|
PR XTRNL ECG REC<48 HRS RECORDING
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 93225
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna Medicare |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$16.54
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$16.54
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$19.85
|
| Rate for Payer: Healthscope Whirlpool |
$19.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.19
|
| Rate for Payer: Nomi Health Commercial |
$19.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: PACE SWMI |
$16.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.56
|
| Rate for Payer: Priority Health Medicare |
$16.54
|
| Rate for Payer: Priority Health Narrow Network |
$25.56
|
| Rate for Payer: Railroad Medicare Medicare |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.54
|
| Rate for Payer: UHC Exchange |
$38.33
|
| Rate for Payer: UHCCP DNSP |
$16.54
|
|
|
PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 93224
|
| Min. Negotiated Rate |
$65.67 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Aetna Medicare |
$65.67
|
| Rate for Payer: BCBS MAPPO |
$65.67
|
| Rate for Payer: BCN Commercial |
$105.08
|
| Rate for Payer: BCN Medicare Advantage |
$65.67
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.67
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Healthscope Whirlpool |
$78.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.24
|
| Rate for Payer: Nomi Health Commercial |
$78.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PACE SWMI |
$65.67
|
| Rate for Payer: PHP Medicare Advantage |
$65.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$99.87
|
| Rate for Payer: Priority Health Medicare |
$65.67
|
| Rate for Payer: Priority Health Narrow Network |
$99.87
|
| Rate for Payer: Railroad Medicare Medicare |
$65.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.67
|
| Rate for Payer: UHC Exchange |
$135.14
|
| Rate for Payer: UHCCP DNSP |
$65.67
|
|
|
PR XTRNL ECG REC<48 HRS RVW&INTERPJ PHYS/QHP
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 93227
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$154.50 |
| Rate for Payer: Aetna Commercial |
$23.24
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: BCBS Complete |
$11.85
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$17.34
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: Meridian Medicaid |
$11.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.07
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.50
|
| Rate for Payer: PACE SWMI |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$17.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.56
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health Narrow Network |
$25.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.34
|
| Rate for Payer: UHC Exchange |
$42.54
|
| Rate for Payer: UHC Medicaid |
$11.29
|
| Rate for Payer: UHCCP DNSP |
$17.34
|
| Rate for Payer: UHCCP Medicaid |
$11.29
|
|
|
PR XTRNL ECG REC<48 HRS SCANNING A/R
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 93226
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna Medicare |
$31.79
|
| Rate for Payer: BCBS MAPPO |
$31.79
|
| Rate for Payer: BCN Commercial |
$51.29
|
| Rate for Payer: BCN Medicare Advantage |
$31.79
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$42.60
|
| Rate for Payer: Cofinity Commercial |
$45.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$38.15
|
| Rate for Payer: Healthscope Whirlpool |
$38.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.97
|
| Rate for Payer: Nomi Health Commercial |
$38.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.50
|
| Rate for Payer: PACE SWMI |
$31.79
|
| Rate for Payer: PHP Medicare Advantage |
$31.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.76
|
| Rate for Payer: Priority Health Medicare |
$31.79
|
| Rate for Payer: Priority Health Narrow Network |
$48.76
|
| Rate for Payer: Railroad Medicare Medicare |
$31.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.79
|
| Rate for Payer: UHC Exchange |
$54.27
|
| Rate for Payer: UHCCP DNSP |
$31.79
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Medicare |
$24.45
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$24.45
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: BCN Medicare Advantage |
$24.45
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$35.21
|
| Rate for Payer: Cofinity Commercial |
$32.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.45
|
| Rate for Payer: Healthscope Commercial |
$29.34
|
| Rate for Payer: Healthscope Whirlpool |
$29.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.67
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.89
|
| Rate for Payer: Nomi Health Commercial |
$29.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PACE SWMI |
$24.45
|
| Rate for Payer: PHP Medicare Advantage |
$24.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$24.45
|
| Rate for Payer: Priority Health Narrow Network |
$35.50
|
| Rate for Payer: Railroad Medicare Medicare |
$24.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.45
|
| Rate for Payer: UHC Exchange |
$43.21
|
| Rate for Payer: UHC Medicaid |
$15.98
|
| Rate for Payer: UHCCP DNSP |
$24.45
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$125.71 |
| Max. Negotiated Rate |
$505.50 |
| Rate for Payer: Aetna Commercial |
$168.45
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Commercial |
$204.18
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cofinity Commercial |
$168.45
|
| Rate for Payer: Cofinity Commercial |
$181.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$150.85
|
| Rate for Payer: Healthscope Whirlpool |
$150.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.28
|
