|
PR SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 36215
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$271.22
|
| Rate for Payer: Aetna Medicare |
$202.40
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS MAPPO |
$202.40
|
| Rate for Payer: BCN Medicare Advantage |
$202.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$291.46
|
| Rate for Payer: Cofinity Commercial |
$271.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.40
|
| Rate for Payer: Healthscope Commercial |
$242.88
|
| Rate for Payer: Healthscope Whirlpool |
$242.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.52
|
| Rate for Payer: Nomi Health Commercial |
$242.88
|
| Rate for Payer: PACE SWMI |
$202.40
|
| Rate for Payer: PHP Medicare Advantage |
$202.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Medicare |
$202.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.40
|
| Rate for Payer: UHC Medicare Advantage |
$202.40
|
| Rate for Payer: UHCCP DNSP |
$202.40
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 36248
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$61.44
|
| Rate for Payer: Aetna Medicare |
$45.85
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS MAPPO |
$45.85
|
| Rate for Payer: BCN Medicare Advantage |
$45.85
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$66.02
|
| Rate for Payer: Cofinity Commercial |
$61.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.85
|
| Rate for Payer: Healthscope Commercial |
$55.02
|
| Rate for Payer: Healthscope Whirlpool |
$55.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.14
|
| Rate for Payer: Nomi Health Commercial |
$55.02
|
| Rate for Payer: PACE SWMI |
$45.85
|
| Rate for Payer: PHP Medicare Advantage |
$45.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Medicare |
$45.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.85
|
| Rate for Payer: UHC Medicare Advantage |
$45.85
|
| Rate for Payer: UHCCP DNSP |
$45.85
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 36218
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$67.48
|
| Rate for Payer: Aetna Medicare |
$50.36
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$50.36
|
| Rate for Payer: BCN Medicare Advantage |
$50.36
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$72.52
|
| Rate for Payer: Cofinity Commercial |
$67.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.36
|
| Rate for Payer: Healthscope Commercial |
$60.43
|
| Rate for Payer: Healthscope Whirlpool |
$60.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.88
|
| Rate for Payer: Nomi Health Commercial |
$60.43
|
| Rate for Payer: PACE SWMI |
$50.36
|
| Rate for Payer: PHP Medicare Advantage |
$50.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$50.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.36
|
| Rate for Payer: UHC Medicare Advantage |
$50.36
|
| Rate for Payer: UHCCP DNSP |
$50.36
|
|
|
PR SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 36015
|
| Min. Negotiated Rate |
$163.57 |
| Max. Negotiated Rate |
$621.40 |
| Rate for Payer: Aetna Commercial |
$219.18
|
| Rate for Payer: Aetna Medicare |
$163.57
|
| Rate for Payer: BCBS Complete |
$382.40
|
| Rate for Payer: BCBS MAPPO |
$163.57
|
| Rate for Payer: BCN Medicare Advantage |
$163.57
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$235.54
|
| Rate for Payer: Cofinity Commercial |
$219.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.57
|
| Rate for Payer: Healthscope Commercial |
$196.28
|
| Rate for Payer: Healthscope Whirlpool |
$196.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.75
|
| Rate for Payer: Nomi Health Commercial |
$196.28
|
| Rate for Payer: PACE SWMI |
$163.57
|
| Rate for Payer: PHP Medicare Advantage |
$163.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health Medicare |
$163.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.57
|
| Rate for Payer: UHC Medicare Advantage |
$163.57
|
| Rate for Payer: UHCCP DNSP |
$163.57
|
|
|
PR SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 36011
|
| Min. Negotiated Rate |
$148.41 |
| Max. Negotiated Rate |
$485.55 |
| Rate for Payer: Aetna Commercial |
$198.87
|
| Rate for Payer: Aetna Medicare |
