|
PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,333.00
|
|
|
Service Code
|
HCPCS 22840
|
| Min. Negotiated Rate |
$735.06 |
| Max. Negotiated Rate |
$2,166.45 |
| Rate for Payer: Aetna Commercial |
$984.98
|
| Rate for Payer: Aetna Medicare |
$735.06
|
| Rate for Payer: BCBS Complete |
$1,333.20
|
| Rate for Payer: BCBS MAPPO |
$735.06
|
| Rate for Payer: BCN Medicare Advantage |
$735.06
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Cofinity Commercial |
$1,058.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.06
|
| Rate for Payer: Healthscope Commercial |
$882.07
|
| Rate for Payer: Healthscope Whirlpool |
$882.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$771.81
|
| Rate for Payer: Nomi Health Commercial |
$882.07
|
| Rate for Payer: PACE SWMI |
$735.06
|
| Rate for Payer: PHP Medicare Advantage |
$735.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,166.45
|
| Rate for Payer: Priority Health Medicare |
$735.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$735.06
|
| Rate for Payer: UHC Medicare Advantage |
$735.06
|
| Rate for Payer: UHCCP DNSP |
$735.06
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE
|
Professional
|
Both
|
$3,929.00
|
|
|
Service Code
|
HCPCS 22844
|
| Min. Negotiated Rate |
$959.85 |
| Max. Negotiated Rate |
$2,553.85 |
| Rate for Payer: Aetna Commercial |
$1,286.20
|
| Rate for Payer: Aetna Medicare |
$959.85
|
| Rate for Payer: BCBS Complete |
$1,571.60
|
| Rate for Payer: BCBS MAPPO |
$959.85
|
| Rate for Payer: BCN Medicare Advantage |
$959.85
|
| Rate for Payer: Cash Price |
$3,143.20
|
| Rate for Payer: Cash Price |
$3,143.20
|
| Rate for Payer: Cofinity Commercial |
$1,382.18
|
| Rate for Payer: Cofinity Commercial |
$1,286.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$959.85
|
| Rate for Payer: Healthscope Commercial |
$1,151.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,151.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,007.84
|
| Rate for Payer: Nomi Health Commercial |
$1,151.82
|
| Rate for Payer: PACE SWMI |
$959.85
|
| Rate for Payer: PHP Medicare Advantage |
$959.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,553.85
|
| Rate for Payer: Priority Health Medicare |
$959.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$959.85
|
| Rate for Payer: UHC Medicare Advantage |
$959.85
|
| Rate for Payer: UHCCP DNSP |
$959.85
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,720.00
|
|
|
Service Code
|
HCPCS 22842
|
| Min. Negotiated Rate |
$745.29 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna Commercial |
$998.69
|
| Rate for Payer: Aetna Medicare |
$745.29
|
| Rate for Payer: BCBS Complete |
$1,488.00
|
| Rate for Payer: BCBS MAPPO |
$745.29
|
| Rate for Payer: BCN Medicare Advantage |
$745.29
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cofinity Commercial |
$998.69
|
| Rate for Payer: Cofinity Commercial |
$1,073.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.29
|
| Rate for Payer: Healthscope Commercial |
$894.35
|
| Rate for Payer: Healthscope Whirlpool |
$894.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$782.55
|
| Rate for Payer: Nomi Health Commercial |
$894.35
|
| Rate for Payer: PACE SWMI |
$745.29
|
| Rate for Payer: PHP Medicare Advantage |
$745.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.00
|
| Rate for Payer: Priority Health Medicare |
$745.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.29
|
| Rate for Payer: UHC Medicare Advantage |
$745.29
|
| Rate for Payer: UHCCP DNSP |
$745.29
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG
|
Professional
|
Both
|
$4,091.00
|
|
|
Service Code
|
HCPCS 22843
|
| Min. Negotiated Rate |
$798.77 |
| Max. Negotiated Rate |
$2,659.15 |
| Rate for Payer: Aetna Commercial |
$1,070.35
|
| Rate for Payer: Aetna Medicare |
$798.77
|
| Rate for Payer: BCBS Complete |
$1,636.40
|
| Rate for Payer: BCBS MAPPO |
$798.77
|
| Rate for Payer: BCN Medicare Advantage |
$798.77
|
| Rate for Payer: Cash Price |
$3,272.80
|
| Rate for Payer: Cash Price |
$3,272.80
|
| Rate for Payer: Cofinity Commercial |
$1,150.23
|
| Rate for Payer: Cofinity Commercial |
$1,070.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.77
