|
PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 90681
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$147.02 |
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: BCBS Trust/PPO |
$147.02
|
| Rate for Payer: BCN Commercial |
$144.54
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.02
|
| Rate for Payer: UHC Exchange |
$147.02
|
|
|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 90680
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$102.74 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: BCBS Trust/PPO |
$102.74
|
| Rate for Payer: BCN Commercial |
$97.11
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.74
|
| Rate for Payer: UHC Exchange |
$102.74
|
|
|
PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY
|
Professional
|
Both
|
$3,236.00
|
|
|
Service Code
|
HCPCS 33476
|
| Min. Negotiated Rate |
$923.78 |
| Max. Negotiated Rate |
$2,703.06 |
| Rate for Payer: Aetna Commercial |
$1,936.26
|
| Rate for Payer: Aetna Medicare |
$1,444.97
|
| Rate for Payer: BCBS Complete |
$969.97
|
| Rate for Payer: BCBS MAPPO |
$1,444.97
|
| Rate for Payer: BCN Commercial |
$2,253.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.97
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cofinity Commercial |
$2,080.76
|
| Rate for Payer: Cofinity Commercial |
$1,936.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.97
|
| Rate for Payer: Healthscope Commercial |
$1,733.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,733.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,517.22
|
| Rate for Payer: Meridian Medicaid |
$969.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,589.47
|
| Rate for Payer: Nomi Health Commercial |
$1,733.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,427.00
|
| Rate for Payer: PACE SWMI |
$1,444.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,423.74
|
| Rate for Payer: Priority Health Medicare |
$1,444.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,423.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,703.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,444.97
|
| Rate for Payer: UHC Exchange |
$2,703.06
|
| Rate for Payer: UHC Medicaid |
$923.78
|
| Rate for Payer: UHCCP DNSP |
$1,444.97
|
| Rate for Payer: UHCCP Medicaid |
$923.78
|
|
|
PR RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 92310
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCN Commercial |
$84.16
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.02
|
| Rate for Payer: Priority Health Narrow Network |
$72.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.35
|
| Rate for Payer: UHC Exchange |
$76.35
|
| Rate for Payer: UHC Medicaid |
$31.10
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
|
|
PR RX&FITG C-LENS TECH CRNL LENS OU XCPT APHAKIA
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 92314
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCN Commercial |
$49.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.61
|
| Rate for Payer: Priority Health Narrow Network |
$42.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.54
|
| Rate for Payer: UHC Exchange |
$45.54
|
|
|
PR RX RIB FRACTURE W EXTERN FIXATN
|
Professional
|
Both
|
$1,357.00
|
|
|
Service Code
|
HCPCS 21810
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.75
|
|
|
PR SACRAL NERVE STIM TEST LEAD
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS A4290
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCN Commercial |
$22.50
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.92
|
| Rate for Payer: UHC Exchange |
$55.92
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$1,801.00
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$465.83 |
| Max. Negotiated Rate |
$1,396.79 |
| Rate for Payer: Aetna Commercial |
$966.93
|
| Rate for Payer: Aetna Medicare |
$721.59
|
| Rate for Payer: BCBS Complete |
$489.12
|
| Rate for Payer: BCBS MAPPO |
$721.59
|
| Rate for Payer: BCN Commercial |
$1,205.61
|
| Rate for Payer: BCN Medicare Advantage |
$721.59
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cofinity Commercial |
$966.93
|
| Rate for Payer: Cofinity Commercial |
$1,039.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.59
|
| Rate for Payer: Healthscope Commercial |
$865.91
|
| Rate for Payer: Healthscope Whirlpool |
$865.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.67
|
| Rate for Payer: Meridian Medicaid |
