|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG
|
Professional
|
Both
|
$7,305.00
|
|
|
Service Code
|
HCPCS 63085
|
| Min. Negotiated Rate |
$1,160.64 |
| Max. Negotiated Rate |
$5,478.75 |
| Rate for Payer: Aetna Commercial |
$2,431.62
|
| Rate for Payer: Aetna Medicare |
$1,814.64
|
| Rate for Payer: BCBS Complete |
$1,218.67
|
| Rate for Payer: BCBS MAPPO |
$1,814.64
|
| Rate for Payer: BCN Commercial |
$3,206.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,814.64
|
| Rate for Payer: Cash Price |
$5,844.00
|
| Rate for Payer: Cash Price |
$5,844.00
|
| Rate for Payer: Cofinity Commercial |
$2,613.08
|
| Rate for Payer: Cofinity Commercial |
$2,431.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,814.64
|
| Rate for Payer: Healthscope Commercial |
$2,177.57
|
| Rate for Payer: Healthscope Whirlpool |
$2,177.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,905.37
|
| Rate for Payer: Meridian Medicaid |
$1,218.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,996.10
|
| Rate for Payer: Nomi Health Commercial |
$2,177.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,478.75
|
| Rate for Payer: PACE SWMI |
$1,814.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,814.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,160.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,389.98
|
| Rate for Payer: Priority Health Medicare |
$1,814.64
|
| Rate for Payer: Priority Health Narrow Network |
$3,389.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,814.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,404.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,814.64
|
| Rate for Payer: UHC Exchange |
$3,404.07
|
| Rate for Payer: UHC Medicaid |
$1,160.64
|
| Rate for Payer: UHCCP DNSP |
$1,814.64
|
| Rate for Payer: UHCCP Medicaid |
$1,160.64
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG
|
Professional
|
Both
|
$2,435.00
|
|
|
Service Code
|
HCPCS 63086
|
| Min. Negotiated Rate |
$109.06 |
| Max. Negotiated Rate |
$1,826.25 |
| Rate for Payer: Aetna Commercial |
$231.28
|
| Rate for Payer: Aetna Medicare |
$172.60
|
| Rate for Payer: BCBS Complete |
$114.51
|
| Rate for Payer: BCBS MAPPO |
$172.60
|
| Rate for Payer: BCN Commercial |
$313.47
|
| Rate for Payer: BCN Medicare Advantage |
$172.60
|
| Rate for Payer: Cash Price |
$1,948.00
|
| Rate for Payer: Cash Price |
$1,948.00
|
| Rate for Payer: Cofinity Commercial |
$248.54
|
| Rate for Payer: Cofinity Commercial |
$231.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.60
|
| Rate for Payer: Healthscope Commercial |
$207.12
|
| Rate for Payer: Healthscope Whirlpool |
$207.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.23
|
| Rate for Payer: Meridian Medicaid |
$114.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$189.86
|
| Rate for Payer: Nomi Health Commercial |
$207.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.25
|
| Rate for Payer: PACE SWMI |
$172.60
|
| Rate for Payer: PHP Medicare Advantage |
$172.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$331.43
|
| Rate for Payer: Priority Health Medicare |
$172.60
|
| Rate for Payer: Priority Health Narrow Network |
$331.43
|
| Rate for Payer: Railroad Medicare Medicare |
$172.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$172.60
|
| Rate for Payer: UHC Exchange |
$339.42
|
| Rate for Payer: UHC Medicaid |
$109.06
|
| Rate for Payer: UHCCP DNSP |
$172.60
|
| Rate for Payer: UHCCP Medicaid |
$109.06
|
|
|
PR VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG
|
Professional
|
Both
|
$1,611.00
|
|
|
Service Code
|
HCPCS 63308
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Aetna Commercial |
$391.05
|
| Rate for Payer: Aetna Medicare |
$291.83
|
| Rate for Payer: BCBS Complete |
$193.46
|
| Rate for Payer: BCBS MAPPO |
$291.83
|
| Rate for Payer: BCN Commercial |
$525.19
|
| Rate for Payer: BCN Medicare Advantage |
$291.83
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cofinity Commercial |
$420.24
|
| Rate for Payer: Cofinity Commercial |
$391.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.83
|
| Rate for Payer: Healthscope Commercial |
$350.20
|
| Rate for Payer: Healthscope Whirlpool |
$350.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.42
|
| Rate for Payer: Meridian Medicaid |
$193.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$321.01
