|
PR CAST SUP SHOULDER CAST FBRGL
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS Q4004
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$218.87 |
| Rate for Payer: Aetna Commercial |
$203.67
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$218.87
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Nomi Health Commercial |
$182.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$153.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.99
|
| Rate for Payer: UHC Exchange |
$151.99
|
| Rate for Payer: UHC Medicare Advantage |
$151.99
|
|
|
PR CAST SUP SHRT LEG FIBERGLASS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$74.09 |
| Rate for Payer: Aetna Commercial |
$68.94
|
| Rate for Payer: Aetna Medicare |
$53.51
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$51.45
|
| Rate for Payer: BCN Medicare Advantage |
$51.45
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$68.94
|
| Rate for Payer: Cofinity Commercial |
$74.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.02
|
| Rate for Payer: Nomi Health Commercial |
$61.74
|
| Rate for Payer: PACE SWMI |
$51.45
|
| Rate for Payer: PHP Medicare Advantage |
$51.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health Medicare |
$51.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.45
|
| Rate for Payer: UHC Exchange |
$51.45
|
| Rate for Payer: UHC Medicare Advantage |
$51.45
|
|
|
PR CAST SUP SHRT LEG PED FBRGLS
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.04 |
| Rate for Payer: Aetna Commercial |
$34.46
|
| Rate for Payer: Aetna Medicare |
$26.75
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$25.72
|
| Rate for Payer: BCN Medicare Advantage |
$25.72
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$37.04
|
| Rate for Payer: Cofinity Commercial |
$34.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.01
|
| Rate for Payer: Nomi Health Commercial |
$30.86
|
| Rate for Payer: PACE SWMI |
$25.72
|
| Rate for Payer: PHP Medicare Advantage |
$25.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$25.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.72
|
| Rate for Payer: UHC Exchange |
$25.72
|
| Rate for Payer: UHC Medicare Advantage |
$25.72
|
|
|
PR CAST SUP SHT ARM ADULT FBRGL
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS Q4010
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna Commercial |
$32.58
|
| Rate for Payer: Aetna Medicare |
$25.28
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$24.31
|
| Rate for Payer: BCN Medicare Advantage |
$24.31
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$35.01
|
| Rate for Payer: Cofinity Commercial |
$32.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.53
|
| Rate for Payer: Nomi Health Commercial |
$29.17
|
| Rate for Payer: PACE SWMI |
$24.31
|
| Rate for Payer: PHP Medicare Advantage |
$24.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$24.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.31
|
| Rate for Payer: UHC Exchange |
$24.31
|
| Rate for Payer: UHC Medicare Advantage |
$24.31
|
|
|
PR CAST SUP SHT ARM PED FBRGLAS
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Commercial |
$16.33
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.55
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$14.63
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.19
|
| Rate for Payer: UHC Exchange |
$12.19
|
| Rate for Payer: UHC Medicare Advantage |
$12.19
|
|
|
PR CAST SUP SHT ARM SPLINT FBRG
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$21.89 |
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna Medicare |
$15.81
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$15.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.20
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$20.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.96
|
| Rate for Payer: Nomi Health Commercial |
$18.24
|
| Rate for Payer: PACE SWMI |
$15.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$15.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.20
|
| Rate for Payer: UHC Exchange |
$15.20
|
| Rate for Payer: UHC Medicare Advantage |
$15.20
|
|
|
PR CAST SUP SHT ARM SPLNT PED F
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: Nomi Health Commercial |
$9.13
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Medicare |
$7.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.61
|
| Rate for Payer: UHC Exchange |
$7.61
|
| Rate for Payer: UHC Medicare Advantage |
$7.61
|
|
|
PR CAST SUP SHT LEG SPLNT FBRGL
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna Commercial |
$31.25
|
| Rate for Payer: Aetna Medicare |
$24.25
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$23.32
|
| Rate for Payer: BCN Medicare Advantage |
$23.32
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$33.58
|
| Rate for Payer: Cofinity Commercial |
$31.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.49
|
| Rate for Payer: Nomi Health Commercial |
$27.98
|
| Rate for Payer: PACE SWMI |
$23.32
|
| Rate for Payer: PHP Medicare Advantage |
$23.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$23.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.32
|
| Rate for Payer: UHC Exchange |
$23.32
|
| Rate for Payer: UHC Medicare Advantage |
$23.32
|
|
|
PR CAST SUP SHT LEG SPLNT PED F
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$15.64
