|
PR PRO HEALTH VISION TESTING
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: ASR ASR |
$24.73
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$21.02
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$24.73
|
| Rate for Payer: Healthscope Whirlpool |
$25.50
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: ASR ASR |
$101.85
|
| Rate for Payer: BCBS Trust/PPO |
$86.23
|
| Rate for Payer: BCN Commercial |
$86.23
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$101.85
|
| Rate for Payer: Healthscope Whirlpool |
$105.00
|
| Rate for Payer: Mclaren Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Nomi Health Commercial |
$86.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Medicare |
$38.85
|
| Rate for Payer: ASR ASR |
$101.85
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS Trust/PPO |
$86.57
|
| Rate for Payer: BCN Commercial |
$86.57
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$101.85
|
| Rate for Payer: Healthscope Whirlpool |
$105.00
|
| Rate for Payer: Mclaren Commercial |
$94.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Nomi Health Commercial |
$86.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.00
|
| Rate for Payer: Priority Health Narrow Network |
$73.61
|
|
|
PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99359
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Aetna Commercial |
$52.40
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCN Commercial |
$53.78
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.37
|
| Rate for Payer: Priority Health Narrow Network |
$48.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.91
|
| Rate for Payer: UHC Exchange |
$76.91
|
|
|
PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 99358
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Aetna Commercial |
$109.68
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCN Commercial |
$130.97
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$117.81
|
| Rate for Payer: Priority Health Narrow Network |
$117.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.42
|
| Rate for Payer: UHC Exchange |
$157.42
|
|
|
PR PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY
|
Professional
|
Both
|
$2,855.00
|
|
|
Service Code
|
HCPCS 33960
|
| Min. Negotiated Rate |
$1,142.00 |
| Max. Negotiated Rate |
$2,141.25 |
| Rate for Payer: BCBS Complete |
$1,142.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,141.25
|
|
|
PR PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 99418
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$38.86
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCN Commercial |
$58.26
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Meridian Medicaid |
$23.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$52.42
|
| Rate for Payer: Priority Health Narrow Network |
$52.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.09
|
| Rate for Payer: UHC Exchange |
$58.09
|
| Rate for Payer: UHC Medicaid |
$22.15
|
| Rate for Payer: UHCCP Medicaid |
$22.15
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 99417
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCN Commercial |
$44.32
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Meridian Medicaid |
$17.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.87
|
| Rate for Payer: Priority Health Narrow Network |
$39.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.48
|
| Rate for Payer: UHC Exchange |
$46.48
|
| Rate for Payer: UHC Medicaid |
$16.83
|
| Rate for Payer: UHCCP Medicaid |
$16.83
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING 1ST HOUR
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 99356
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.00
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 99357
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 99354
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.00
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 99355
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: BCBS Complete |
$71.20
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.50
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS G0316
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$36.77
|
| Rate for Payer: Aetna Medicare |
$27.44
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS MAPPO |
$27.44
|
| Rate for Payer: BCN Commercial |
$45.32
|
| Rate for Payer: BCN Medicare Advantage |
$27.44
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$39.51
|
| Rate for Payer: Cofinity Commercial |
$36.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.44
|
| Rate for Payer: Healthscope Commercial |
$32.93
|
| Rate for Payer: Healthscope Whirlpool |
$32.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.18
|
| Rate for Payer: Nomi Health Commercial |
$32.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PACE SWMI |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40.77
|
| Rate for Payer: Priority Health Medicare |
$27.44
|
| Rate for Payer: Priority Health Narrow Network |
$40.77
|
| Rate for Payer: Railroad Medicare Medicare |
$27.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.44
|
| Rate for Payer: UHC Exchange |
$45.03
|
| Rate for Payer: UHCCP DNSP |
$27.44
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS G2212
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: Aetna Medicare |
$27.14
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$27.14
|
| Rate for Payer: BCN Commercial |
$37.27
|
| Rate for Payer: BCN Medicare Advantage |
$27.14
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Cofinity Commercial |
$36.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.14