$148.41
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: BCBS MAPPO |
$148.41
|
| Rate for Payer: BCN Medicare Advantage |
$148.41
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cofinity Commercial |
$213.71
|
| Rate for Payer: Cofinity Commercial |
$198.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.41
|
| Rate for Payer: Healthscope Commercial |
$178.09
|
| Rate for Payer: Healthscope Whirlpool |
$178.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.83
|
| Rate for Payer: Nomi Health Commercial |
$178.09
|
| Rate for Payer: PACE SWMI |
$148.41
|
| Rate for Payer: PHP Medicare Advantage |
$148.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.55
|
| Rate for Payer: Priority Health Medicare |
$148.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.41
|
| Rate for Payer: UHC Medicare Advantage |
$148.41
|
| Rate for Payer: UHCCP DNSP |
$148.41
|
|
|
PR SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 36012
|
| Min. Negotiated Rate |
$166.65 |
| Max. Negotiated Rate |
$637.00 |
| Rate for Payer: Aetna Commercial |
$223.31
|
| Rate for Payer: Aetna Medicare |
$166.65
|
| Rate for Payer: BCBS Complete |
$392.00
|
| Rate for Payer: BCBS MAPPO |
$166.65
|
| Rate for Payer: BCN Medicare Advantage |
$166.65
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cofinity Commercial |
$239.98
|
| Rate for Payer: Cofinity Commercial |
$223.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.65
|
| Rate for Payer: Healthscope Commercial |
$199.98
|
| Rate for Payer: Healthscope Whirlpool |
$199.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.98
|
| Rate for Payer: Nomi Health Commercial |
$199.98
|
| Rate for Payer: PACE SWMI |
$166.65
|
| Rate for Payer: PHP Medicare Advantage |
$166.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.00
|
| Rate for Payer: Priority Health Medicare |
$166.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.65
|
| Rate for Payer: UHC Medicare Advantage |
$166.65
|
| Rate for Payer: UHCCP DNSP |
$166.65
|
|
|
PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 36225
|
| Min. Negotiated Rate |
$318.61 |
| Max. Negotiated Rate |
$1,162.20 |
| Rate for Payer: Aetna Commercial |
$426.94
|
| Rate for Payer: Aetna Medicare |
$318.61
|
| Rate for Payer: BCBS Complete |
$715.20
|
| Rate for Payer: BCBS MAPPO |
$318.61
|
| Rate for Payer: BCN Medicare Advantage |
$318.61
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cofinity Commercial |
$458.80
|
| Rate for Payer: Cofinity Commercial |
$426.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.61
|
| Rate for Payer: Healthscope Commercial |
$382.33
|
| Rate for Payer: Healthscope Whirlpool |
$382.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.54
|
| Rate for Payer: Nomi Health Commercial |
$382.33
|
| Rate for Payer: PACE SWMI |
$318.61
|
| Rate for Payer: PHP Medicare Advantage |
$318.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.20
|
| Rate for Payer: Priority Health Medicare |
$318.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.61
|
| Rate for Payer: UHC Medicare Advantage |
$318.61
|
| Rate for Payer: UHCCP DNSP |
$318.61
|
|
|
PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 36226
|
| Min. Negotiated Rate |
$357.06 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna Commercial |
$478.46
|
| Rate for Payer: Aetna Medicare |
$357.06
|
| Rate for Payer: BCBS Complete |
$504.00
|
| Rate for Payer: BCBS MAPPO |
$357.06
|
| Rate for Payer: BCN Medicare Advantage |
$357.06
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cofinity Commercial |
$514.17
|
| Rate for Payer: Cofinity Commercial |
$478.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.06
|
| Rate for Payer: Healthscope Commercial |
$428.47
|
| Rate for Payer: Healthscope Whirlpool |
$428.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.91
|
| Rate for Payer: Nomi Health Commercial |
$428.47
|
| Rate for Payer: PACE SWMI |
$357.06
|
| Rate for Payer: PHP Medicare Advantage |
$357.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health Medicare |
$357.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.06
|
| Rate for Payer: UHC Medicare Advantage |
$357.06
|