|
| Rate for Payer: Nomi Health Commercial |
$350.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.25
|
| Rate for Payer: PACE SWMI |
$291.83
|
| Rate for Payer: PHP Medicare Advantage |
$291.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$555.27
|
| Rate for Payer: Priority Health Medicare |
$291.83
|
| Rate for Payer: Priority Health Narrow Network |
$555.27
|
| Rate for Payer: Railroad Medicare Medicare |
$291.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$575.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$291.83
|
| Rate for Payer: UHC Exchange |
$575.26
|
| Rate for Payer: UHC Medicaid |
$184.25
|
| Rate for Payer: UHCCP DNSP |
$291.83
|
| Rate for Payer: UHCCP Medicaid |
$184.25
|
|
|
PR VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL
|
Professional
|
Both
|
$1,810.00
|
|
|
Service Code
|
HCPCS 22512
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$1,357.50 |
| Rate for Payer: Aetna Commercial |
$244.04
|
| Rate for Payer: Aetna Medicare |
$182.12
|
| Rate for Payer: BCBS Complete |
$121.44
|
| Rate for Payer: BCBS MAPPO |
$182.12
|
| Rate for Payer: BCN Commercial |
$306.75
|
| Rate for Payer: BCN Medicare Advantage |
$182.12
|
| Rate for Payer: Cash Price |
$1,448.00
|
| Rate for Payer: Cash Price |
$1,448.00
|
| Rate for Payer: Cofinity Commercial |
$262.25
|
| Rate for Payer: Cofinity Commercial |
$244.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.12
|
| Rate for Payer: Healthscope Commercial |
$218.54
|
| Rate for Payer: Healthscope Whirlpool |
$218.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.23
|
| Rate for Payer: Meridian Medicaid |
$121.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.33
|
| Rate for Payer: Nomi Health Commercial |
$218.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,357.50
|
| Rate for Payer: PACE SWMI |
$182.12
|
| Rate for Payer: PHP Medicare Advantage |
$182.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$327.91
|
| Rate for Payer: Priority Health Medicare |
$182.12
|
| Rate for Payer: Priority Health Narrow Network |
$327.91
|
| Rate for Payer: Railroad Medicare Medicare |
$182.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.12
|
| Rate for Payer: UHC Exchange |
$366.65
|
| Rate for Payer: UHC Medicaid |
$115.66
|
| Rate for Payer: UHCCP DNSP |
$182.12
|
| Rate for Payer: UHCCP Medicaid |
$115.66
|
|
|
PR VESICULOTOMY COMPLICATED
|
Professional
|
Both
|
$855.00
|
|
|
Service Code
|
HCPCS 55605
|
| Min. Negotiated Rate |
$307.36 |
| Max. Negotiated Rate |
$917.94 |
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$641.25
|
| Rate for Payer: PACE SWMI |
$472.80
|
| Rate for Payer: PHP Medicare Advantage |
$472.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$859.26
|
| Rate for Payer: Priority Health Medicare |
$472.80
|
| Rate for Payer: Priority Health Narrow Network |
$859.26
|
| Rate for Payer: Railroad Medicare Medicare |
$472.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$917.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$472.80
|
| Rate for Payer: UHC Exchange |
$917.94
|
| Rate for Payer: UHC Medicaid |
$307.36
|
| Rate for Payer: UHCCP DNSP |
$472.80
|
| Rate for Payer: UHCCP Medicaid |
$307.36
|
| Rate for Payer: Aetna Commercial |
$633.55
|
| Rate for Payer: Aetna Medicare |
$472.80
|
| Rate for Payer: BCBS Complete |
$322.73
|
| Rate for Payer: BCBS MAPPO |
$472.80
|
| Rate for Payer: BCN Commercial |
$788.80
|
| Rate for Payer: BCN Medicare Advantage |
$472.80
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cofinity Commercial |
$680.83
|
| Rate for Payer: Cofinity Commercial |
$633.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.80
|
| Rate for Payer: Healthscope Commercial |
$567.36
|
| Rate for Payer: Healthscope Whirlpool |
$567.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$496.44
|
| Rate for Payer: Meridian Medicaid |
$322.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$520.08
|
| Rate for Payer: Nomi Health Commercial |
$567.36
|
|
|
PR VESSEL MAPPING HEMO ACCESS
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS G0365
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$282.75 |
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.75
|
|
|
PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV
|
Professional
|
Both