| Rate for Payer: Nomi Health Commercial |
$150.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$505.50
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$194.05
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$194.05
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.71
|
| Rate for Payer: UHC Exchange |
$248.33
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Aetna Commercial |
$10.32
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: BCBS MAPPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$11.95
|
| Rate for Payer: BCN Medicare Advantage |
$7.70
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$11.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.70
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Healthscope Whirlpool |
$9.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.47
|
| Rate for Payer: Nomi Health Commercial |
$9.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.25
|
| Rate for Payer: PACE SWMI |
$7.70
|
| Rate for Payer: PHP Medicare Advantage |
$7.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.35
|
| Rate for Payer: Priority Health Medicare |
$7.70
|
| Rate for Payer: Priority Health Narrow Network |
$11.35
|
| Rate for Payer: Railroad Medicare Medicare |
$7.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.70
|
| Rate for Payer: UHC Exchange |
$13.35
|
| Rate for Payer: UHCCP DNSP |
$7.70
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 93268
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$672.75 |
| Rate for Payer: Aetna Commercial |
$209.96
|
| Rate for Payer: Aetna Medicare |
$156.69
|
| Rate for Payer: BCBS MAPPO |
$156.69
|
| Rate for Payer: BCN Commercial |
$251.48
|
| Rate for Payer: BCN Medicare Advantage |
$156.69
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cofinity Commercial |
$209.96
|
| Rate for Payer: Cofinity Commercial |
$225.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.69
|
| Rate for Payer: Healthscope Commercial |
$188.03
|
| Rate for Payer: Healthscope Whirlpool |
$188.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$172.36
|
| Rate for Payer: Nomi Health Commercial |
$188.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$672.75
|
| Rate for Payer: PACE SWMI |
$156.69
|
| Rate for Payer: PHP Medicare Advantage |
$156.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$239.02
|
| Rate for Payer: Priority Health Medicare |
$156.69
|
| Rate for Payer: Priority Health Narrow Network |
$239.02
|
| Rate for Payer: Railroad Medicare Medicare |
$156.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$156.69
|
| Rate for Payer: UHC Exchange |
$302.62
|
| Rate for Payer: UHCCP DNSP |
$156.69
|
|
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 93272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Aetna Commercial |
$31.20
|
| Rate for Payer: Aetna Medicare |
$23.28
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$23.28
|
| Rate for Payer: BCN Commercial |
$35.35
|
| Rate for Payer: BCN Medicare Advantage |
$23.28
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cofinity Commercial |
$33.52
|
| Rate for Payer: Cofinity Commercial |
$31.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.28
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Whirlpool |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.44
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.61
|
| Rate for Payer: Nomi Health Commercial |
$27.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.25
|
| Rate for Payer: PACE SWMI |
$23.28
|
| Rate for Payer: PHP Medicare Advantage |
$23.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.61
|
| Rate for Payer: Priority Health Medicare |
$23.28
|
| Rate for Payer: Priority Health Narrow Network |
$33.61
|
| Rate for Payer: Railroad Medicare Medicare |
$23.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.28
|
| Rate for Payer: UHC Exchange |
$40.94
|
| Rate for Payer: UHC Medicaid |
$15.12
|
| Rate for Payer: UHCCP DNSP |
$23.28
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 41015
|
| Min. Negotiated Rate |
$178.49 |
| Max. Negotiated Rate |
$555.18 |
| Rate for Payer: Aetna Commercial |
$362.28
|
| Rate for Payer: Aetna Medicare |
$270.36
|
| Rate for Payer: BCBS Complete |
$187.41
|
| Rate for Payer: BCBS MAPPO |
$270.36
|
| Rate for Payer: BCN Commercial |
$455.65
|
| Rate for Payer: BCN Medicare Advantage |
$270.36
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cofinity Commercial |
$389.32
|
| Rate for Payer: Cofinity Commercial |
$362.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.36
|
| Rate for Payer: Healthscope Commercial |
$324.43
|
| Rate for Payer: Healthscope Whirlpool |
$324.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$283.88
|
| Rate for Payer: Meridian Medicaid |
$187.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$297.40
|
| Rate for Payer: Nomi Health Commercial |
$324.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$469.50
|
| Rate for Payer: PACE SWMI |
$270.36
|
| Rate for Payer: PHP Medicare Advantage |
$270.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$555.18
|
| Rate for Payer: Priority Health Medicare |
$270.36
|
| Rate for Payer: Priority Health Narrow Network |
$555.18
|
| Rate for Payer: Railroad Medicare Medicare |
$270.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$536.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$270.36
|
| Rate for Payer: UHC Exchange |
$536.15
|
| Rate for Payer: UHC Medicaid |
$178.49
|
| Rate for Payer: UHCCP DNSP |
$270.36
|
| Rate for Payer: UHCCP Medicaid |
$178.49
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 41016
|
| Min. Negotiated Rate |
$207.46 |
| Max. Negotiated Rate |
$635.28 |
| Rate for Payer: Aetna Commercial |
$419.35
|
| Rate for Payer: Aetna Medicare |