|
| Rate for Payer: Healthscope Commercial |
$958.52
|
| Rate for Payer: Healthscope Whirlpool |
$958.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.71
|
| Rate for Payer: Nomi Health Commercial |
$958.52
|
| Rate for Payer: PACE SWMI |
$798.77
|
| Rate for Payer: PHP Medicare Advantage |
$798.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,659.15
|
| Rate for Payer: Priority Health Medicare |
$798.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.77
|
| Rate for Payer: UHC Medicare Advantage |
$798.77
|
| Rate for Payer: UHCCP DNSP |
$798.77
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: Aetna Commercial |
$233.83
|
| Rate for Payer: Aetna Medicare |
$174.50
|
| Rate for Payer: BCBS Complete |
$179.60
|
| Rate for Payer: BCBS MAPPO |
$174.50
|
| Rate for Payer: BCN Medicare Advantage |
$174.50
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$251.28
|
| Rate for Payer: Cofinity Commercial |
$233.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.50
|
| Rate for Payer: Healthscope Commercial |
$209.40
|
| Rate for Payer: Healthscope Whirlpool |
$209.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.22
|
| Rate for Payer: Nomi Health Commercial |
$209.40
|
| Rate for Payer: PACE SWMI |
$174.50
|
| Rate for Payer: PHP Medicare Advantage |
$174.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$174.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.50
|
| Rate for Payer: UHC Medicare Advantage |
$174.50
|
| Rate for Payer: UHCCP DNSP |
$174.50
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: Aetna Commercial |
$38.26
|
| Rate for Payer: Aetna Medicare |
$28.55
|
| Rate for Payer: BCBS Complete |
$92.40
|
| Rate for Payer: BCBS MAPPO |
$28.55
|
| Rate for Payer: BCN Medicare Advantage |
$28.55
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$41.11
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.55
|
| Rate for Payer: Healthscope Commercial |
$34.26
|
| Rate for Payer: Healthscope Whirlpool |
$34.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.98
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: PACE SWMI |
$28.55
|
| Rate for Payer: PHP Medicare Advantage |
$28.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health Medicare |
$28.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.55
|
| Rate for Payer: UHC Medicare Advantage |
$28.55
|
| Rate for Payer: UHCCP DNSP |
$28.55
|
|
|
PR POTASSIUM HYDROXIDE PREPS
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS Q0112
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$7.81
|
| Rate for Payer: Aetna Medicare |
$5.83
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$5.83
|
| Rate for Payer: BCN Medicare Advantage |
$5.83
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.83
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Healthscope Whirlpool |
$7.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.12
|
| Rate for Payer: Nomi Health Commercial |
$7.00
|
| Rate for Payer: PACE SWMI |
$5.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Medicare |
$5.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.83
|
| Rate for Payer: UHC Medicare Advantage |
$5.83
|
| Rate for Payer: UHCCP DNSP |
$5.83
|
|
|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Aetna Commercial |
$207.70
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCBS MAPPO |
$155.00
|
| Rate for Payer: BCN Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$223.20
|
| Rate for Payer: Cofinity Commercial |
$207.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.00
|
| Rate for Payer: Healthscope Commercial |
$186.00
|
| Rate for Payer: Healthscope Whirlpool |
$186.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.75
|
| Rate for Payer: Nomi Health Commercial |
$186.00
|
| Rate for Payer: PACE SWMI |
$155.00
|
| Rate for Payer: PHP Medicare Advantage |
$155.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.00
|
| Rate for Payer: UHC Medicare Advantage |
$155.00
|
| Rate for Payer: UHCCP DNSP |
$155.00
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$175.46 |
| Rate for Payer: Aetna Commercial |
$163.28
|
| Rate for Payer: Aetna Medicare |