|
| Rate for Payer: Healthscope Commercial |
$32.57
|
| Rate for Payer: Healthscope Whirlpool |
$32.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.50
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.85
|
| Rate for Payer: Nomi Health Commercial |
$32.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: PACE SWMI |
$27.14
|
| Rate for Payer: PHP Medicare Advantage |
$27.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.88
|
| Rate for Payer: Priority Health Medicare |
$27.14
|
| Rate for Payer: Priority Health Narrow Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$27.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.14
|
| Rate for Payer: UHC Exchange |
$46.48
|
| Rate for Payer: UHC Medicaid |
$17.47
|
| Rate for Payer: UHCCP DNSP |
$27.14
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
|
|
PR PROMETHAZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J2550
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Aetna Commercial |
$4.48
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: BCBS MAPPO |
$3.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.33
|
| Rate for Payer: BCN Commercial |
$0.27
|
| Rate for Payer: BCN Medicare Advantage |
$3.34
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$4.81
|
| Rate for Payer: Cofinity Commercial |
$4.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Whirlpool |
$4.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$4.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PACE SWMI |
$3.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.34
|
| Rate for Payer: Priority Health Medicare |
$3.34
|
| Rate for Payer: Railroad Medicare Medicare |
$3.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.34
|
| Rate for Payer: UHC Exchange |
$3.97
|
| Rate for Payer: UHCCP DNSP |
$3.34
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR
|
Professional
|
Both
|
$2,865.00
|
|
|
Service Code
|
HCPCS 27495
|
| Min. Negotiated Rate |
$1,017.27 |
| Max. Negotiated Rate |
$2,148.75 |
| Rate for Payer: Aetna Commercial |
$1,363.14
|
| Rate for Payer: Aetna Medicare |
$1,017.27
|
| Rate for Payer: BCBS Complete |
$1,146.00
|
| Rate for Payer: BCBS MAPPO |
$1,017.27
|
| Rate for Payer: BCN Commercial |
$1,711.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,017.27
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cofinity Commercial |
$1,464.87
|
| Rate for Payer: Cofinity Commercial |
$1,363.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,017.27
|
| Rate for Payer: Healthscope Commercial |
$1,220.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,220.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,119.00
|
| Rate for Payer: Nomi Health Commercial |
$1,220.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,148.75
|
| Rate for Payer: PACE SWMI |
$1,017.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,017.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,829.61
|
| Rate for Payer: Priority Health Medicare |
$1,017.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,829.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,017.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,978.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,017.27
|
| Rate for Payer: UHC Exchange |
$1,978.62
|
| Rate for Payer: UHCCP DNSP |
$1,017.27
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA
|
Professional
|
Both
|
$2,212.00
|
|
|
Service Code
|
HCPCS 27745
|
| Min. Negotiated Rate |
$663.17 |
| Max. Negotiated Rate |
$1,659.00 |
| Rate for Payer: Aetna Commercial |
$888.65
|
| Rate for Payer: Aetna Medicare |
$663.17
|
| Rate for Payer: BCBS Complete |
$884.80
|
| Rate for Payer: BCBS MAPPO |
$663.17
|
| Rate for Payer: BCN Commercial |
$1,116.47
|
| Rate for Payer: BCN Medicare Advantage |
$663.17
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Cofinity Commercial |
$954.96
|
| Rate for Payer: Cofinity Commercial |
$888.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.17
|
| Rate for Payer: Healthscope Commercial |
$795.80
|
| Rate for Payer: Healthscope Whirlpool |
$795.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$729.49
|
| Rate for Payer: Nomi Health Commercial |
$795.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,659.00
|
| Rate for Payer: PACE SWMI |
$663.17
|
| Rate for Payer: PHP Medicare Advantage |
$663.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,193.48
|
| Rate for Payer: Priority Health Medicare |
$663.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$663.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,328.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$663.17
|
| Rate for Payer: UHC Exchange |
$1,328.59
|
| Rate for Payer: UHCCP DNSP |
$663.17
|
|
|
PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR
|
Professional
|
Both
|
$2,102.00
|
|
|
Service Code
|
HCPCS 27187
|
| Min. Negotiated Rate |
$840.80 |
| Max. Negotiated Rate |
$1,743.32 |
| Rate for Payer: Aetna Commercial |
$1,207.81
|
| Rate for Payer: Aetna Medicare |
$901.35
|
| Rate for Payer: BCBS Complete |
$840.80
|
| Rate for Payer: BCBS MAPPO |
$901.35
|
| Rate for Payer: BCN Commercial |
$1,512.87
|
| Rate for Payer: BCN Medicare Advantage |
$901.35
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cofinity Commercial |
$1,297.94
|
| Rate for Payer: Cofinity Commercial |
$1,207.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$901.35
|
| Rate for Payer: Healthscope Commercial |
$1,081.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,081.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$946.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$991.49
|
| Rate for Payer: Nomi Health Commercial |
