|
PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
HCPCS 43763
|
| Min. Negotiated Rate |
$83.93 |
| Max. Negotiated Rate |
$417.95 |
| Rate for Payer: Aetna Commercial |
$112.47
|
| Rate for Payer: Aetna Medicare |
$83.93
|
| Rate for Payer: BCBS Complete |
$257.20
|
| Rate for Payer: BCBS MAPPO |
$83.93
|
| Rate for Payer: BCN Medicare Advantage |
$83.93
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Commercial |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.93
|
| Rate for Payer: Healthscope Commercial |
$100.72
|
| Rate for Payer: Healthscope Whirlpool |
$100.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.13
|
| Rate for Payer: Nomi Health Commercial |
$100.72
|
| Rate for Payer: PACE SWMI |
$83.93
|
| Rate for Payer: PHP Medicare Advantage |
$83.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.95
|
| Rate for Payer: Priority Health Medicare |
$83.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.93
|
| Rate for Payer: UHC Medicare Advantage |
$83.93
|
| Rate for Payer: UHCCP DNSP |
$83.93
|
|
|
PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
HCPCS 0201T
|
| Min. Negotiated Rate |
$977.60 |
| Max. Negotiated Rate |
$1,588.60 |
| Rate for Payer: Aetna Medicare |
$1,222.00
|
| Rate for Payer: BCBS Complete |
$977.60
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.60
|
|
|
PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL
|
Professional
|
Both
|
$2,317.00
|
|
|
Service Code
|
HCPCS 0200T
|
| Min. Negotiated Rate |
$926.80 |
| Max. Negotiated Rate |
$1,506.05 |
| Rate for Payer: Aetna Medicare |
$1,158.50
|
| Rate for Payer: BCBS Complete |
$926.80
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.05
|
|
|
PR PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS 27216
|
| Min. Negotiated Rate |
$1,268.80 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Medicare |
$1,586.00
|
| Rate for Payer: BCBS Complete |
$1,268.80
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
|
|
PR PERQ SKELETAL FIXATION ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 25651
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$684.17 |
| Rate for Payer: Aetna Commercial |
$636.66
|
| Rate for Payer: Aetna Medicare |
$475.12
|
| Rate for Payer: BCBS Complete |
$346.80
|
| Rate for Payer: BCBS MAPPO |
$475.12
|
| Rate for Payer: BCN Medicare Advantage |
$475.12
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$684.17
|
| Rate for Payer: Cofinity Commercial |
$636.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.12
|
| Rate for Payer: Healthscope Commercial |
$570.14
|
| Rate for Payer: Healthscope Whirlpool |
$570.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.88
|
| Rate for Payer: Nomi Health Commercial |
$570.14
|
| Rate for Payer: PACE SWMI |
$475.12
|
| Rate for Payer: PHP Medicare Advantage |
$475.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health Medicare |
$475.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.12
|
| Rate for Payer: UHC Medicare Advantage |
$475.12
|
| Rate for Payer: UHCCP DNSP |
$475.12
|
|
|
PR PERQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 25671
|
| Min. Negotiated Rate |
$519.45 |
| Max. Negotiated Rate |
$928.20 |
| Rate for Payer: Aetna Commercial |
$696.06
|
| Rate for Payer: Aetna Medicare |
$519.45
|
| Rate for Payer: BCBS Complete |
$571.20
|
| Rate for Payer: BCBS MAPPO |
$519.45
|
| Rate for Payer: BCN Medicare Advantage |
$519.45
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cofinity Commercial |
$748.01
|
| Rate for Payer: Cofinity Commercial |
$696.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.45
|
| Rate for Payer: Healthscope Commercial |
$623.34
|
| Rate for Payer: Healthscope Whirlpool |
$623.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.42
|
| Rate for Payer: Nomi Health Commercial |
$623.34
|
| Rate for Payer: PACE SWMI |
$519.45
|
| Rate for Payer: PHP Medicare Advantage |
$519.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health Medicare |
$519.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.45
|
| Rate for Payer: UHC Medicare Advantage |
$519.45
|
| Rate for Payer: UHCCP DNSP |
$519.45
|
|
|
PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25606
|
| Min. Negotiated Rate |