|
$3,738.00
|
|
|
Service Code
|
HCPCS 43640
|
| Min. Negotiated Rate |
$715.25 |
| Max. Negotiated Rate |
$2,803.50 |
| Rate for Payer: Aetna Commercial |
$1,495.65
|
| Rate for Payer: Aetna Medicare |
$1,116.16
|
| Rate for Payer: BCBS Complete |
$751.01
|
| Rate for Payer: BCBS MAPPO |
$1,116.16
|
| Rate for Payer: BCN Commercial |
$1,794.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,116.16
|
| Rate for Payer: Cash Price |
$2,990.40
|
| Rate for Payer: Cash Price |
$2,990.40
|
| Rate for Payer: Cofinity Commercial |
$1,495.65
|
| Rate for Payer: Cofinity Commercial |
$1,607.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,116.16
|
| Rate for Payer: Healthscope Commercial |
$1,339.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,339.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,171.97
|
| Rate for Payer: Meridian Medicaid |
$751.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,227.78
|
| Rate for Payer: Nomi Health Commercial |
$1,339.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,803.50
|
| Rate for Payer: PACE SWMI |
$1,116.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,116.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,186.14
|
| Rate for Payer: Priority Health Medicare |
$1,116.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,186.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,116.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,102.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,116.16
|
| Rate for Payer: UHC Exchange |
$2,102.25
|
| Rate for Payer: UHC Medicaid |
$715.25
|
| Rate for Payer: UHCCP DNSP |
$1,116.16
|
| Rate for Payer: UHCCP Medicaid |
$715.25
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 34845
|
| Min. Negotiated Rate |
$672.75 |
| Max. Negotiated Rate |
$2,923.92 |
| Rate for Payer: Aetna Commercial |
$2,344.71
|
| Rate for Payer: BCBS Complete |
$1,424.60
|
| Rate for Payer: BCN Commercial |
$1,831.76
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Meridian Medicaid |
$1,424.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$672.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,356.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,923.92
|
| Rate for Payer: Priority Health Narrow Network |
$2,923.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,696.18
|
| Rate for Payer: UHC Exchange |
$2,696.18
|
| Rate for Payer: UHC Medicaid |
$1,356.76
|
| Rate for Payer: UHCCP Medicaid |
$1,356.76
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS
|
Professional
|
Both
|
$3,152.00
|
|
|
Service Code
|
HCPCS 34846
|
| Min. Negotiated Rate |
$1,492.43 |
| Max. Negotiated Rate |
$3,161.14 |
| Rate for Payer: Aetna Commercial |
$2,496.07
|
| Rate for Payer: BCBS Complete |
$1,567.05
|
| Rate for Payer: BCN Commercial |
$2,035.28
|
| Rate for Payer: Cash Price |
$2,521.60
|
| Rate for Payer: Cash Price |
$2,521.60
|
| Rate for Payer: Meridian Medicaid |
$1,567.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,364.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,492.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,161.14
|
| Rate for Payer: Priority Health Narrow Network |
$3,161.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,811.60
|
| Rate for Payer: UHC Exchange |
$2,811.60
|
| Rate for Payer: UHC Medicaid |
$1,492.43
|
| Rate for Payer: UHCCP Medicaid |
$1,492.43
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS
|
Professional
|
Both
|
$5,253.00
|
|
|
Service Code
|
HCPCS 34847
|
| Min. Negotiated Rate |
$1,628.11 |
| Max. Negotiated Rate |
$3,939.75 |
| Rate for Payer: Aetna Commercial |
$2,642.90
|
| Rate for Payer: BCBS Complete |
$1,709.52
|
| Rate for Payer: BCN Commercial |
$2,442.34
|
| Rate for Payer: Cash Price |
$4,202.40
|
| Rate for Payer: Cash Price |
$4,202.40
|
| Rate for Payer: Meridian Medicaid |
$1,709.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,939.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,628.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,343.77
|
| Rate for Payer: Priority Health Narrow Network |
$3,343.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,825.88
|
| Rate for Payer: UHC Exchange |
$2,825.88
|
| Rate for Payer: UHC Medicaid |
$1,628.11
|
| Rate for Payer: UHCCP Medicaid |
$1,628.11
|
|
|
PR VISCO GEL SPACER - LARGE
|
Professional