$1,081.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.50
|
| Rate for Payer: PACE SWMI |
$901.35
|
| Rate for Payer: PHP Medicare Advantage |
$901.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,617.22
|
| Rate for Payer: Priority Health Medicare |
$901.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,617.22
|
| Rate for Payer: Railroad Medicare Medicare |
$901.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,743.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$901.35
|
| Rate for Payer: UHC Exchange |
$1,743.32
|
| Rate for Payer: UHCCP DNSP |
$901.35
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT
|
Professional
|
Both
|
$2,659.00
|
|
|
Service Code
|
HCPCS 24498
|
| Min. Negotiated Rate |
$785.45 |
| Max. Negotiated Rate |
$1,994.25 |
| Rate for Payer: Aetna Commercial |
$1,052.50
|
| Rate for Payer: Aetna Medicare |
$785.45
|
| Rate for Payer: BCBS Complete |
$1,063.60
|
| Rate for Payer: BCBS MAPPO |
$785.45
|
| Rate for Payer: BCN Commercial |
$1,314.17
|
| Rate for Payer: BCN Medicare Advantage |
$785.45
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cofinity Commercial |
$1,131.05
|
| Rate for Payer: Cofinity Commercial |
$1,052.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.45
|
| Rate for Payer: Healthscope Commercial |
$942.54
|
| Rate for Payer: Healthscope Whirlpool |
$942.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$864.00
|
| Rate for Payer: Nomi Health Commercial |
$942.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,994.25
|
| Rate for Payer: PACE SWMI |
$785.45
|
| Rate for Payer: PHP Medicare Advantage |
$785.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,404.81
|
| Rate for Payer: Priority Health Medicare |
$785.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,404.81
|
| Rate for Payer: Railroad Medicare Medicare |
$785.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,515.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$785.45
|
| Rate for Payer: UHC Exchange |
$1,515.87
|
| Rate for Payer: UHCCP DNSP |
$785.45
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS
|
Professional
|
Both
|
$2,153.00
|
|
|
Service Code
|
HCPCS 23491
|
| Min. Negotiated Rate |
$861.20 |
| Max. Negotiated Rate |
$1,778.68 |
| Rate for Payer: Aetna Commercial |
$1,231.45
|
| Rate for Payer: Aetna Medicare |
$918.99
|
| Rate for Payer: BCBS Complete |
$861.20
|
| Rate for Payer: BCBS MAPPO |
$918.99
|
| Rate for Payer: BCN Commercial |
$1,543.25
|
| Rate for Payer: BCN Medicare Advantage |
$918.99
|
| Rate for Payer: Cash Price |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,722.40
|
| Rate for Payer: Cofinity Commercial |
$1,323.35
|
| Rate for Payer: Cofinity Commercial |
$1,231.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.99
|
| Rate for Payer: Healthscope Commercial |
$1,102.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,102.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,010.89
|
| Rate for Payer: Nomi Health Commercial |
$1,102.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,614.75
|
| Rate for Payer: PACE SWMI |
$918.99
|
| Rate for Payer: PHP Medicare Advantage |
$918.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,649.69
|
| Rate for Payer: Priority Health Medicare |
$918.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,649.69
|
| Rate for Payer: Railroad Medicare Medicare |
$918.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,778.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$918.99
|
| Rate for Payer: UHC Exchange |
$1,778.68
|
| Rate for Payer: UHCCP DNSP |
$918.99
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE RADIUS
|
Professional
|
Both
|
$2,319.00
|
|
|
Service Code
|
HCPCS 25490
|
| Min. Negotiated Rate |
$661.81 |
| Max. Negotiated Rate |
$1,739.25 |
| Rate for Payer: Aetna Commercial |
$886.83
|
| Rate for Payer: Aetna Medicare |
$661.81
|
| Rate for Payer: BCBS Complete |
$927.60
|
| Rate for Payer: BCBS MAPPO |
$661.81
|
| Rate for Payer: BCN Commercial |
$1,100.04
|
| Rate for Payer: BCN Medicare Advantage |
$661.81
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cofinity Commercial |
$953.01
|
| Rate for Payer: Cofinity Commercial |
$886.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$661.81
|
| Rate for Payer: Healthscope Commercial |
$794.17
|
| Rate for Payer: Healthscope Whirlpool |
$794.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$694.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$727.99
|
| Rate for Payer: Nomi Health Commercial |
$794.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,739.25
|
| Rate for Payer: PACE SWMI |
$661.81
|
| Rate for Payer: PHP Medicare Advantage |
$661.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,175.91
|
| Rate for Payer: Priority Health Medicare |
$661.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,175.91
|
| Rate for Payer: Railroad Medicare Medicare |
$661.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,253.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$661.81
|
| Rate for Payer: UHC Exchange |
$1,253.79
|
| Rate for Payer: UHCCP DNSP |
$661.81
|
|
|
PR PROSTATE CA SCREENING; DRE
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0102
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$7.61
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Healthscope Commercial |
$9.13
|
| Rate for Payer: Healthscope Whirlpool |
$9.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.37
|
| Rate for Payer: Nomi Health Commercial |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.00
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.64
|