$647.59 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$867.77
|
| Rate for Payer: Aetna Medicare |
$647.59
|
| Rate for Payer: BCBS Complete |
$777.60
|
| Rate for Payer: BCBS MAPPO |
$647.59
|
| Rate for Payer: BCN Medicare Advantage |
$647.59
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$932.53
|
| Rate for Payer: Cofinity Commercial |
$867.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.59
|
| Rate for Payer: Healthscope Commercial |
$777.11
|
| Rate for Payer: Healthscope Whirlpool |
$777.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.97
|
| Rate for Payer: Nomi Health Commercial |
$777.11
|
| Rate for Payer: PACE SWMI |
$647.59
|
| Rate for Payer: PHP Medicare Advantage |
$647.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health Medicare |
$647.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.59
|
| Rate for Payer: UHC Medicare Advantage |
$647.59
|
| Rate for Payer: UHCCP DNSP |
$647.59
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 36906
|
| Min. Negotiated Rate |
$482.07 |
| Max. Negotiated Rate |
$1,002.30 |
| Rate for Payer: Aetna Commercial |
$645.97
|
| Rate for Payer: Aetna Medicare |
$482.07
|
| Rate for Payer: BCBS Complete |
$616.80
|
| Rate for Payer: BCBS MAPPO |
$482.07
|
| Rate for Payer: BCN Medicare Advantage |
$482.07
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cofinity Commercial |
$694.18
|
| Rate for Payer: Cofinity Commercial |
$645.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.07
|
| Rate for Payer: Healthscope Commercial |
$578.48
|
| Rate for Payer: Healthscope Whirlpool |
$578.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$506.17
|
| Rate for Payer: Nomi Health Commercial |
$578.48
|
| Rate for Payer: PACE SWMI |
$482.07
|
| Rate for Payer: PHP Medicare Advantage |
$482.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.30
|
| Rate for Payer: Priority Health Medicare |
$482.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.07
|
| Rate for Payer: UHC Medicare Advantage |
$482.07
|
| Rate for Payer: UHCCP DNSP |
$482.07
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 36905
|
| Min. Negotiated Rate |
$418.19 |
| Max. Negotiated Rate |
$859.30 |
| Rate for Payer: Aetna Commercial |
$560.37
|
| Rate for Payer: Aetna Medicare |
$418.19
|
| Rate for Payer: BCBS Complete |
$528.80
|
| Rate for Payer: BCBS MAPPO |
$418.19
|
| Rate for Payer: BCN Medicare Advantage |
$418.19
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cofinity Commercial |
$602.19
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.19
|
| Rate for Payer: Healthscope Commercial |
$501.83
|
| Rate for Payer: Healthscope Whirlpool |
$501.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$439.10
|
| Rate for Payer: Nomi Health Commercial |
$501.83
|
| Rate for Payer: PACE SWMI |
$418.19
|
| Rate for Payer: PHP Medicare Advantage |
$418.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.30
|
| Rate for Payer: Priority Health Medicare |
$418.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$418.19
|
| Rate for Payer: UHC Medicare Advantage |
$418.19
|
| Rate for Payer: UHCCP DNSP |
$418.19
|
|
|
PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 36904
|
| Min. Negotiated Rate |
$347.99 |
| Max. Negotiated Rate |
$576.55 |
| Rate for Payer: Aetna Commercial |
$466.31
|
| Rate for Payer: Aetna Medicare |
$347.99
|
| Rate for Payer: BCBS Complete |
$354.80
|
| Rate for Payer: BCBS MAPPO |
$347.99
|
| Rate for Payer: BCN Medicare Advantage |
$347.99
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cofinity Commercial |
$501.11
|
| Rate for Payer: Cofinity Commercial |
$466.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.99
|
| Rate for Payer: Healthscope Commercial |
$417.59
|
| Rate for Payer: Healthscope Whirlpool |
$417.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.39
|
| Rate for Payer: Nomi Health Commercial |
$417.59
|
| Rate for Payer: PACE SWMI |
$347.99
|
| Rate for Payer: PHP Medicare Advantage |
$347.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.55
|
| Rate for Payer: Priority Health Medicare |
$347.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.99
|
| Rate for Payer: UHC Medicare Advantage |