$489.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$793.75
|
| Rate for Payer: Nomi Health Commercial |
$865.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.75
|
| Rate for Payer: PACE SWMI |
$721.59
|
| Rate for Payer: PHP Medicare Advantage |
$721.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,221.03
|
| Rate for Payer: Priority Health Medicare |
$721.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,221.03
|
| Rate for Payer: Railroad Medicare Medicare |
$721.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,396.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$721.59
|
| Rate for Payer: UHC Exchange |
$1,396.79
|
| Rate for Payer: UHC Medicaid |
$465.83
|
| Rate for Payer: UHCCP DNSP |
$721.59
|
| Rate for Payer: UHCCP Medicaid |
$465.83
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$2,102.00
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$445.38 |
| Max. Negotiated Rate |
$1,576.50 |
| Rate for Payer: Aetna Commercial |
$924.13
|
| Rate for Payer: Aetna Medicare |
$689.65
|
| Rate for Payer: BCBS Complete |
$467.65
|
| Rate for Payer: BCBS MAPPO |
$689.65
|
| Rate for Payer: BCN Commercial |
$1,143.36
|
| Rate for Payer: BCN Medicare Advantage |
$689.65
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cofinity Commercial |
$993.10
|
| Rate for Payer: Cofinity Commercial |
$924.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.65
|
| Rate for Payer: Healthscope Commercial |
$827.58
|
| Rate for Payer: Healthscope Whirlpool |
$827.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$724.13
|
| Rate for Payer: Meridian Medicaid |
$467.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$758.62
|
| Rate for Payer: Nomi Health Commercial |
$827.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.50
|
| Rate for Payer: PACE SWMI |
$689.65
|
| Rate for Payer: PHP Medicare Advantage |
$689.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,157.99
|
| Rate for Payer: Priority Health Medicare |
$689.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,157.99
|
| Rate for Payer: Railroad Medicare Medicare |
$689.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,314.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$689.65
|
| Rate for Payer: UHC Exchange |
$1,314.83
|
| Rate for Payer: UHC Medicaid |
$445.38
|
| Rate for Payer: UHCCP DNSP |
$689.65
|
| Rate for Payer: UHCCP Medicaid |
$445.38
|
|
|
PR SALPINGOSTOMY
|
Professional
|
Both
|
$2,809.00
|
|
|
Service Code
|
HCPCS 58770
|
| Min. Negotiated Rate |
$484.79 |
| Max. Negotiated Rate |
$2,106.75 |
| Rate for Payer: Aetna Commercial |
$1,010.57
|
| Rate for Payer: Aetna Medicare |
$754.16
|
| Rate for Payer: BCBS Complete |
$509.03
|
| Rate for Payer: BCBS MAPPO |
$754.16
|
| Rate for Payer: BCN Commercial |
$1,290.27
|
| Rate for Payer: BCN Medicare Advantage |
$754.16
|
| Rate for Payer: Cash Price |
$2,247.20
|
| Rate for Payer: Cash Price |
$2,247.20
|
| Rate for Payer: Cofinity Commercial |
$1,085.99
|
| Rate for Payer: Cofinity Commercial |
$1,010.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$754.16
|
| Rate for Payer: Healthscope Commercial |
$904.99
|
| Rate for Payer: Healthscope Whirlpool |
$904.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$791.87
|
| Rate for Payer: Meridian Medicaid |
$509.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$829.58
|
| Rate for Payer: Nomi Health Commercial |
$904.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,106.75
|
| Rate for Payer: PACE SWMI |
$754.16
|
| Rate for Payer: PHP Medicare Advantage |
$754.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,306.77
|
| Rate for Payer: Priority Health Medicare |
$754.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,306.77
|
| Rate for Payer: Railroad Medicare Medicare |
$754.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,525.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$754.16
|
| Rate for Payer: UHC Exchange |
$1,525.91
|
| Rate for Payer: UHC Medicaid |
$484.79
|
| Rate for Payer: UHCCP DNSP |
$754.16
|
| Rate for Payer: UHCCP Medicaid |
$484.79
|
|
|
PR SARSCOV2 VACC 10MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 91319
|
| Min. Negotiated Rate |
$75.76 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Aetna Commercial |
$127.03
|
| Rate for Payer: Aetna Medicare |
$94.80
|
| Rate for Payer: BCBS MAPPO |
$94.80
|
| Rate for Payer: BCBS Trust/PPO |
$83.16
|
| Rate for Payer: BCN Commercial |
