|
PR MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 69990
|
| Min. Negotiated Rate |
$139.52 |
| Max. Negotiated Rate |
$11,952.59 |
| Rate for Payer: Aetna Commercial |
$223.01
|
| Rate for Payer: Aetna Medicare |
$250.50
|
| Rate for Payer: BCBS Complete |
$146.50
|
| Rate for Payer: BCBS Trust/PPO |
$11,952.59
|
| Rate for Payer: BCN Commercial |
$349.21
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Meridian Medicaid |
$146.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.11
|
| Rate for Payer: Priority Health Narrow Network |
$317.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.76
|
| Rate for Payer: UHC Exchange |
$247.76
|
| Rate for Payer: UHCCP Medicaid |
$139.52
|
|
|
PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 69440
|
| Min. Negotiated Rate |
$441.12 |
| Max. Negotiated Rate |
$1,668.90 |
| Rate for Payer: Aetna Commercial |
$785.70
|
| Rate for Payer: Aetna Medicare |
$852.00
|
| Rate for Payer: BCBS Complete |
$463.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.90
|
| Rate for Payer: BCN Commercial |
$1,024.27
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Meridian Medicaid |
$463.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,107.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,018.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$747.58
|
| Rate for Payer: UHC Exchange |
$747.58
|
| Rate for Payer: UHCCP Medicaid |
$441.12
|
|
|
PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES
|
Professional
|
Both
|
$2,972.00
|
|
|
Service Code
|
HCPCS 15730
|
| Min. Negotiated Rate |
$584.69 |
| Max. Negotiated Rate |
$2,089.09 |
| Rate for Payer: Aetna Commercial |
$982.33
|
| Rate for Payer: Aetna Medicare |
$1,486.00
|
| Rate for Payer: BCBS Complete |
$613.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,930.99
|
| Rate for Payer: BCN Commercial |
$2,089.09
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Meridian Medicaid |
$613.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,931.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,236.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,236.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,060.62
|
| Rate for Payer: UHC Exchange |
$1,060.62
|
| Rate for Payer: UHCCP Medicaid |
$584.69
|
|
|
PR MIRENA, 52 MG
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7298
|
| Min. Negotiated Rate |
$736.00 |
| Max. Negotiated Rate |
$1,351.89 |
| Rate for Payer: Aetna Commercial |
$1,101.70
|
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: BCBS Complete |
$1,351.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.90
|
| Rate for Payer: BCN Commercial |
$1,107.20
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Meridian Medicaid |
$1,351.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,156.79
|
| Rate for Payer: UHC Exchange |
$1,156.79
|
| Rate for Payer: UHCCP Medicaid |
$1,287.51
|
|
|
PR MISC VISION ITEM OR SERVICE
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS V2799
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR MISOPROSTOL, ORAL, 200 MCG
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS S0191
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$0.96
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
PR MITOMYCIN INJECTION
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS J9280
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$65.25
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$10.36
|
| Rate for Payer: BCN Commercial |
$3.72
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.29
|
| Rate for Payer: UHC Exchange |
$60.29
|
|
|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 95805
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$434.52
|
| Rate for Payer: Aetna Commercial |
$434.52
|
| Rate for Payer: Aetna Medicare |
$122.50
|
| Rate for Payer: Aetna Medicare |
$497.50
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS Trust/PPO |
$639.77
|
| Rate for Payer: BCBS Trust/PPO |
$639.77
|
| Rate for Payer: BCN Commercial |
$610.36
|
| Rate for Payer: BCN Commercial |
$610.36
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.98
|
| Rate for Payer: Priority Health Narrow Network |
$75.98
|
| Rate for Payer: Priority Health Narrow Network |
$75.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.67
|
| Rate for Payer: UHC Exchange |
$401.67
|
| Rate for Payer: UHC Exchange |
$401.67
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$598.65 |
| Max. Negotiated Rate |
$2,430.48 |
| Rate for Payer: Aetna Commercial |
$828.90
|
| Rate for Payer: Aetna Medicare |
$1,568.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: ASR ASR |
$893.37
|
| Rate for Payer: ASR Commercial |
$893.37
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$754.21
|
| Rate for Payer: BCN Commercial |
$714.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$865.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$921.00
|
| Rate for Payer: Healthscope Whirlpool |
$893.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.05
|
| Rate for Payer: Mclaren Commercial |
$828.90
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.85
|
| Rate for Payer: Nomi Health Commercial |
$755.22
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,724.86
|
| Rate for Payer: PHP Medicaid |
$840.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$806.98
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$645.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$810.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,430.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP DNSP |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$598.65 |
| Max. Negotiated Rate |
$921.00 |
| Rate for Payer: Aetna Commercial |
$828.90
|
| Rate for Payer: ASR ASR |
$893.37
|
| Rate for Payer: ASR Commercial |
$893.37
|
| Rate for Payer: BCBS Trust/PPO |
$750.52
|
| Rate for Payer: BCN Commercial |
$714.05