$312.95
|
| Rate for Payer: BCBS Complete |
$217.83
|
| Rate for Payer: BCBS MAPPO |
$312.95
|
| Rate for Payer: BCN Commercial |
$521.38
|
| Rate for Payer: BCN Medicare Advantage |
$312.95
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cofinity Commercial |
$450.65
|
| Rate for Payer: Cofinity Commercial |
$419.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.95
|
| Rate for Payer: Healthscope Commercial |
$375.54
|
| Rate for Payer: Healthscope Whirlpool |
$375.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.60
|
| Rate for Payer: Meridian Medicaid |
$217.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$344.25
|
| Rate for Payer: Nomi Health Commercial |
$375.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$560.25
|
| Rate for Payer: PACE SWMI |
$312.95
|
| Rate for Payer: PHP Medicare Advantage |
$312.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$635.28
|
| Rate for Payer: Priority Health Medicare |
$312.95
|
| Rate for Payer: Priority Health Narrow Network |
$635.28
|
| Rate for Payer: Railroad Medicare Medicare |
$312.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$312.95
|
| Rate for Payer: UHC Exchange |
$594.78
|
| Rate for Payer: UHC Medicaid |
$207.46
|
| Rate for Payer: UHCCP DNSP |
$312.95
|
| Rate for Payer: UHCCP Medicaid |
$207.46
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 41017
|
| Min. Negotiated Rate |
$204.91 |
| Max. Negotiated Rate |
$696.75 |
| Rate for Payer: Aetna Commercial |
$414.35
|
| Rate for Payer: Aetna Medicare |
$309.22
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: BCBS MAPPO |
$309.22
|
| Rate for Payer: BCN Commercial |
$517.40
|
| Rate for Payer: BCN Medicare Advantage |
$309.22
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cofinity Commercial |
$445.28
|
| Rate for Payer: Cofinity Commercial |
$414.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.22
|
| Rate for Payer: Healthscope Commercial |
$371.06
|
| Rate for Payer: Healthscope Whirlpool |
$371.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.68
|
| Rate for Payer: Meridian Medicaid |
$215.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$340.14
|
| Rate for Payer: Nomi Health Commercial |
$371.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.75
|
| Rate for Payer: PACE SWMI |
$309.22
|
| Rate for Payer: PHP Medicare Advantage |
$309.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$630.42
|
| Rate for Payer: Priority Health Medicare |
$309.22
|
| Rate for Payer: Priority Health Narrow Network |
$630.42
|
| Rate for Payer: Railroad Medicare Medicare |
$309.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$591.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$309.22
|
| Rate for Payer: UHC Exchange |
$591.11
|
| Rate for Payer: UHC Medicaid |
$204.91
|
| Rate for Payer: UHCCP DNSP |
$309.22
|
| Rate for Payer: UHCCP Medicaid |
$204.91
|
|
|
PR ZINC PASTE BAND W >=3""<5""/YD
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS A6456
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$1.79
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS MAPPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: BCN Medicare Advantage |
$1.79
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$2.15
|
| Rate for Payer: Healthscope Whirlpool |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.97
|
| Rate for Payer: Nomi Health Commercial |
$2.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.25
|
| Rate for Payer: PACE SWMI |
$1.79
|
| Rate for Payer: PHP Medicare Advantage |
$1.79
|
| Rate for Payer: Priority Health Medicare |
$1.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.79
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHCCP DNSP |
$1.79
|
|
|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$221.01 |
| Rate for Payer: Aetna Commercial |
$216.92
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS Trust/PPO |
$221.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.05
|
| Rate for Payer: UHC Exchange |
$219.05
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$32.30
|
|
|
Service Code
|
NDC 70000047501
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: Aetna Medicare |
$11.95
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: BCBS Complete |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$26.63
|
| Rate for Payer: BCN Commercial |
$26.63
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cofinity Commercial |
$30.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$31.33
|
| Rate for Payer: Healthscope Whirlpool |
$32.30
|
| Rate for Payer: Mclaren Commercial |
$29.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.30
|
| Rate for Payer: Priority Health Narrow Network |
$22.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.02
|
|
|
Service Code
|
NDC 904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: ASR ASR |
$31.05
|
| Rate for Payer: BCBS Trust/PPO |
$26.29
|
| Rate for Payer: BCN Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$30.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.61
|
| Rate for Payer: Healthscope Commercial |
$31.05
|
| Rate for Payer: Healthscope Whirlpool |
$32.02
|
| Rate for Payer: Mclaren Commercial |
$28.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.21
|
| Rate for Payer: Nomi Health Commercial |
$26.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.17
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$28.79
|
|
|
Service Code
|
NDC 810067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$28.79 |
| Rate for Payer: Aetna Commercial |
$25.91
|
| Rate for Payer: Aetna Medicare |
$10.65
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: BCBS Complete |
$11.51
|
| Rate for Payer: BCBS Trust/PPO |
$23.73
|
| Rate for Payer: BCN Commercial |
$23.73