$75.76
|
| Rate for Payer: BCN Medicare Advantage |
$94.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$136.51
|
| Rate for Payer: Cofinity Commercial |
$127.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.80
|
| Rate for Payer: Healthscope Commercial |
$113.76
|
| Rate for Payer: Healthscope Whirlpool |
$113.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.28
|
| Rate for Payer: Nomi Health Commercial |
$113.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.50
|
| Rate for Payer: PACE SWMI |
$94.80
|
| Rate for Payer: PHP Medicare Advantage |
$94.80
|
| Rate for Payer: Priority Health Medicare |
$94.80
|
| Rate for Payer: Railroad Medicare Medicare |
$94.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.80
|
| Rate for Payer: UHC Exchange |
$83.16
|
| Rate for Payer: UHCCP DNSP |
$94.80
|
|
|
PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 91320
|
| Min. Negotiated Rate |
$134.56 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$168.37
|
| Rate for Payer: BCBS MAPPO |
$168.37
|
| Rate for Payer: BCBS Trust/PPO |
$168.94
|
| Rate for Payer: BCN Commercial |
$134.56
|
| Rate for Payer: BCN Medicare Advantage |
$168.37
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$225.62
|
| Rate for Payer: Cofinity Commercial |
$242.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.37
|
| Rate for Payer: Healthscope Commercial |
$202.04
|
| Rate for Payer: Healthscope Whirlpool |
$202.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.21
|
| Rate for Payer: Nomi Health Commercial |
$202.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.75
|
| Rate for Payer: PACE SWMI |
$168.37
|
| Rate for Payer: PHP Medicare Advantage |
$168.37
|
| Rate for Payer: Priority Health Medicare |
$168.37
|
| Rate for Payer: Railroad Medicare Medicare |
$168.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.37
|
| Rate for Payer: UHC Exchange |
$169.84
|
| Rate for Payer: UHCCP DNSP |
$168.37
|
|
|
PR SARSCOV2 VACC 3MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 91318
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$65.36
|
| Rate for Payer: BCBS Trust/PPO |
$57.50
|
| Rate for Payer: BCN Commercial |
$56.58
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.55
|
| Rate for Payer: UHC Exchange |
$65.55
|
|
|
PR SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 91321
|
| Min. Negotiated Rate |
$126.93 |
| Max. Negotiated Rate |
$267.00 |
| Rate for Payer: Aetna Commercial |
$197.06
|
| Rate for Payer: Aetna Medicare |
$147.06
|
| Rate for Payer: BCBS MAPPO |
$147.06
|
| Rate for Payer: BCBS Trust/PPO |
$129.00
|
| Rate for Payer: BCN Commercial |
$126.93
|
| Rate for Payer: BCN Medicare Advantage |
$147.06
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$197.06
|
| Rate for Payer: Cofinity Commercial |
$211.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.06
|
| Rate for Payer: Healthscope Commercial |
$176.47
|
| Rate for Payer: Healthscope Whirlpool |
$176.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$161.77
|
| Rate for Payer: Nomi Health Commercial |
$176.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.00
|
| Rate for Payer: PACE SWMI |
$147.06
|
| Rate for Payer: PHP Medicare Advantage |
$147.06
|
| Rate for Payer: Priority Health Medicare |
$147.06
|
| Rate for Payer: Railroad Medicare Medicare |
$147.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$147.06
|
| Rate for Payer: UHC Exchange |
$129.00
|
| Rate for Payer: UHCCP DNSP |
$147.06
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$157.68 |
| Rate for Payer: Aetna Commercial |
$141.85
|
| Rate for Payer: Aetna Medicare |
$105.86
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$105.86
|
| Rate for Payer: BCN Commercial |
$127.86
|
| Rate for Payer: BCN Medicare Advantage |
$105.86
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$152.44
|
| Rate for Payer: Cofinity Commercial |
$141.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.86
|
| Rate for Payer: Healthscope Commercial |
$116.45
|
| Rate for Payer: Healthscope Whirlpool |
$116.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.15
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.45
|
| Rate for Payer: Nomi Health Commercial |
$127.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: PACE SWMI |
$105.86
|
| Rate for Payer: PHP Medicare Advantage |
$105.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$157.68