|
Both
|
$7.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
|
|
PR VISCO GEL SPACER - MEDIUM
|
Professional
|
Both
|
$7.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
|
|
PR VISCO GEL SPACER - SMALL
|
Professional
|
Both
|
$7.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
|
|
PR VISION EXAM
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: ASR ASR |
$51.41
|
| Rate for Payer: BCBS Trust/PPO |
$43.52
|
| Rate for Payer: BCN Commercial |
$43.52
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Healthscope Whirlpool |
$53.00
|
| Rate for Payer: Mclaren Commercial |
$47.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Nomi Health Commercial |
$43.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.64
|
|
|
PR VISION EXAM
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Medicare |
$19.61
|
| Rate for Payer: ASR ASR |
$51.41
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Trust/PPO |
$43.70
|
| Rate for Payer: BCN Commercial |
$43.70
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Healthscope Whirlpool |
$53.00
|
| Rate for Payer: Mclaren Commercial |
$47.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Nomi Health Commercial |
$43.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.44
|
| Rate for Payer: Priority Health Narrow Network |
$37.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.64
|
|
|
PR VISIT TO DETERM LDCT ELIG
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS G0296
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$29.69
|
| Rate for Payer: Aetna Medicare |
$22.16
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$22.16
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: BCN Medicare Advantage |
$22.16
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$31.91
|
| Rate for Payer: Cofinity Commercial |
$29.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$26.59
|
| Rate for Payer: Healthscope Whirlpool |
$26.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.38
|
| Rate for Payer: Nomi Health Commercial |
$26.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: PACE SWMI |
$22.16
|
| Rate for Payer: PHP Medicare Advantage |
$22.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.44
|
| Rate for Payer: Priority Health Medicare |
$22.16
|
| Rate for Payer: Priority Health Narrow Network |
$34.44
|
| Rate for Payer: Railroad Medicare Medicare |
$22.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.16
|
| Rate for Payer: UHC Exchange |
$38.58
|
| Rate for Payer: UHCCP DNSP |
$22.16
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 95930
|
| Min. Negotiated Rate |
$63.04 |
| Max. Negotiated Rate |
$210.75 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare |
$63.04
|
| Rate for Payer: BCBS MAPPO |
$63.04
|
| Rate for Payer: BCN Commercial |
$98.60
|
| Rate for Payer: BCN Medicare Advantage |
$63.04
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$84.47
|
| Rate for Payer: Cofinity Commercial |
$90.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.04
|
| Rate for Payer: Healthscope Commercial |
$75.65
|
| Rate for Payer: Healthscope Whirlpool |
$75.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.34
|
| Rate for Payer: Nomi Health Commercial |
$75.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.75
|
| Rate for Payer: PACE SWMI |
$63.04
|
| Rate for Payer: PHP Medicare Advantage |
$63.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$90.94
|
| Rate for Payer: Priority Health Medicare |
$63.04
|
| Rate for Payer: Priority Health Narrow Network |
$90.94
|
| Rate for Payer: Railroad Medicare Medicare |
$63.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$63.04
|
| Rate for Payer: UHC Exchange |
$101.78
|
| Rate for Payer: UHCCP DNSP |
$63.04
|
|
|
PR VISUAL REINFORCEMENT AUDIOMETRY
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 92579
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna Commercial |
$39.11
|
| Rate for Payer: Aetna Medicare |
$29.19
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS MAPPO |
$29.19
|
| Rate for Payer: BCN Commercial |
$54.78
|
| Rate for Payer: BCN Medicare Advantage |
$29.19
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$42.03
|
| Rate for Payer: Cofinity Commercial |
$39.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$35.03
|