$121.85
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$121.85
|
| Rate for Payer: BCN Medicare Advantage |
$121.85
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$175.46
|
| Rate for Payer: Cofinity Commercial |
$163.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.85
|
| Rate for Payer: Healthscope Commercial |
$146.22
|
| Rate for Payer: Healthscope Whirlpool |
$146.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.94
|
| Rate for Payer: Nomi Health Commercial |
$146.22
|
| Rate for Payer: PACE SWMI |
$121.85
|
| Rate for Payer: PHP Medicare Advantage |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Medicare |
$121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.85
|
| Rate for Payer: UHC Medicare Advantage |
$121.85
|
| Rate for Payer: UHCCP DNSP |
$121.85
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$133.47
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS MAPPO |
$133.47
|
| Rate for Payer: BCN Medicare Advantage |
$133.47
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$192.20
|
| Rate for Payer: Cofinity Commercial |
$178.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.47
|
| Rate for Payer: Healthscope Commercial |
$160.16
|
| Rate for Payer: Healthscope Whirlpool |
$160.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.14
|
| Rate for Payer: Nomi Health Commercial |
$160.16
|
| Rate for Payer: PACE SWMI |
$133.47
|
| Rate for Payer: PHP Medicare Advantage |
$133.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.90
|
| Rate for Payer: Priority Health Medicare |
$133.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.47
|
| Rate for Payer: UHC Medicare Advantage |
$133.47
|
| Rate for Payer: UHCCP DNSP |
$133.47
|
|
|
PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 45112
|
| Min. Negotiated Rate |
$1,726.13 |
| Max. Negotiated Rate |
$3,023.80 |
| Rate for Payer: Aetna Commercial |
$2,313.01
|
| Rate for Payer: Aetna Medicare |
$1,726.13
|
| Rate for Payer: BCBS Complete |
$1,860.80
|
| Rate for Payer: BCBS MAPPO |
$1,726.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,726.13
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$2,485.63
|
| Rate for Payer: Cofinity Commercial |
$2,313.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,726.13
|
| Rate for Payer: Healthscope Commercial |
$2,071.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,071.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,812.44
|
| Rate for Payer: Nomi Health Commercial |
$2,071.36
|
| Rate for Payer: PACE SWMI |
$1,726.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,726.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health Medicare |
$1,726.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,726.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,726.13
|
| Rate for Payer: UHCCP DNSP |
$1,726.13
|
|
|
PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST
|
Professional
|
Both
|
$4,725.00
|
|
|
Service Code
|
HCPCS 45110
|
| Min. Negotiated Rate |
$1,731.08 |
| Max. Negotiated Rate |
$3,071.25 |
| Rate for Payer: Aetna Commercial |
$2,319.65
|
| Rate for Payer: Aetna Medicare |
$1,731.08
|
| Rate for Payer: BCBS Complete |
$1,890.00
|
| Rate for Payer: BCBS MAPPO |
$1,731.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,731.08
|
| Rate for Payer: Cash Price |
$3,780.00
|
| Rate for Payer: Cash Price |
$3,780.00
|
| Rate for Payer: Cofinity Commercial |
$2,492.76
|
| Rate for Payer: Cofinity Commercial |
$2,319.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,731.08
|
| Rate for Payer: Healthscope Commercial |
$2,077.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,077.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,817.63
|
| Rate for Payer: Nomi Health Commercial |
$2,077.30
|
| Rate for Payer: PACE SWMI |
$1,731.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,731.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,071.25
|
| Rate for Payer: Priority Health Medicare |
$1,731.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,731.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,731.08
|
| Rate for Payer: UHCCP DNSP |
$1,731.08
|
|
|
PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS
|
Professional
|
Both
|
$4,993.00
|
|
|
Service Code
|
HCPCS 45120
|
| Min. Negotiated Rate |
$1,555.36 |
| Max. Negotiated Rate |
$3,245.45 |
| Rate for Payer: Aetna Commercial |
$2,084.18
|
| Rate for Payer: Aetna Medicare |
$1,555.36
|
| Rate for Payer: BCBS Complete |
$1,997.20
|
| Rate for Payer: BCBS MAPPO |
$1,555.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,555.36
|
| Rate for Payer: Cash Price |
$3,994.40
|
| Rate for Payer: Cash Price |
$3,994.40
|
| Rate for Payer: Cofinity Commercial |
$2,239.72
|
| Rate for Payer: Cofinity Commercial |
$2,084.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,555.36
|
| Rate for Payer: Healthscope Commercial |
$1,866.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,866.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,633.13
|
| Rate for Payer: Nomi Health Commercial |
$1,866.43
|
| Rate for Payer: PACE SWMI |
$1,555.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,555.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,245.45
|
| Rate for Payer: Priority Health Medicare |
$1,555.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,555.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.36
|
| Rate for Payer: UHCCP DNSP |
$1,555.36
|
|
|
PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS
|
Professional
|
Both
|
$4,900.00
|
|
|
Service Code
|
HCPCS 45121
|
| Min. Negotiated Rate |
$1,696.93 |
| Max. Negotiated Rate |
$3,185.00 |
| Rate for Payer: Aetna Commercial |
$2,273.89
|
| Rate for Payer: Aetna Medicare |
$1,696.93
|
| Rate for Payer: BCBS Complete |
$1,960.00
|
| Rate for Payer: BCBS MAPPO |
$1,696.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,696.93
|
| Rate for Payer: Cash Price |
$3,920.00
|
| Rate for Payer: Cash Price |
$3,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,443.58
|
| Rate for Payer: Cofinity Commercial |
$2,273.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,696.93
|
| Rate for Payer: Healthscope Commercial |
$2,036.32
|
| Rate for Payer: Healthscope Whirlpool |
$2,036.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,781.78
|
| Rate for Payer: Nomi Health Commercial |
$2,036.32
|
| Rate for Payer: PACE SWMI |
$1,696.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,696.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,185.00
|
| Rate for Payer: Priority Health Medicare |
$1,696.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,696.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,696.93
|
| Rate for Payer: UHCCP DNSP |
$1,696.93
|
|
|
PR PRCTECT PRTL RESCJ RECTUM TABDL APPR
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 45111
|
| Min. Negotiated Rate |
$789.20 |
| Max. Negotiated Rate |
$1,500.64 |
| Rate for Payer: Aetna Commercial |
$1,396.43
|
| Rate for Payer: Aetna Medicare |
$1,042.11
|
| Rate for Payer: BCBS Complete |
$789.20
|
| Rate for Payer: BCBS MAPPO |
$1,042.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,042.11
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cofinity Commercial |
$1,500.64
|
| Rate for Payer: Cofinity Commercial |
$1,396.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,042.11
|
| Rate for Payer: Healthscope Commercial |
$1,250.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,094.22
|
| Rate for Payer: Nomi Health Commercial |
$1,250.53
|
| Rate for Payer: PACE SWMI |
$1,042.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,042.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,282.45
|
| Rate for Payer: Priority Health Medicare |
$1,042.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,042.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,042.11
|
| Rate for Payer: UHCCP DNSP |
$1,042.11
|
|
|
PR PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH
|
Professional
|
Both
|
$3,259.00
|
|
|
Service Code
|
HCPCS 45114
|
| Min. Negotiated Rate |
$1,303.60 |
| Max. Negotiated Rate |
$2,544.12 |
| Rate for Payer: Aetna Commercial |
$2,367.45
|
| Rate for Payer: Aetna Medicare |
$1,766.75
|
| Rate for Payer: BCBS Complete |
$1,303.60
|
| Rate for Payer: BCBS MAPPO |
$1,766.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,766.75