| Rate for Payer: UHCCP DNSP |
$357.06
|
|
|
PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 36227
|
| Min. Negotiated Rate |
$117.73 |
| Max. Negotiated Rate |
$258.70 |
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Medicare |
$117.73
|
| Rate for Payer: BCBS Complete |
$159.20
|
| Rate for Payer: BCBS MAPPO |
$117.73
|
| Rate for Payer: BCN Medicare Advantage |
$117.73
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Cofinity Commercial |
$157.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.73
|
| Rate for Payer: Healthscope Commercial |
$141.28
|
| Rate for Payer: Healthscope Whirlpool |
$141.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.62
|
| Rate for Payer: Nomi Health Commercial |
$141.28
|
| Rate for Payer: PACE SWMI |
$117.73
|
| Rate for Payer: PHP Medicare Advantage |
$117.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.70
|
| Rate for Payer: Priority Health Medicare |
$117.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.73
|
| Rate for Payer: UHC Medicare Advantage |
$117.73
|
| Rate for Payer: UHCCP DNSP |
$117.73
|
|
|
PR SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 95806
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$126.68 |
| Rate for Payer: Aetna Commercial |
$117.88
|
| Rate for Payer: Aetna Commercial |
$117.88
|
| Rate for Payer: Aetna Medicare |
$87.97
|
| Rate for Payer: Aetna Medicare |
$87.97
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS Complete |
$226.80
|
| Rate for Payer: BCBS MAPPO |
$87.97
|
| Rate for Payer: BCBS MAPPO |
$87.97
|
| Rate for Payer: BCN Medicare Advantage |
$87.97
|
| Rate for Payer: BCN Medicare Advantage |
$87.97
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cofinity Commercial |
$117.88
|
| Rate for Payer: Cofinity Commercial |
$126.68
|
| Rate for Payer: Cofinity Commercial |
$117.88
|
| Rate for Payer: Cofinity Commercial |
$126.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.97
|
| Rate for Payer: Healthscope Commercial |
$105.56
|
| Rate for Payer: Healthscope Commercial |
$105.56
|
| Rate for Payer: Healthscope Whirlpool |
$105.56
|
| Rate for Payer: Healthscope Whirlpool |
$105.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.37
|
| Rate for Payer: Nomi Health Commercial |
$105.56
|
| Rate for Payer: Nomi Health Commercial |
$105.56
|
| Rate for Payer: PACE SWMI |
$87.97
|
| Rate for Payer: PACE SWMI |
$87.97
|
| Rate for Payer: PHP Medicare Advantage |
$87.97
|
| Rate for Payer: PHP Medicare Advantage |
$87.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.55
|
| Rate for Payer: Priority Health Medicare |
$87.97
|
| Rate for Payer: Priority Health Medicare |
$87.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.97
|
| Rate for Payer: UHC Medicare Advantage |
$87.97
|
| Rate for Payer: UHC Medicare Advantage |
$87.97
|
| Rate for Payer: UHCCP DNSP |
$87.97
|
| Rate for Payer: UHCCP DNSP |
$87.97
|
|
|
PR SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 95807
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$534.28 |
| Rate for Payer: Aetna Commercial |
$497.18
|
| Rate for Payer: Aetna Commercial |
$497.18
|
| Rate for Payer: Aetna Medicare |
$371.03
|
| Rate for Payer: Aetna Medicare |
$371.03
|
| Rate for Payer: BCBS Complete |
$595.60
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS MAPPO |
$371.03
|
| Rate for Payer: BCBS MAPPO |
$371.03
|
| Rate for Payer: BCN Medicare Advantage |
$371.03
|
| Rate for Payer: BCN Medicare Advantage |
$371.03
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cofinity Commercial |
$497.18
|
| Rate for Payer: Cofinity Commercial |
$534.28
|
| Rate for Payer: Cofinity Commercial |
$497.18
|
| Rate for Payer: Cofinity Commercial |
$534.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.03
|
| Rate for Payer: Healthscope Commercial |
$445.24
|
| Rate for Payer: Healthscope Commercial |
$445.24
|
| Rate for Payer: Healthscope Whirlpool |
$445.24
|
| Rate for Payer: Healthscope Whirlpool |
$445.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.58
|
| Rate for Payer: Nomi Health Commercial |
$445.24
|
| Rate for Payer: Nomi Health Commercial |
$445.24
|
| Rate for Payer: PACE SWMI |
$371.03