| Rate for Payer: Healthscope Whirlpool |
$35.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.11
|
| Rate for Payer: Nomi Health Commercial |
$35.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.25
|
| Rate for Payer: PACE SWMI |
$29.19
|
| Rate for Payer: PHP Medicare Advantage |
$29.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50.52
|
| Rate for Payer: Priority Health Medicare |
$29.19
|
| Rate for Payer: Priority Health Narrow Network |
$50.52
|
| Rate for Payer: Railroad Medicare Medicare |
$29.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.19
|
| Rate for Payer: UHC Exchange |
$61.55
|
| Rate for Payer: UHCCP DNSP |
$29.19
|
|
|
PR VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 94150
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$38.19 |
| Rate for Payer: Aetna Commercial |
$26.29
|
| Rate for Payer: BCN Commercial |
$37.85
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.90
|
| Rate for Payer: Priority Health Narrow Network |
$34.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.19
|
| Rate for Payer: UHC Exchange |
$38.19
|
|
|
PR VITAMIN B12 INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3420
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Cofinity Commercial |
$0.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$0.80
|
| Rate for Payer: Healthscope Whirlpool |
$0.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.74
|
| Rate for Payer: Nomi Health Commercial |
$0.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Medicare |
$0.67
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.67
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHCCP DNSP |
$0.67
|
|
|
PR VITAMIN K PHYTONADIONE INJ
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3430
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$4.23
|
| Rate for Payer: Aetna Medicare |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: BCN Medicare Advantage |
$3.16
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$4.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.16
|
| Rate for Payer: Healthscope Commercial |
$3.79
|
| Rate for Payer: Healthscope Whirlpool |
$3.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.48
|
| Rate for Payer: Nomi Health Commercial |
$3.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.16
|
| Rate for Payer: PHP Medicare Advantage |
$3.16
|
| Rate for Payer: Priority Health Medicare |
$3.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.16
|
| Rate for Payer: UHC Exchange |
$2.81
|
| Rate for Payer: UHCCP DNSP |
$3.16
|
|
|
PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING
|
Professional
|
Both
|
$5,278.00
|
|
|
Service Code
|
HCPCS 33427
|
| Min. Negotiated Rate |
$1,449.68 |
| Max. Negotiated Rate |
$4,358.56 |
| Rate for Payer: Aetna Commercial |
$3,052.96
|
| Rate for Payer: Aetna Medicare |
$2,278.33
|
| Rate for Payer: BCBS Complete |
$1,522.16
|
| Rate for Payer: BCBS MAPPO |
$2,278.33
|
| Rate for Payer: BCN Commercial |
$3,579.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,278.33
|
| Rate for Payer: Cash Price |
$4,222.40
|
| Rate for Payer: Cash Price |
$4,222.40
|
| Rate for Payer: Cofinity Commercial |
$3,280.80
|
| Rate for Payer: Cofinity Commercial |
$3,052.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,278.33
|
| Rate for Payer: Healthscope Commercial |
$2,734.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,734.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,392.25
|
| Rate for Payer: Meridian Medicaid |
$1,522.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,506.16
|
| Rate for Payer: Nomi Health Commercial |
$2,734.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,958.50
|
| Rate for Payer: PACE SWMI |
$2,278.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,278.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,449.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,849.82
|
| Rate for Payer: Priority Health Medicare |
$2,278.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,849.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,278.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,358.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,278.33
|
| Rate for Payer: UHC Exchange |
$4,358.56
|
| Rate for Payer: UHC Medicaid |
$1,449.68
|
| Rate for Payer: UHCCP DNSP |
$2,278.33
|