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cofinity Commercial |
$2,544.12
|
| Rate for Payer: Cofinity Commercial |
$2,367.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,766.75
|
| Rate for Payer: Healthscope Commercial |
$2,120.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,120.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,855.09
|
| Rate for Payer: Nomi Health Commercial |
$2,120.10
|
| Rate for Payer: PACE SWMI |
$1,766.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,766.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,118.35
|
| Rate for Payer: Priority Health Medicare |
$1,766.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,766.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,766.75
|
| Rate for Payer: UHCCP DNSP |
$1,766.75
|
|
|
PR PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY
|
Professional
|
Both
|
$3,811.00
|
|
|
Service Code
|
HCPCS 45116
|
| Min. Negotiated Rate |
$1,469.87 |
| Max. Negotiated Rate |
$2,477.15 |
| Rate for Payer: Aetna Commercial |
$1,969.63
|
| Rate for Payer: Aetna Medicare |
$1,469.87
|
| Rate for Payer: BCBS Complete |
$1,524.40
|
| Rate for Payer: BCBS MAPPO |
$1,469.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,469.87
|
| Rate for Payer: Cash Price |
$3,048.80
|
| Rate for Payer: Cash Price |
$3,048.80
|
| Rate for Payer: Cofinity Commercial |
$2,116.61
|
| Rate for Payer: Cofinity Commercial |
$1,969.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,469.87
|
| Rate for Payer: Healthscope Commercial |
$1,763.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,763.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,543.36
|
| Rate for Payer: Nomi Health Commercial |
$1,763.84
|
| Rate for Payer: PACE SWMI |
$1,469.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,469.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,477.15
|
| Rate for Payer: Priority Health Medicare |
$1,469.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,469.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,469.87
|
| Rate for Payer: UHCCP DNSP |
$1,469.87
|
|
|
PR PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR
|
Professional
|
Both
|
$5,455.00
|
|
|
Service Code
|
HCPCS 45113
|
| Min. Negotiated Rate |
$1,769.06 |
| Max. Negotiated Rate |
$3,545.75 |
| Rate for Payer: Aetna Commercial |
$2,370.54
|
| Rate for Payer: Aetna Medicare |
$1,769.06
|
| Rate for Payer: BCBS Complete |
$2,182.00
|
| Rate for Payer: BCBS MAPPO |
$1,769.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,769.06
|
| Rate for Payer: Cash Price |
$4,364.00
|
| Rate for Payer: Cash Price |
$4,364.00
|
| Rate for Payer: Cofinity Commercial |
$2,547.45
|
| Rate for Payer: Cofinity Commercial |
$2,370.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,769.06
|
| Rate for Payer: Healthscope Commercial |
$2,122.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,122.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,857.51
|
| Rate for Payer: Nomi Health Commercial |
$2,122.87
|
| Rate for Payer: PACE SWMI |
$1,769.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,769.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,545.75
|
| Rate for Payer: Priority Health Medicare |
$1,769.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,769.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.06
|
| Rate for Payer: UHCCP DNSP |
$1,769.06
|
|
|
PR PRCTECT PRTL W/O ANAST PRNL APPR
|
Professional
|
Both
|
$3,047.00
|
|
|
Service Code
|
HCPCS 45123
|
| Min. Negotiated Rate |
$1,064.41 |
| Max. Negotiated Rate |
$1,980.55 |
| Rate for Payer: Aetna Commercial |
$1,426.31
|
| Rate for Payer: Aetna Medicare |
$1,064.41
|
| Rate for Payer: BCBS Complete |
$1,218.80
|
| Rate for Payer: BCBS MAPPO |
$1,064.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,064.41
|
| Rate for Payer: Cash Price |
$2,437.60
|
| Rate for Payer: Cash Price |
$2,437.60
|
| Rate for Payer: Cofinity Commercial |
$1,532.75
|
| Rate for Payer: Cofinity Commercial |
$1,426.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,064.41
|
| Rate for Payer: Healthscope Commercial |