$347.99
|
| Rate for Payer: UHCCP DNSP |
$347.99
|
|
|
PR PERQ TRANSLUMINAL ANGIOPLASTY NATIVE/RECR COA
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 33897
|
| Min. Negotiated Rate |
$497.60 |
| Max. Negotiated Rate |
$808.60 |
| Rate for Payer: Aetna Commercial |
$740.91
|
| Rate for Payer: Aetna Medicare |
$552.92
|
| Rate for Payer: BCBS Complete |
$497.60
|
| Rate for Payer: BCBS MAPPO |
$552.92
|
| Rate for Payer: BCN Medicare Advantage |
$552.92
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$796.20
|
| Rate for Payer: Cofinity Commercial |
$740.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.92
|
| Rate for Payer: Healthscope Commercial |
$663.50
|
| Rate for Payer: Healthscope Whirlpool |
$663.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$580.57
|
| Rate for Payer: Nomi Health Commercial |
$663.50
|
| Rate for Payer: PACE SWMI |
$552.92
|
| Rate for Payer: PHP Medicare Advantage |
$552.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health Medicare |
$552.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.92
|
| Rate for Payer: UHC Medicare Advantage |
$552.92
|
| Rate for Payer: UHCCP DNSP |
$552.92
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 22513
|
| Min. Negotiated Rate |
$487.67 |
| Max. Negotiated Rate |
$1,004.90 |
| Rate for Payer: Aetna Commercial |
$653.48
|
| Rate for Payer: Aetna Medicare |
$487.67
|
| Rate for Payer: BCBS Complete |
$618.40
|
| Rate for Payer: BCBS MAPPO |
$487.67
|
| Rate for Payer: BCN Medicare Advantage |
$487.67
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$702.24
|
| Rate for Payer: Cofinity Commercial |
$653.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.67
|
| Rate for Payer: Healthscope Commercial |
$585.20
|
| Rate for Payer: Healthscope Whirlpool |
$585.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.05
|
| Rate for Payer: Nomi Health Commercial |
$585.20
|
| Rate for Payer: PACE SWMI |
$487.67
|
| Rate for Payer: PHP Medicare Advantage |
$487.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.90
|
| Rate for Payer: Priority Health Medicare |
$487.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.67
|
| Rate for Payer: UHC Medicare Advantage |
$487.67
|
| Rate for Payer: UHCCP DNSP |
$487.67
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 22515
|
| Min. Negotiated Rate |
$209.25 |
| Max. Negotiated Rate |
$523.90 |
| Rate for Payer: Aetna Commercial |
$280.39
|
| Rate for Payer: Aetna Medicare |
$209.25
|
| Rate for Payer: BCBS Complete |
$322.40
|
| Rate for Payer: BCBS MAPPO |
$209.25
|
| Rate for Payer: BCN Medicare Advantage |
$209.25
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Cofinity Commercial |
$280.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.25
|
| Rate for Payer: Healthscope Commercial |
$251.10
|
| Rate for Payer: Healthscope Whirlpool |
$251.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.71
|
| Rate for Payer: Nomi Health Commercial |
$251.10
|
| Rate for Payer: PACE SWMI |
$209.25
|
| Rate for Payer: PHP Medicare Advantage |
$209.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.90
|
| Rate for Payer: Priority Health Medicare |
$209.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.25
|
| Rate for Payer: UHC Medicare Advantage |
$209.25
|
| Rate for Payer: UHCCP DNSP |
$209.25
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
HCPCS 22514
|
| Min. Negotiated Rate |
$455.37 |
| Max. Negotiated Rate |
$938.60 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Medicare |
$455.37
|
| Rate for Payer: BCBS Complete |
$577.60
|
| Rate for Payer: BCBS MAPPO |
$455.37
|
| Rate for Payer: BCN Medicare Advantage |
$455.37
|
| Rate for Payer: Cash Price |
$1,155.20
|
| Rate for Payer: Cash Price |
$1,155.20
|
| Rate for Payer: Cofinity Commercial |
$655.73
|
| Rate for Payer: Cofinity Commercial |
$610.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.37
|
| Rate for Payer: Healthscope Commercial |
$546.44
|
| Rate for Payer: Healthscope Whirlpool |
$546.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$478.14
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE SWMI |
$455.37
|
| Rate for Payer: PHP Medicare Advantage |
$455.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.60