|
| Rate for Payer: PACE SWMI |
$371.03
|
| Rate for Payer: PHP Medicare Advantage |
$371.03
|
| Rate for Payer: PHP Medicare Advantage |
$371.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health Medicare |
$371.03
|
| Rate for Payer: Priority Health Medicare |
$371.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.03
|
| Rate for Payer: UHC Medicare Advantage |
$371.03
|
| Rate for Payer: UHC Medicare Advantage |
$371.03
|
| Rate for Payer: UHCCP DNSP |
$371.03
|
| Rate for Payer: UHCCP DNSP |
$371.03
|
|
|
PR SLING OPERATION STRESS INCONTINENCE
|
Professional
|
Both
|
$2,280.00
|
|
|
Service Code
|
HCPCS 57288
|
| Min. Negotiated Rate |
$712.02 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Aetna Commercial |
$954.11
|
| Rate for Payer: Aetna Medicare |
$712.02
|
| Rate for Payer: BCBS Complete |
$912.00
|
| Rate for Payer: BCBS MAPPO |
$712.02
|
| Rate for Payer: BCN Medicare Advantage |
$712.02
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cofinity Commercial |
$954.11
|
| Rate for Payer: Cofinity Commercial |
$1,025.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.02
|
| Rate for Payer: Healthscope Commercial |
$854.42
|
| Rate for Payer: Healthscope Whirlpool |
$854.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$747.62
|
| Rate for Payer: Nomi Health Commercial |
$854.42
|
| Rate for Payer: PACE SWMI |
$712.02
|
| Rate for Payer: PHP Medicare Advantage |
$712.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,482.00
|
| Rate for Payer: Priority Health Medicare |
$712.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.02
|
| Rate for Payer: UHC Medicare Advantage |
$712.02
|
| Rate for Payer: UHCCP DNSP |
$712.02
|
|
|
PR SLING OPRATION CORRJ MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 53440
|
| Min. Negotiated Rate |
$670.80 |
| Max. Negotiated Rate |
$1,090.05 |
| Rate for Payer: Aetna Commercial |
$963.79
|
| Rate for Payer: Aetna Medicare |
$719.25
|
| Rate for Payer: BCBS Complete |
$670.80
|
| Rate for Payer: BCBS MAPPO |
$719.25
|
| Rate for Payer: BCN Medicare Advantage |
$719.25
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cofinity Commercial |
$963.79
|
| Rate for Payer: Cofinity Commercial |
$1,035.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.25
|
| Rate for Payer: Healthscope Commercial |
$863.10
|
| Rate for Payer: Healthscope Whirlpool |
$863.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.21
|
| Rate for Payer: Nomi Health Commercial |
$863.10
|
| Rate for Payer: PACE SWMI |
$719.25
|
| Rate for Payer: PHP Medicare Advantage |
$719.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health Medicare |
$719.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.25
|
| Rate for Payer: UHC Medicare Advantage |
$719.25
|
| Rate for Payer: UHCCP DNSP |
$719.25
|
|
|
PR SLINGS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$10.76
|
| Rate for Payer: BCN Medicare Advantage |
$10.76
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$15.49
|
| Rate for Payer: Cofinity Commercial |
$14.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.76
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Healthscope Whirlpool |
$12.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.30
|
| Rate for Payer: Nomi Health Commercial |
$12.91
|
| Rate for Payer: PACE SWMI |
$10.76
|
| Rate for Payer: PHP Medicare Advantage |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$10.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.76
|
| Rate for Payer: UHC Medicare Advantage |
$10.76
|
| Rate for Payer: UHCCP DNSP |
$10.76
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$217.75 |
| Rate for Payer: Aetna Commercial |
$180.43
|
| Rate for Payer: Aetna Medicare |
$134.65
|
| Rate for Payer: BCBS Complete |
$134.00
|
| Rate for Payer: BCBS MAPPO |
$134.65
|
| Rate for Payer: BCN Medicare Advantage |
$134.65
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$193.90
|
| Rate for Payer: Cofinity Commercial |
$180.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.65
|
| Rate for Payer: Healthscope Commercial |
$161.58
|
| Rate for Payer: Healthscope Whirlpool |
$161.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.38