| Rate for Payer: UHCCP Medicaid |
$1,449.68
|
|
|
PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING
|
Professional
|
Both
|
$9,170.00
|
|
|
Service Code
|
HCPCS 33426
|
| Min. Negotiated Rate |
$1,423.27 |
| Max. Negotiated Rate |
$6,877.50 |
| Rate for Payer: Aetna Commercial |
$2,995.64
|
| Rate for Payer: Aetna Medicare |
$2,235.55
|
| Rate for Payer: BCBS Complete |
$1,494.43
|
| Rate for Payer: BCBS MAPPO |
$2,235.55
|
| Rate for Payer: BCN Commercial |
$3,502.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,235.55
|
| Rate for Payer: Cash Price |
$7,336.00
|
| Rate for Payer: Cash Price |
$7,336.00
|
| Rate for Payer: Cofinity Commercial |
$3,219.19
|
| Rate for Payer: Cofinity Commercial |
$2,995.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,235.55
|
| Rate for Payer: Healthscope Commercial |
$2,682.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,682.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,347.33
|
| Rate for Payer: Meridian Medicaid |
$1,494.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,459.11
|
| Rate for Payer: Nomi Health Commercial |
$2,682.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,877.50
|
| Rate for Payer: PACE SWMI |
$2,235.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,235.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,423.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,766.81
|
| Rate for Payer: Priority Health Medicare |
$2,235.55
|
| Rate for Payer: Priority Health Narrow Network |
$3,766.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,235.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,247.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,235.55
|
| Rate for Payer: UHC Exchange |
$4,247.22
|
| Rate for Payer: UHC Medicaid |
$1,423.27
|
| Rate for Payer: UHCCP DNSP |
$2,235.55
|
| Rate for Payer: UHCCP Medicaid |
$1,423.27
|
|
|
PR VNPNXR <3 YEARS PHY/QHP SKILL FEMORAL/JUGULAR VN
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 36400
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Aetna Commercial |
$20.84
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS MAPPO |
$15.55
|
| Rate for Payer: BCN Commercial |
$27.39
|
| Rate for Payer: BCN Medicare Advantage |
$15.55
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Cofinity Commercial |
$20.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.55
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Healthscope Whirlpool |
$18.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.33
|
| Rate for Payer: Meridian Medicaid |
$10.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.11
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.75
|
| Rate for Payer: PACE SWMI |
$15.55
|
| Rate for Payer: PHP Medicare Advantage |
$15.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.45
|
| Rate for Payer: Priority Health Medicare |
$15.55
|
| Rate for Payer: Priority Health Narrow Network |
$29.45
|
| Rate for Payer: Railroad Medicare Medicare |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.55
|
| Rate for Payer: UHC Exchange |
$33.22
|
| Rate for Payer: UHC Medicaid |
$10.01
|
| Rate for Payer: UHCCP DNSP |
$15.55
|
| Rate for Payer: UHCCP Medicaid |
$10.01
|
|
|
PR VNPNXR 3 YEARS/> PHYS/QHP SKILL DX/THER PURPOSES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 36410
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$10.71
|
| Rate for Payer: Aetna Medicare |
$7.99
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$7.99
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: BCN Medicare Advantage |
$7.99
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.99
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Healthscope Whirlpool |
$9.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.79
|
| Rate for Payer: Nomi Health Commercial |
$9.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.00
|
| Rate for Payer: PACE SWMI |
$7.99
|
| Rate for Payer: PHP Medicare Advantage |
$7.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.45
|
| Rate for Payer: Priority Health Medicare |
$7.99
|
| Rate for Payer: Priority Health Narrow Network |
$14.45
|
| Rate for Payer: Railroad Medicare Medicare |
$7.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.99
|
| Rate for Payer: UHC Exchange |
$16.58
|
| Rate for Payer: UHCCP DNSP |
$7.99
|
|