|
| Rate for Payer: Priority Health Medicare |
$105.86
|
| Rate for Payer: Priority Health Narrow Network |
$157.68
|
| Rate for Payer: Railroad Medicare Medicare |
$105.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$105.86
|
| Rate for Payer: UHC Exchange |
$147.13
|
| Rate for Payer: UHC Medicaid |
$68.16
|
| Rate for Payer: UHCCP DNSP |
$105.86
|
| Rate for Payer: UHCCP Medicaid |
$68.16
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$105.71 |
| Rate for Payer: Aetna Commercial |
$93.57
|
| Rate for Payer: Aetna Medicare |
$69.83
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS MAPPO |
$69.83
|
| Rate for Payer: BCN Commercial |
$85.73
|
| Rate for Payer: BCN Medicare Advantage |
$69.83
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$93.57
|
| Rate for Payer: Cofinity Commercial |
$100.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.83
|
| Rate for Payer: Healthscope Commercial |
$76.81
|
| Rate for Payer: Healthscope Whirlpool |
$76.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.32
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.81
|
| Rate for Payer: Nomi Health Commercial |
$83.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: PACE SWMI |
$69.83
|
| Rate for Payer: PHP Medicare Advantage |
$69.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$105.71
|
| Rate for Payer: Priority Health Medicare |
$69.83
|
| Rate for Payer: Priority Health Narrow Network |
$105.71
|
| Rate for Payer: Railroad Medicare Medicare |
$69.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$69.83
|
| Rate for Payer: UHC Exchange |
$102.10
|
| Rate for Payer: UHC Medicaid |
$44.94
|
| Rate for Payer: UHCCP DNSP |
$69.83
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$65.40 |
| Rate for Payer: Aetna Commercial |
$58.61
|
| Rate for Payer: Aetna Medicare |
$43.74
|
| Rate for Payer: BCBS Complete |
$29.53
|
| Rate for Payer: BCBS MAPPO |
$43.74
|
| Rate for Payer: BCN Commercial |
$53.03
|
| Rate for Payer: BCN Medicare Advantage |
$43.74
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$62.99
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.74
|
| Rate for Payer: Healthscope Commercial |
$48.11
|
| Rate for Payer: Healthscope Whirlpool |
$48.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.93
|
| Rate for Payer: Meridian Medicaid |
$29.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.11
|
| Rate for Payer: Nomi Health Commercial |
$52.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.00
|
| Rate for Payer: PACE SWMI |
$43.74
|
| Rate for Payer: PHP Medicare Advantage |
$43.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.40
|
| Rate for Payer: Priority Health Medicare |
$43.74
|
| Rate for Payer: Priority Health Narrow Network |
$65.40
|
| Rate for Payer: Railroad Medicare Medicare |
$43.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43.74
|
| Rate for Payer: UHC Exchange |
$55.62
|
| Rate for Payer: UHC Medicaid |
$28.12
|
| Rate for Payer: UHCCP DNSP |
$43.74
|
| Rate for Payer: UHCCP Medicaid |
$28.12
|
|
|
PR SBSQ INTENSIVE CARE INFANT PBW 2,501-5,000 GRAMS
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 99480
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$295.50 |
| Rate for Payer: Aetna Commercial |
$134.62
|
| Rate for Payer: Aetna Medicare |
$100.46
|
| Rate for Payer: BCBS Complete |
$105.48
|
| Rate for Payer: BCBS MAPPO |
$100.46
|
| Rate for Payer: BCN Commercial |
$170.81
|
| Rate for Payer: BCN Medicare Advantage |
$100.46
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$144.66
|
| Rate for Payer: Cofinity Commercial |
$134.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.46
|
| Rate for Payer: Healthscope Commercial |
$110.51
|
| Rate for Payer: Healthscope Whirlpool |
$110.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.48
|
| Rate for Payer: Meridian Medicaid |
$105.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.51
|
| Rate for Payer: Nomi Health Commercial |
$120.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.50
|
| Rate for Payer: PACE SWMI |
$100.46
|
| Rate for Payer: PHP Medicare Advantage |
$100.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$153.65
|
| Rate for Payer: Priority Health Medicare |
$100.46
|
| Rate for Payer: Priority Health Narrow Network |
$153.65
|
| Rate for Payer: Railroad Medicare Medicare |
$100.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$100.46
|