|
| Rate for Payer: Priority Health Medicare |
$455.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$455.37
|
| Rate for Payer: UHC Medicare Advantage |
$455.37
|
| Rate for Payer: UHCCP DNSP |
$455.37
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL
|
Professional
|
Both
|
$1,057.00
|
|
|
Service Code
|
HCPCS 22511
|
| Min. Negotiated Rate |
$388.54 |
| Max. Negotiated Rate |
$687.05 |
| Rate for Payer: Aetna Commercial |
$520.64
|
| Rate for Payer: Aetna Medicare |
$388.54
|
| Rate for Payer: BCBS Complete |
$422.80
|
| Rate for Payer: BCBS MAPPO |
$388.54
|
| Rate for Payer: BCN Medicare Advantage |
$388.54
|
| Rate for Payer: Cash Price |
$845.60
|
| Rate for Payer: Cash Price |
$845.60
|
| Rate for Payer: Cofinity Commercial |
$559.50
|
| Rate for Payer: Cofinity Commercial |
$520.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.54
|
| Rate for Payer: Healthscope Commercial |
$466.25
|
| Rate for Payer: Healthscope Whirlpool |
$466.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.97
|
| Rate for Payer: Nomi Health Commercial |
$466.25
|
| Rate for Payer: PACE SWMI |
$388.54
|
| Rate for Payer: PHP Medicare Advantage |
$388.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.05
|
| Rate for Payer: Priority Health Medicare |
$388.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.54
|
| Rate for Payer: UHC Medicare Advantage |
$388.54
|
| Rate for Payer: UHCCP DNSP |
$388.54
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC
|
Professional
|
Both
|
$3,421.00
|
|
|
Service Code
|
HCPCS 22510
|
| Min. Negotiated Rate |
$413.04 |
| Max. Negotiated Rate |
$2,223.65 |
| Rate for Payer: Aetna Commercial |
$553.47
|
| Rate for Payer: Aetna Medicare |
$413.04
|
| Rate for Payer: BCBS Complete |
$1,368.40
|
| Rate for Payer: BCBS MAPPO |
$413.04
|
| Rate for Payer: BCN Medicare Advantage |
$413.04
|
| Rate for Payer: Cash Price |
$2,736.80
|
| Rate for Payer: Cash Price |
$2,736.80
|
| Rate for Payer: Cofinity Commercial |
$594.78
|
| Rate for Payer: Cofinity Commercial |
$553.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.04
|
| Rate for Payer: Healthscope Commercial |
$495.65
|
| Rate for Payer: Healthscope Whirlpool |
$495.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$433.69
|
| Rate for Payer: Nomi Health Commercial |
$495.65
|
| Rate for Payer: PACE SWMI |
$413.04
|
| Rate for Payer: PHP Medicare Advantage |
$413.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,223.65
|
| Rate for Payer: Priority Health Medicare |
$413.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.04
|
| Rate for Payer: UHC Medicare Advantage |
$413.04
|
| Rate for Payer: UHCCP DNSP |
$413.04
|
|
|
PR PESSARY REUSABLE NONRUBBER
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4562
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$102.46 |
| Rate for Payer: Aetna Commercial |
$95.34
|
| Rate for Payer: Aetna Medicare |
$71.15
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$71.15
|
| Rate for Payer: BCN Medicare Advantage |
$71.15
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$95.34
|
| Rate for Payer: Cofinity Commercial |
$102.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.15
|
| Rate for Payer: Healthscope Commercial |
$85.38
|
| Rate for Payer: Healthscope Whirlpool |
$85.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.71
|
| Rate for Payer: Nomi Health Commercial |
$85.38
|
| Rate for Payer: PACE SWMI |
$71.15
|
| Rate for Payer: PHP Medicare Advantage |
$71.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$71.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.15
|
| Rate for Payer: UHC Medicare Advantage |
$71.15
|
| Rate for Payer: UHCCP DNSP |
$71.15
|
|
|
PR PESSARY REUSABLE RUB ANYTYPE
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4561
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Commercial |
$38.38
|
| Rate for Payer: Aetna Medicare |
$28.64
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$28.64
|
| Rate for Payer: BCN Medicare Advantage |
$28.64
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$41.24
|
| Rate for Payer: Cofinity Commercial |
$38.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.64
|