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$865.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.80
|
| Rate for Payer: Healthscope Commercial |
$921.00
|
| Rate for Payer: Healthscope Whirlpool |
$893.37
|
| Rate for Payer: Mclaren Commercial |
$828.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.85
|
| Rate for Payer: Nomi Health Commercial |
$755.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$810.48
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna Medicare |
$460.50
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS Trust/PPO |
$286.11
|
| Rate for Payer: BCN Commercial |
$288.81
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.28
|
| Rate for Payer: Priority Health Narrow Network |
$303.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.36
|
| Rate for Payer: UHC Exchange |
$220.36
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna Medicare |
$460.50
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS Trust/PPO |
$286.11
|
| Rate for Payer: BCN Commercial |
$288.81
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.28
|
| Rate for Payer: Priority Health Narrow Network |
$303.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.36
|
| Rate for Payer: UHC Exchange |
$220.36
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 20950
|
| Min. Negotiated Rate |
$103.91 |
| Max. Negotiated Rate |
$29,358.48 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS Trust/PPO |
$29,358.48
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.35
|
| Rate for Payer: Priority Health Narrow Network |
$135.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.91
|
| Rate for Payer: UHC Exchange |
$103.91
|
|
|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$1,085.13 |
| Rate for Payer: Aetna Commercial |
$162.80
|
| Rate for Payer: Aetna Medicare |
$206.00
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.13
|
| Rate for Payer: BCN Commercial |
$173.96
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.38
|
| Rate for Payer: Priority Health Narrow Network |
$212.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.80
|
| Rate for Payer: UHC Exchange |
$149.80
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99149
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99150
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 99143
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Medicare |
$93.00
|
| Rate for Payer: BCBS Complete |
$74.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.90
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99144
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Medicare |
$69.00
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 99145
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
|
|
PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 99157
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$660.90 |
| Rate for Payer: Aetna Commercial |
$69.79
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS Trust/PPO |
$660.90
|
| Rate for Payer: BCN Commercial |
$98.47
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.91
|
| Rate for Payer: Priority Health Narrow Network |
$169.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.06
|
| Rate for Payer: UHC Exchange |
$63.06
|
| Rate for Payer: UHCCP Medicaid |
$36.42
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 99155
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$880.15 |
| Rate for Payer: Aetna Commercial |
$93.68
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS Trust/PPO |
$880.15
|
| Rate for Payer: BCN Commercial |
$131.29
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.50
|
| Rate for Payer: Priority Health Narrow Network |
$236.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.55
|
| Rate for Payer: UHC Exchange |
$101.55
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99156
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$672.53 |
| Rate for Payer: Aetna Commercial |
$85.20
|
| Rate for Payer: Aetna Medicare |
$77.50
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.53
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Meridian Medicaid |
$49.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.31
|
| Rate for Payer: Priority Health Narrow Network |
$214.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.21
|
| Rate for Payer: UHC Exchange |
$83.21
|
| Rate for Payer: UHCCP Medicaid |
$46.86
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 99153
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$674.11 |
| Rate for Payer: Aetna Commercial |
$11.06
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$674.11
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.20
|
| Rate for Payer: Priority Health Narrow Network |
$19.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.59
|
| Rate for Payer: UHC Exchange |
$11.59
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99151
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$726.41 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS Trust/PPO |
$726.41
|
| Rate for Payer: BCN Commercial |
$96.86
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.53
|
| Rate for Payer: Priority Health Narrow Network |
$68.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.92
|
| Rate for Payer: UHC Exchange |
$25.92
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99152
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Medicare |
$77.50
|
| Rate for Payer: BCBS Complete |
$8.05
|
| Rate for Payer: BCBS Trust/PPO |
$552.07
|
| Rate for Payer: BCN Commercial |
$80.72
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Meridian Medicaid |
$8.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.51
|
| Rate for Payer: Priority Health Narrow Network |
$39.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.49
|
| Rate for Payer: UHC Exchange |
$13.49
|
| Rate for Payer: UHCCP Medicaid |
$7.67
|
|