|
| Rate for Payer: Nomi Health Commercial |
$161.58
|
| Rate for Payer: PACE SWMI |
$134.65
|
| Rate for Payer: PHP Medicare Advantage |
$134.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$134.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.65
|
| Rate for Payer: UHC Medicare Advantage |
$134.65
|
| Rate for Payer: UHCCP DNSP |
$134.65
|
|
|
PR SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 95800
|
| Min. Negotiated Rate |
$116.32 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$155.87
|
| Rate for Payer: Aetna Commercial |
$155.87
|
| Rate for Payer: Aetna Medicare |
$116.32
|
| Rate for Payer: Aetna Medicare |
$116.32
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$116.32
|
| Rate for Payer: BCBS MAPPO |
$116.32
|
| Rate for Payer: BCN Medicare Advantage |
$116.32
|
| Rate for Payer: BCN Medicare Advantage |
$116.32
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$155.87
|
| Rate for Payer: Cofinity Commercial |
$167.50
|
| Rate for Payer: Cofinity Commercial |
$155.87
|
| Rate for Payer: Cofinity Commercial |
$167.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.32
|
| Rate for Payer: Healthscope Commercial |
$139.58
|
| Rate for Payer: Healthscope Commercial |
$139.58
|
| Rate for Payer: Healthscope Whirlpool |
$139.58
|
| Rate for Payer: Healthscope Whirlpool |
$139.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.14
|
| Rate for Payer: Nomi Health Commercial |
$139.58
|
| Rate for Payer: Nomi Health Commercial |
$139.58
|
| Rate for Payer: PACE SWMI |
$116.32
|
| Rate for Payer: PACE SWMI |
$116.32
|
| Rate for Payer: PHP Medicare Advantage |
$116.32
|
| Rate for Payer: PHP Medicare Advantage |
$116.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$116.32
|
| Rate for Payer: Priority Health Medicare |
$116.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.32
|
| Rate for Payer: UHC Medicare Advantage |
$116.32
|
| Rate for Payer: UHC Medicare Advantage |
$116.32
|
| Rate for Payer: UHCCP DNSP |
$116.32
|
| Rate for Payer: UHCCP DNSP |
$116.32
|
|
|
PR SMOKE/TOBACCO COUNSELNG 3-10
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0375
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$76.39
|
| Rate for Payer: Aetna Medicare |
$57.01
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$57.01
|
| Rate for Payer: BCN Medicare Advantage |
$57.01
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$82.09
|
| Rate for Payer: Cofinity Commercial |
$76.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.01
|
| Rate for Payer: Healthscope Commercial |
$68.41
|
| Rate for Payer: Healthscope Whirlpool |
$68.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.86
|
| Rate for Payer: Nomi Health Commercial |
$68.41
|
| Rate for Payer: PACE SWMI |
$57.01
|
| Rate for Payer: PHP Medicare Advantage |
$57.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$57.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.01
|
| Rate for Payer: UHC Medicare Advantage |
$57.01
|
| Rate for Payer: UHCCP DNSP |
$57.01
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$123.39
|
| Rate for Payer: Aetna Medicare |
$92.08
|
| Rate for Payer: BCBS Complete |
$229.20
|
| Rate for Payer: BCBS MAPPO |
$92.08
|
| Rate for Payer: BCN Medicare Advantage |
$92.08
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cofinity Commercial |
$132.60
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$110.50
|
| Rate for Payer: Healthscope Whirlpool |
$110.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.68
|
| Rate for Payer: Nomi Health Commercial |
$110.50
|
| Rate for Payer: PACE SWMI |
$92.08
|
| Rate for Payer: PHP Medicare Advantage |
$92.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health Medicare |
$92.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.08
|
| Rate for Payer: UHC Medicare Advantage |
$92.08
|
| Rate for Payer: UHCCP DNSP |
$92.08
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Aetna Commercial |
$152.71
|
| Rate for Payer: Aetna Medicare |
$113.96
|
| Rate for Payer: BCBS Complete |
$292.40
|
| Rate for Payer: BCBS MAPPO |
$113.96
|
| Rate for Payer: BCN Medicare Advantage |
$113.96