| Rate for Payer: UHC Exchange |
$169.59
|
| Rate for Payer: UHC Medicaid |
$100.46
|
| Rate for Payer: UHCCP DNSP |
$100.46
|
| Rate for Payer: UHCCP Medicaid |
$100.46
|
|
|
PR SBSQ INTENSIVE CARE LBW INFANT 1,500-2,500 GRAMS
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 99479
|
| Min. Negotiated Rate |
$104.41 |
| Max. Negotiated Rate |
$295.50 |
| Rate for Payer: Aetna Commercial |
$139.91
|
| Rate for Payer: Aetna Medicare |
$104.41
|
| Rate for Payer: BCBS Complete |
$109.63
|
| Rate for Payer: BCBS MAPPO |
$104.41
|
| Rate for Payer: BCN Commercial |
$177.29
|
| Rate for Payer: BCN Medicare Advantage |
$104.41
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$150.35
|
| Rate for Payer: Cofinity Commercial |
$139.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.41
|
| Rate for Payer: Healthscope Commercial |
$114.85
|
| Rate for Payer: Healthscope Whirlpool |
$114.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.63
|
| Rate for Payer: Meridian Medicaid |
$109.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.85
|
| Rate for Payer: Nomi Health Commercial |
$125.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.50
|
| Rate for Payer: PACE SWMI |
$104.41
|
| Rate for Payer: PHP Medicare Advantage |
$104.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$159.46
|
| Rate for Payer: Priority Health Medicare |
$104.41
|
| Rate for Payer: Priority Health Narrow Network |
$159.46
|
| Rate for Payer: Railroad Medicare Medicare |
$104.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.41
|
| Rate for Payer: UHC Exchange |
$176.63
|
| Rate for Payer: UHC Medicaid |
$104.41
|
| Rate for Payer: UHCCP DNSP |
$104.41
|
| Rate for Payer: UHCCP Medicaid |
$104.41
|
|
|
PR SBSQ INTENSIVE CARE VLBW INFANT<1,500 GRAMS
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 99478
|
| Min. Negotiated Rate |
$115.04 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$154.15
|
| Rate for Payer: Aetna Medicare |
$115.04
|
| Rate for Payer: BCBS Complete |
$120.79
|
| Rate for Payer: BCBS MAPPO |
$115.04
|
| Rate for Payer: BCN Commercial |
$195.21
|
| Rate for Payer: BCN Medicare Advantage |
$115.04
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$165.66
|
| Rate for Payer: Cofinity Commercial |
$154.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.04
|
| Rate for Payer: Healthscope Commercial |
$126.54
|
| Rate for Payer: Healthscope Whirlpool |
$126.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.79
|
| Rate for Payer: Meridian Medicaid |
$120.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.54
|
| Rate for Payer: Nomi Health Commercial |
$138.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PACE SWMI |
$115.04
|
| Rate for Payer: PHP Medicare Advantage |
$115.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$175.59
|
| Rate for Payer: Priority Health Medicare |
$115.04
|
| Rate for Payer: Priority Health Narrow Network |
$175.59
|
| Rate for Payer: Railroad Medicare Medicare |
$115.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.04
|
| Rate for Payer: UHC Exchange |
$194.70
|
| Rate for Payer: UHC Medicaid |
$115.04
|
| Rate for Payer: UHCCP DNSP |
$115.04
|
| Rate for Payer: UHCCP Medicaid |
$115.04
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$228.57 |
| Rate for Payer: Aetna Commercial |
$184.56
|
| Rate for Payer: Aetna Medicare |
$137.73
|
| Rate for Payer: BCBS Complete |
$129.62
|
| Rate for Payer: BCBS MAPPO |
$137.73
|
| Rate for Payer: BCN Commercial |
$228.57
|
| Rate for Payer: BCN Medicare Advantage |
$137.73
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$198.33
|
| Rate for Payer: Cofinity Commercial |
$184.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.73
|
| Rate for Payer: Healthscope Commercial |
$151.50
|
| Rate for Payer: Healthscope Whirlpool |
$151.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.62
|
| Rate for Payer: Meridian Medicaid |
$129.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$151.50
|
| Rate for Payer: Nomi Health Commercial |
$165.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PACE SWMI |
$137.73
|
| Rate for Payer: PHP Medicare Advantage |
$137.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$205.60
|
| Rate for Payer: Priority Health Medicare |
$137.73
|
| Rate for Payer: Priority Health Narrow Network |
$205.60
|
| Rate for Payer: Railroad Medicare Medicare |
$137.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$137.73