$1,277.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,277.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,117.63
|
| Rate for Payer: Nomi Health Commercial |
$1,277.29
|
| Rate for Payer: PACE SWMI |
$1,064.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,064.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,980.55
|
| Rate for Payer: Priority Health Medicare |
$1,064.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,064.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,064.41
|
| Rate for Payer: UHCCP DNSP |
$1,064.41
|
|
|
PR PREDNISONE IR OR DR ORAL 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.01
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: PACE SWMI |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.01
|
| Rate for Payer: UHC Medicare Advantage |
$0.01
|
| Rate for Payer: UHCCP DNSP |
$0.01
|
|
|
PR PREDNISONE ORAL
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J7506
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
|
|
PR PREPARE FECAL MICROBIOTA FOR INSTILLATION
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 44705
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 49013
|
| Min. Negotiated Rate |
$376.80 |
| Max. Negotiated Rate |
$638.55 |
| Rate for Payer: Aetna Commercial |
$594.21
|
| Rate for Payer: Aetna Medicare |
$443.44
|
| Rate for Payer: BCBS Complete |
$376.80
|
| Rate for Payer: BCBS MAPPO |
$443.44
|
| Rate for Payer: BCN Medicare Advantage |
$443.44
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cofinity Commercial |
$638.55
|
| Rate for Payer: Cofinity Commercial |
$594.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.44
|
| Rate for Payer: Healthscope Commercial |
$532.13
|
| Rate for Payer: Healthscope Whirlpool |
$532.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.61
|
| Rate for Payer: Nomi Health Commercial |
$532.13
|
| Rate for Payer: PACE SWMI |
$443.44
|
| Rate for Payer: PHP Medicare Advantage |
$443.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.30
|
| Rate for Payer: Priority Health Medicare |
$443.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$443.44
|
| Rate for Payer: UHC Medicare Advantage |
$443.44
|
| Rate for Payer: UHCCP DNSP |
$443.44
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 15004
|
| Min. Negotiated Rate |
$248.67 |
| Max. Negotiated Rate |
$435.50 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Medicare |
$248.67
|
| Rate for Payer: BCBS Complete |
$268.00
|
| Rate for Payer: BCBS MAPPO |
$248.67
|
| Rate for Payer: BCN Medicare Advantage |
$248.67
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cofinity Commercial |
$358.08
|
| Rate for Payer: Cofinity Commercial |
$333.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.67
|
| Rate for Payer: Healthscope Commercial |
$298.40
|
| Rate for Payer: Healthscope Whirlpool |
$298.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.10
|
| Rate for Payer: Nomi Health Commercial |
$298.40
|
| Rate for Payer: PACE SWMI |
$248.67
|
| Rate for Payer: PHP Medicare Advantage |
$248.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.50
|
| Rate for Payer: Priority Health Medicare |
$248.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.67
|
| Rate for Payer: UHC Medicare Advantage |
$248.67
|
| Rate for Payer: UHCCP DNSP |
$248.67
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 15005
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$86.46
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$86.46
|
| Rate for Payer: BCN Medicare Advantage |
$86.46
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$124.50
|
| Rate for Payer: Cofinity Commercial |
$115.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.46
|
| Rate for Payer: Healthscope Commercial |
$103.75
|
| Rate for Payer: Healthscope Whirlpool |
$103.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.78
|
| Rate for Payer: Nomi Health Commercial |
$103.75
|
| Rate for Payer: PACE SWMI |
$86.46
|
| Rate for Payer: PHP Medicare Advantage |
$86.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$86.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.46
|
| Rate for Payer: UHC Medicare Advantage |
$86.46
|
| Rate for Payer: UHCCP DNSP |
$86.46
|
|