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cofinity Commercial |
$164.10
|
| Rate for Payer: Cofinity Commercial |
$152.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.96
|
| Rate for Payer: Healthscope Commercial |
$136.75
|
| Rate for Payer: Healthscope Whirlpool |
$136.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.66
|
| Rate for Payer: Nomi Health Commercial |
$136.75
|
| Rate for Payer: PACE SWMI |
$113.96
|
| Rate for Payer: PHP Medicare Advantage |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.15
|
| Rate for Payer: Priority Health Medicare |
$113.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.96
|
| Rate for Payer: UHC Medicare Advantage |
$113.96
|
| Rate for Payer: UHCCP DNSP |
$113.96
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$113.79 |
| Rate for Payer: Aetna Commercial |
$105.89
|
| Rate for Payer: Aetna Medicare |
$79.02
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$79.02
|
| Rate for Payer: BCN Medicare Advantage |
$79.02
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$113.79
|
| Rate for Payer: Cofinity Commercial |
$105.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.02
|
| Rate for Payer: Healthscope Commercial |
$94.82
|
| Rate for Payer: Healthscope Whirlpool |
$94.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.97
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: PACE SWMI |
$79.02
|
| Rate for Payer: PHP Medicare Advantage |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$79.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.02
|
| Rate for Payer: UHC Medicare Advantage |
$79.02
|
| Rate for Payer: UHCCP DNSP |
$79.02
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$36.05
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$26.90
|
| Rate for Payer: BCN Medicare Advantage |
$26.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$38.74
|
| Rate for Payer: Cofinity Commercial |
$36.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.90
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Healthscope Whirlpool |
$32.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.25
|
| Rate for Payer: Nomi Health Commercial |
$32.28
|
| Rate for Payer: PACE SWMI |
$26.90
|
| Rate for Payer: PHP Medicare Advantage |
$26.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.90
|
| Rate for Payer: UHC Medicare Advantage |
$26.90
|
| Rate for Payer: UHCCP DNSP |
$26.90
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$59.95 |
| Rate for Payer: Aetna Commercial |
$55.78
|
| Rate for Payer: Aetna Medicare |
$41.63
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$41.63
|
| Rate for Payer: BCN Medicare Advantage |
$41.63
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$55.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.63
|
| Rate for Payer: Healthscope Commercial |
$49.96
|
| Rate for Payer: Healthscope Whirlpool |
$49.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.71
|
| Rate for Payer: Nomi Health Commercial |
$49.96
|
| Rate for Payer: PACE SWMI |
$41.63
|
| Rate for Payer: PHP Medicare Advantage |
$41.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$41.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.63
|
| Rate for Payer: UHC Medicare Advantage |
$41.63
|
| Rate for Payer: UHCCP DNSP |
$41.63
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna Medicare |
$152.94
|
| Rate for Payer: BCBS Complete |
$360.00
|
| Rate for Payer: BCBS MAPPO |
$152.94
|
| Rate for Payer: BCN Medicare Advantage |
$152.94
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$204.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.94
|
| Rate for Payer: Healthscope Commercial |
$183.53
|
| Rate for Payer: Healthscope Whirlpool |
$183.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.59
|
| Rate for Payer: Nomi Health Commercial |
$183.53
|
| Rate for Payer: PACE SWMI |
$152.94
|
| Rate for Payer: PHP Medicare Advantage |
$152.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.00
|
| Rate for Payer: Priority Health Medicare |
$152.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.94
|
| Rate for Payer: UHC Medicare Advantage |
$152.94
|
| Rate for Payer: UHCCP DNSP |
$152.94
|
|