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$27.92
|
| Rate for Payer: Healthscope Whirlpool |
$28.79
|
| Rate for Payer: Mclaren Commercial |
$25.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.22
|
| Rate for Payer: Priority Health Narrow Network |
$20.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.30
|
|
|
Service Code
|
NDC 70000047501
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$26.52
|
| Rate for Payer: BCN Commercial |
$26.52
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cofinity Commercial |
$30.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$31.33
|
| Rate for Payer: Healthscope Whirlpool |
$32.30
|
| Rate for Payer: Mclaren Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$32.30
|
|
|
Service Code
|
NDC 9629513673
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: Aetna Medicare |
$11.95
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: BCBS Complete |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$26.63
|
| Rate for Payer: BCN Commercial |
$26.63
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cofinity Commercial |
$30.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$31.33
|
| Rate for Payer: Healthscope Whirlpool |
$32.30
|
| Rate for Payer: Mclaren Commercial |
$29.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.30
|
| Rate for Payer: Priority Health Narrow Network |
$22.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$32.02
|
|
|
Service Code
|
NDC 904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: ASR ASR |
$31.05
|
| Rate for Payer: BCBS Complete |
$12.81
|
| Rate for Payer: BCBS Trust/PPO |
$26.40
|
| Rate for Payer: BCN Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$30.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.61
|
| Rate for Payer: Healthscope Commercial |
$31.05
|
| Rate for Payer: Healthscope Whirlpool |
$32.02
|
| Rate for Payer: Mclaren Commercial |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.21
|
| Rate for Payer: Nomi Health Commercial |
$26.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.05
|
| Rate for Payer: Priority Health Narrow Network |
$22.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.17
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$28.79
|
|
|
Service Code
|
NDC 810067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.59 |
| Max. Negotiated Rate |
$28.79 |
| Rate for Payer: Aetna Commercial |
$25.91
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$23.64
|
| Rate for Payer: BCN Commercial |
$23.64
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$27.92
|
| Rate for Payer: Healthscope Whirlpool |
$28.79
|
| Rate for Payer: Mclaren Commercial |
$25.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$32.30
|
|
|
Service Code
|
NDC 9629513673
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: ASR ASR |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$26.52
|
| Rate for Payer: BCN Commercial |
$26.52
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cofinity Commercial |
$30.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$31.33
|
| Rate for Payer: Healthscope Whirlpool |
$32.30
|
| Rate for Payer: Mclaren Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.45
|
| Rate for Payer: Nomi Health Commercial |
$26.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.42
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$19,190.36
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$11,222.49 |
| Max. Negotiated Rate |
$19,190.36 |
| Rate for Payer: Aetna Medicare |
$11,813.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,766.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,766.44
|
| Rate for Payer: BCBS MAPPO |
$11,813.15
|
| Rate for Payer: BCN Medicare Advantage |
$11,813.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,813.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,813.15
|
| Rate for Payer: Mclaren Medicare |
$11,813.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,403.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,585.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,994.47
|
| Rate for Payer: PACE Medicare |
$11,222.49
|
| Rate for Payer: PACE SWMI |
$11,813.15
|
| Rate for Payer: PHP Commercial |
$12,994.47
|
| Rate for Payer: PHP Medicare Advantage |
$11,813.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,190.36
|
| Rate for Payer: Priority Health Medicare |
$11,813.15
|
| Rate for Payer: Priority Health Narrow Network |
$15,352.28
|
| Rate for Payer: Railroad Medicare Medicare |
$11,813.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,813.15
|
| Rate for Payer: UHC Exchange |
$18,310.38
|
| Rate for Payer: UHCCP DNSP |
$11,813.15
|
| Rate for Payer: VA VA |
$11,813.15
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: ASR ASR |
$8.58
|
| Rate for Payer: BCBS Trust/PPO |
$7.26
|
| Rate for Payer: BCN Commercial |
$7.26
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$8.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$8.58
|
| Rate for Payer: Healthscope Whirlpool |
$8.85
|
| Rate for Payer: Mclaren Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.78
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
OP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna Medicare |
$3.27
|
| Rate for Payer: ASR ASR |
$8.58
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$7.29
|
| Rate for Payer: BCN Commercial |
$7.29
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$8.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$8.58
|
| Rate for Payer: Healthscope Whirlpool |
$8.85
|
| Rate for Payer: Mclaren Commercial |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.75
|
| Rate for Payer: Priority Health Narrow Network |
$6.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.78
|
|