| Rate for Payer: Healthscope Commercial |
$34.37
|
| Rate for Payer: Healthscope Whirlpool |
$34.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$34.37
|
| Rate for Payer: PACE SWMI |
$28.64
|
| Rate for Payer: PHP Medicare Advantage |
$28.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$28.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.64
|
| Rate for Payer: UHC Medicare Advantage |
$28.64
|
| Rate for Payer: UHCCP DNSP |
$28.64
|
|
|
PR PHALANGECTOMY TOE EACH TOE
|
Professional
|
Both
|
$849.00
|
|
|
Service Code
|
HCPCS 28150
|
| Min. Negotiated Rate |
$267.77 |
| Max. Negotiated Rate |
$551.85 |
| Rate for Payer: Aetna Commercial |
$358.81
|
| Rate for Payer: Aetna Medicare |
$267.77
|
| Rate for Payer: BCBS Complete |
$339.60
|
| Rate for Payer: BCBS MAPPO |
$267.77
|
| Rate for Payer: BCN Medicare Advantage |
$267.77
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Cofinity Commercial |
$385.59
|
| Rate for Payer: Cofinity Commercial |
$358.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.77
|
| Rate for Payer: Healthscope Commercial |
$321.32
|
| Rate for Payer: Healthscope Whirlpool |
$321.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.16
|
| Rate for Payer: Nomi Health Commercial |
$321.32
|
| Rate for Payer: PACE SWMI |
$267.77
|
| Rate for Payer: PHP Medicare Advantage |
$267.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.85
|
| Rate for Payer: Priority Health Medicare |
$267.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.77
|
| Rate for Payer: UHC Medicare Advantage |
$267.77
|
| Rate for Payer: UHCCP DNSP |
$267.77
|
|
|
PR PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 90863
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
|
|
PR PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
HCPCS 42950
|
| Min. Negotiated Rate |
$576.40 |
| Max. Negotiated Rate |
$1,064.30 |
| Rate for Payer: Aetna Commercial |
$990.39
|
| Rate for Payer: Aetna Medicare |
$739.10
|
| Rate for Payer: BCBS Complete |
$576.40
|
| Rate for Payer: BCBS MAPPO |
$739.10
|
| Rate for Payer: BCN Medicare Advantage |
$739.10
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Commercial |
$990.39
|
| Rate for Payer: Cofinity Commercial |
$1,064.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.10
|
| Rate for Payer: Healthscope Commercial |
$886.92
|
| Rate for Payer: Healthscope Whirlpool |
$886.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$776.05
|
| Rate for Payer: Nomi Health Commercial |
$886.92
|
| Rate for Payer: PACE SWMI |
$739.10
|
| Rate for Payer: PHP Medicare Advantage |
$739.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$936.65
|
| Rate for Payer: Priority Health Medicare |
$739.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$739.10
|
| Rate for Payer: UHC Medicare Advantage |
$739.10
|
| Rate for Payer: UHCCP DNSP |
$739.10
|
|
|
PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 99195
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna Commercial |
$106.68
|
| Rate for Payer: Aetna Medicare |
$79.61
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$79.61
|
| Rate for Payer: BCN Medicare Advantage |
$79.61
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$114.64
|
| Rate for Payer: Cofinity Commercial |
$106.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.61
|
| Rate for Payer: Healthscope Commercial |
$95.53
|
| Rate for Payer: Healthscope Whirlpool |
$95.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.59
|
| Rate for Payer: Nomi Health Commercial |
$95.53
|
| Rate for Payer: PACE SWMI |
$79.61
|
| Rate for Payer: PHP Medicare Advantage |
$79.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$79.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.61
|
| Rate for Payer: UHC Medicare Advantage |
$79.61
|
| Rate for Payer: UHCCP DNSP |
$79.61
|
|
|
PR PHTFAC ARMS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00079
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR PHTFAC CHEST/SHLD
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00077
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR PHTFAC FACE & NECK/ FL ARMS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00076
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
