPO |
$14.85
|
| Rate for Payer: BCBS Trust/PPO |
$63.68
|
| Rate for Payer: BCN Commercial |
$181.79
|
| Rate for Payer: BCN Medicare Advantage |
$14.85
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Healthscope Whirlpool |
$17.82
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.59
|
| Rate for Payer: PACE SWMI |
$14.85
|
| Rate for Payer: PHP Medicare Advantage |
$14.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.09
|
| Rate for Payer: Priority Health Medicare |
$14.85
|
| Rate for Payer: Priority Health Narrow Network |
$18.09
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
|
|
PR XEOMIN
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 00085
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 94617
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$127.06 |
| Rate for Payer: Aetna Commercial |
$110.60
|
| Rate for Payer: Aetna Medicare |
$82.54
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$82.54
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$127.06
|
| Rate for Payer: BCN Medicare Advantage |
$82.54
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$118.86
|
| Rate for Payer: Cofinity Commercial |
$110.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.54
|
| Rate for Payer: Healthscope Commercial |
$99.05
|
| Rate for Payer: Healthscope Whirlpool |
$99.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.67
|
| Rate for Payer: PACE SWMI |
$82.54
|
| Rate for Payer: PHP Medicare Advantage |
$82.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.78
|
| Rate for Payer: Priority Health Medicare |
$82.54
|
| Rate for Payer: Priority Health Narrow Network |
$116.78
|
| Rate for Payer: UHC Medicare Advantage |
$85.02
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 94619
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$225.12 |
| Rate for Payer: Aetna Commercial |
$96.60
|
| Rate for Payer: Aetna Medicare |
$72.09
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS MAPPO |
$72.09
|
| Rate for Payer: BCBS Trust/PPO |
$225.12
|
| Rate for Payer: BCN Commercial |
$111.42
|
| Rate for Payer: BCN Medicare Advantage |
$72.09
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$103.81
|
| Rate for Payer: Cofinity Commercial |
$96.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$86.51
|
| Rate for Payer: Healthscope Whirlpool |
$86.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.69
|
| Rate for Payer: PACE SWMI |
$72.09
|
| Rate for Payer: PHP Medicare Advantage |
$72.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.40
|
| Rate for Payer: Priority Health Medicare |
$72.09
|
| Rate for Payer: Priority Health Narrow Network |
$102.40
|
| Rate for Payer: UHC Medicare Advantage |
$74.25
|
|
|
PR XTRNL ECG & 48 HR RECORDING
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 93225
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$2,547.99 |
| Rate for Payer: Aetna Commercial |
$22.83
|
| Rate for Payer: Aetna Medicare |
$17.04
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$17.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,547.99
|
| Rate for Payer: BCN Commercial |
$26.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.04
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$22.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.04
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Whirlpool |
$20.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.89
|
| Rate for Payer: PACE SWMI |
$17.04
|
| Rate for Payer: PHP Medicare Advantage |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.01
|
| Rate for Payer: Priority Health Medicare |
$17.04
|
| Rate for Payer: Priority Health Narrow Network |
$26.01
|
| Rate for Payer: UHC Medicare Advantage |
$17.55
|
|
|
PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 93224
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$1,872.30 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$68.33
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: BCN Commercial |
$106.04
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$82.00
|
| Rate for Payer: Healthscope Whirlpool |
$82.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.62
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: Priority Health Narrow Network |
$102.62
|
| Rate for Payer: UHC Medicare Advantage |
$70.38
|
|
|
PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 93227
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$2,081.50 |
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.50
|
| Rate for Payer: BCN Commercial |
$26.39
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$25.78
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$21.48
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.54
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$25.54
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
|
|
PR XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT
|
Professional
|
Both
|
$3,819.00
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$578.50 |
| Max. Negotiated Rate |
$2,803.47 |
| Rate for Payer: Aetna Commercial |