| Rate for Payer: Priority Health Medicare |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$11.64
|
| Rate for Payer: Railroad Medicare Medicare |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.61
|
| Rate for Payer: UHC Exchange |
$14.18
|
| Rate for Payer: UHC Medicaid |
$4.90
|
| Rate for Payer: UHCCP DNSP |
$7.61
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
|
|
PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC
|
Professional
|
Both
|
$3,767.00
|
|
|
Service Code
|
HCPCS 55815
|
| Min. Negotiated Rate |
$997.27 |
| Max. Negotiated Rate |
$3,121.59 |
| Rate for Payer: Aetna Commercial |
$2,078.26
|
| Rate for Payer: Aetna Medicare |
$1,550.94
|
| Rate for Payer: BCBS Complete |
$1,047.13
|
| Rate for Payer: BCBS MAPPO |
$1,550.94
|
| Rate for Payer: BCN Commercial |
$2,616.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,550.94
|
| Rate for Payer: Cash Price |
$3,013.60
|
| Rate for Payer: Cash Price |
$3,013.60
|
| Rate for Payer: Cofinity Commercial |
$2,233.35
|
| Rate for Payer: Cofinity Commercial |
$2,078.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,550.94
|
| Rate for Payer: Healthscope Commercial |
$1,861.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,861.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,628.49
|
| Rate for Payer: Meridian Medicaid |
$1,047.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,706.03
|
| Rate for Payer: Nomi Health Commercial |
$1,861.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,825.25
|
| Rate for Payer: PACE SWMI |
$1,550.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,550.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$997.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,850.65
|
| Rate for Payer: Priority Health Medicare |
$1,550.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,850.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,550.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,121.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,550.94
|
| Rate for Payer: UHC Exchange |
$3,121.59
|
| Rate for Payer: UHC Medicaid |
$997.27
|
| Rate for Payer: UHCCP DNSP |
$1,550.94
|
| Rate for Payer: UHCCP Medicaid |
$997.27
|
|
|
PR PROSTATECTOMY RETROPUBIC SUBTOTAL
|
Professional
|
Both
|
$3,441.00
|
|
|
Service Code
|
HCPCS 55831
|
| Min. Negotiated Rate |
$494.16 |
| Max. Negotiated Rate |
$2,580.75 |
| Rate for Payer: Aetna Commercial |
$1,026.59
|
| Rate for Payer: Aetna Medicare |
$766.11
|
| Rate for Payer: BCBS Complete |
$518.87
|
| Rate for Payer: BCBS MAPPO |
$766.11
|
| Rate for Payer: BCN Commercial |
$1,285.29
|
| Rate for Payer: BCN Medicare Advantage |
$766.11
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cofinity Commercial |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$1,026.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.11
|
| Rate for Payer: Healthscope Commercial |
$919.33
|
| Rate for Payer: Healthscope Whirlpool |
$919.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.42
|
| Rate for Payer: Meridian Medicaid |
$518.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$842.72
|
| Rate for Payer: Nomi Health Commercial |
$919.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,580.75
|
| Rate for Payer: PACE SWMI |
$766.11
|
| Rate for Payer: PHP Medicare Advantage |
$766.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$494.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,400.09
|
| Rate for Payer: Priority Health Medicare |
$766.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,400.09
|
| Rate for Payer: Railroad Medicare Medicare |
$766.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,671.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$766.11
|
| Rate for Payer: UHC Exchange |
$1,671.97
|
| Rate for Payer: UHC Medicaid |
$494.16
|
| Rate for Payer: UHCCP DNSP |
$766.11
|
| Rate for Payer: UHCCP Medicaid |
$494.16
|
|
|
PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING
|
Professional
|
Both
|
$2,640.00
|
|
|
Service Code
|
HCPCS 55840
|
| Min. Negotiated Rate |
$666.48 |
| Max. Negotiated Rate |
$2,069.71 |
| Rate for Payer: Aetna Commercial |
$1,386.02
|
| Rate for Payer: Aetna Medicare |
$1,034.34
|
| Rate for Payer: BCBS Complete |
$699.80
|
| Rate for Payer: BCBS MAPPO |
$1,034.34
|
| Rate for Payer: BCN Commercial |
$1,745.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,034.34
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cofinity Commercial |
$1,489.45
|
| Rate for Payer: Cofinity Commercial |
$1,386.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,034.34
|
| Rate for Payer: Healthscope Commercial |
$1,241.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,241.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,086.06
|
| Rate for Payer: Meridian Medicaid |
$699.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,137.77
|
| Rate for Payer: Nomi Health Commercial |
$1,241.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,980.00
|
| Rate for Payer: PACE SWMI |
$1,034.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,034.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$666.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,901.88
|
| Rate for Payer: Priority Health Medicare |
$1,034.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,901.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,034.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,069.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,034.34
|
| Rate for Payer: UHC Exchange |
$2,069.71
|
| Rate for Payer: UHC Medicaid |
$666.48
|
| Rate for Payer: UHCCP DNSP |
$1,034.34
|
| Rate for Payer: UHCCP Medicaid |
$666.48
|
|