|
| Rate for Payer: UHC Exchange |
$188.52
|
| Rate for Payer: UHC Medicaid |
$123.45
|
| Rate for Payer: UHCCP DNSP |
$137.73
|
| Rate for Payer: UHCCP Medicaid |
$123.45
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$59.66 |
| Max. Negotiated Rate |
$110.55 |
| Rate for Payer: Aetna Commercial |
$88.79
|
| Rate for Payer: Aetna Medicare |
$66.26
|
| Rate for Payer: BCBS Complete |
$62.64
|
| Rate for Payer: BCBS MAPPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$110.55
|
| Rate for Payer: BCN Medicare Advantage |
$66.26
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$88.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.26
|
| Rate for Payer: Healthscope Commercial |
$72.89
|
| Rate for Payer: Healthscope Whirlpool |
$72.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.57
|
| Rate for Payer: Meridian Medicaid |
$62.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.89
|
| Rate for Payer: Nomi Health Commercial |
$79.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.50
|
| Rate for Payer: PACE SWMI |
$66.26
|
| Rate for Payer: PHP Medicare Advantage |
$66.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$105.05
|
| Rate for Payer: Priority Health Medicare |
$66.26
|
| Rate for Payer: Priority Health Narrow Network |
$105.05
|
| Rate for Payer: Railroad Medicare Medicare |
$66.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$66.26
|
| Rate for Payer: UHC Exchange |
$96.83
|
| Rate for Payer: UHC Medicaid |
$59.66
|
| Rate for Payer: UHCCP DNSP |
$66.26
|
| Rate for Payer: UHCCP Medicaid |
$59.66
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$86.71 |
| Max. Negotiated Rate |
$160.35 |
| Rate for Payer: Aetna Commercial |
$129.38
|
| Rate for Payer: Aetna Medicare |
$96.55
|
| Rate for Payer: BCBS Complete |
$91.05
|
| Rate for Payer: BCBS MAPPO |
$96.55
|
| Rate for Payer: BCN Commercial |
$160.35
|
| Rate for Payer: BCN Medicare Advantage |
$96.55
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$139.03
|
| Rate for Payer: Cofinity Commercial |
$129.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$106.20
|
| Rate for Payer: Healthscope Whirlpool |
$106.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.38
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$106.20
|
| Rate for Payer: Nomi Health Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PACE SWMI |
$96.55
|
| Rate for Payer: PHP Medicare Advantage |
$96.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.47
|
| Rate for Payer: Priority Health Medicare |
$96.55
|
| Rate for Payer: Priority Health Narrow Network |
$138.47
|
| Rate for Payer: Railroad Medicare Medicare |
$96.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$96.55
|
| Rate for Payer: UHC Exchange |
$127.64
|
| Rate for Payer: UHC Medicaid |
$86.71
|
| Rate for Payer: UHCCP DNSP |
$96.55
|
| Rate for Payer: UHCCP Medicaid |
$86.71
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$32.62 |
| Max. Negotiated Rate |
$61.67 |
| Rate for Payer: Aetna Commercial |
$48.56
|
| Rate for Payer: Aetna Medicare |
$36.24
|
| Rate for Payer: BCBS Complete |
$34.25
|
| Rate for Payer: BCBS MAPPO |
$36.24
|
| Rate for Payer: BCN Commercial |
$59.26
|
| Rate for Payer: BCN Medicare Advantage |
$36.24
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$48.56
|
| Rate for Payer: Cofinity Commercial |
$52.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.24
|
| Rate for Payer: Healthscope Commercial |
$39.86
|
| Rate for Payer: Healthscope Whirlpool |
$39.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.05
|
| Rate for Payer: Meridian Medicaid |
$34.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.86
|
| Rate for Payer: Nomi Health Commercial |
$43.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.75
|
| Rate for Payer: PACE SWMI |
$36.24
|
| Rate for Payer: PHP Medicare Advantage |
$36.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$36.24
|
| Rate for Payer: Priority Health Narrow Network |
$53.30
|
| Rate for Payer: Railroad Medicare Medicare |
$36.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36.24
|
| Rate for Payer: UHC Exchange |
$61.67
|
| Rate for Payer: UHC Medicaid |
$32.62
|
| Rate for Payer: UHCCP DNSP |
$36.24
|
| Rate for Payer: UHCCP Medicaid |
$32.62
|
|
|
PR SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 99224
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.00
|
|