$2,271.37
|
| Rate for Payer: Aetna Medicare |
$1,695.05
|
| Rate for Payer: BCBS Complete |
$1,527.60
|
| Rate for Payer: BCBS MAPPO |
$1,695.05
|
| Rate for Payer: BCBS Trust/PPO |
$578.50
|
| Rate for Payer: BCN Commercial |
$2,682.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,695.05
|
| Rate for Payer: Cash Price |
$3,055.20
|
| Rate for Payer: Cash Price |
$3,055.20
|
| Rate for Payer: Cofinity Commercial |
$2,440.87
|
| Rate for Payer: Cofinity Commercial |
$2,271.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,695.05
|
| Rate for Payer: Healthscope Commercial |
$2,034.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,034.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,779.80
|
| Rate for Payer: PACE SWMI |
$1,695.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,695.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,673.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,803.47
|
| Rate for Payer: Priority Health Medicare |
$1,695.05
|
| Rate for Payer: Priority Health Narrow Network |
$2,803.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,745.90
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$454.34 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$24.82
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$24.82
|
| Rate for Payer: BCBS Trust/PPO |
$454.34
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: BCN Medicare Advantage |
$24.82
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$35.74
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.82
|
| Rate for Payer: Healthscope Commercial |
$29.78
|
| Rate for Payer: Healthscope Whirlpool |
$29.78
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.06
|
| Rate for Payer: PACE SWMI |
$24.82
|
| Rate for Payer: PHP Medicare Advantage |
$24.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.47
|
| Rate for Payer: Priority Health Medicare |
$24.82
|
| Rate for Payer: Priority Health Narrow Network |
$35.47
|
| Rate for Payer: UHC Medicare Advantage |
$25.56
|
|
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$867.47 |
| Rate for Payer: Aetna Commercial |
$180.85
|
| Rate for Payer: Aetna Medicare |
$134.96
|
| Rate for Payer: BCBS Complete |
$256.40
|
| Rate for Payer: BCBS MAPPO |
$134.96
|
| Rate for Payer: BCBS Trust/PPO |
$867.47
|
| Rate for Payer: BCN Commercial |
$213.55
|
| Rate for Payer: BCN Medicare Advantage |
$134.96
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$180.85
|
| Rate for Payer: Cofinity Commercial |
$194.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.96
|
| Rate for Payer: Healthscope Commercial |
$161.95
|
| Rate for Payer: Healthscope Whirlpool |
$161.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$141.71
|
| Rate for Payer: PACE SWMI |
$134.96
|
| Rate for Payer: PHP Medicare Advantage |
$134.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.65
|
| Rate for Payer: Priority Health Medicare |
$134.96
|
| Rate for Payer: Priority Health Narrow Network |
$206.65
|
| Rate for Payer: UHC Medicare Advantage |
$139.01
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$1,098.86 |
| Rate for Payer: Aetna Commercial |
$10.41
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS MAPPO |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.86
|
| Rate for Payer: BCN Commercial |
$12.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.77
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$11.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.77
|
| Rate for Payer: Healthscope Commercial |
$9.32
|
| Rate for Payer: Healthscope Whirlpool |
$9.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.16
|
| Rate for Payer: PACE SWMI |
$7.77
|
| Rate for Payer: PHP Medicare Advantage |
$7.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.82
|
| Rate for Payer: Priority Health Medicare |
$7.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.82
|
| Rate for Payer: UHC Medicare Advantage |
$8.00
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 93268
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$869.58 |
| Rate for Payer: Aetna Commercial |
$222.90
|
| Rate for Payer: Aetna Medicare |
$166.34
|
| Rate for Payer: BCBS Complete |
$341.60
|
| Rate for Payer: BCBS MAPPO |
$166.34
|
| Rate for Payer: BCBS Trust/PPO |
$869.58
|
| Rate for Payer: BCN Commercial |
$260.46
|
| Rate for Payer: BCN Medicare Advantage |
$166.34
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cofinity Commercial |
$222.90
|
| Rate for Payer: Cofinity Commercial |
$239.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.34
|
| Rate for Payer: Healthscope Commercial |
$199.61
|
| Rate for Payer: Healthscope Whirlpool |
$199.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.66
|
| Rate for Payer: PACE SWMI |
$166.34
|
| Rate for Payer: PHP Medicare Advantage |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.04
|
| Rate for Payer: Priority Health Medicare |
$166.34
|
| Rate for Payer: Priority Health Narrow Network |
$252.04
|
| Rate for Payer: UHC Medicare Advantage |
$171.33
|
|