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$11.67
|
| Rate for Payer: BCN Medicare Advantage |
$11.67
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$15.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.25
|
| Rate for Payer: Nomi Health Commercial |
$14.00
|
| Rate for Payer: PACE SWMI |
$11.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$11.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.67
|
| Rate for Payer: UHC Exchange |
$11.67
|
| Rate for Payer: UHC Medicare Advantage |
$11.67
|
|
|
PR CAST SUP SHT LEG SPLNT PED P
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q4047
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: Aetna Medicare |
$7.51
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$7.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.22
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$9.67
|
| Rate for Payer: Cofinity Commercial |
$10.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.58
|
| Rate for Payer: Nomi Health Commercial |
$8.66
|
| Rate for Payer: PACE SWMI |
$7.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$7.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.22
|
| Rate for Payer: UHC Exchange |
$7.22
|
| Rate for Payer: UHC Medicare Advantage |
$7.22
|
|
|
PR CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 36660
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$92.32 |
| Rate for Payer: Aetna Commercial |
$85.91
|
| Rate for Payer: Aetna Medicare |
$66.67
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$64.11
|
| Rate for Payer: BCN Medicare Advantage |
$64.11
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$92.32
|
| Rate for Payer: Cofinity Commercial |
$85.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.32
|
| Rate for Payer: Nomi Health Commercial |
$76.93
|
| Rate for Payer: PACE SWMI |
$64.11
|
| Rate for Payer: PHP Medicare Advantage |
$64.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health Medicare |
$64.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.11
|
| Rate for Payer: UHC Exchange |
$64.11
|
| Rate for Payer: UHC Medicare Advantage |
$64.11
|
|
|
PR CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 31717
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Commercial |
$132.79
|
| Rate for Payer: Aetna Medicare |
$103.06
|
| Rate for Payer: BCBS Complete |
$212.00
|
| Rate for Payer: BCBS MAPPO |
$99.10
|
| Rate for Payer: BCN Medicare Advantage |
$99.10
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cofinity Commercial |
$142.70
|
| Rate for Payer: Cofinity Commercial |
$132.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.06
|
| Rate for Payer: Nomi Health Commercial |
$118.92
|
| Rate for Payer: PACE SWMI |
$99.10
|
| Rate for Payer: PHP Medicare Advantage |
$99.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.50
|
| Rate for Payer: Priority Health Medicare |
$100.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.10
|
| Rate for Payer: UHC Exchange |
$99.10
|
| Rate for Payer: UHC Medicare Advantage |
$99.10
|
|
|
PR CATHETERIZE FOR URINE SPEC
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS P9612
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Commercial |
$12.18
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$9.09
|
| Rate for Payer: BCN Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$13.09
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$10.91
|
| Rate for Payer: PACE SWMI |
$9.09
|
| Rate for Payer: PHP Medicare Advantage |
$9.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.09
|
| Rate for Payer: UHC Exchange |
$9.09
|
| Rate for Payer: UHC Medicare Advantage |
$9.09
|
|
|
PR CATHJ UMBILICAL VEIN DX/THER NB
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 36510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Aetna Commercial |
$66.21
|
| Rate for Payer: Aetna Medicare |
$51.39
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: BCBS MAPPO |
$49.41
|
| Rate for Payer: BCN Medicare Advantage |
$49.41
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.88
|
| Rate for Payer: Nomi Health Commercial |
$59.29
|
| Rate for Payer: PACE SWMI |
$49.41
|
| Rate for Payer: PHP Medicare Advantage |
$49.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.85
|
| Rate for Payer: Priority Health Medicare |
$49.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.41
|
| Rate for Payer: UHC Exchange |
$49.41
|
| Rate for Payer: UHC Medicare Advantage |
$49.41
|
|
|
PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
|
Professional
|
Both
|
$1,713.00
|
|
|
Service Code
|
HCPCS 93454
|
| Min. Negotiated Rate |
$685.20 |
| Max. Negotiated Rate |
$1,126.04 |
| Rate for Payer: Aetna Commercial |
$1,047.84
|
| Rate for Payer: Aetna Commercial |
$1,047.84
|
| Rate for Payer: Aetna Medicare |
$813.25
|
| Rate for Payer: Aetna Medicare |
$813.25
|
| Rate for Payer: BCBS Complete |
$685.20
|
| Rate for Payer: BCBS Complete |
$312.80
|
| Rate for Payer: BCBS MAPPO |
$781.97
|
| Rate for Payer: BCBS MAPPO |
$781.97
|
| Rate for Payer: BCN Medicare Advantage |
$781.97
|
| Rate for Payer: BCN Medicare Advantage |
$781.97
|
| Rate for Payer: Cash Price |
$625.60
|
| Rate for Payer: Cash Price |
$625.60
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cofinity Commercial |
$1,126.04
|
| Rate for Payer: Cofinity Commercial |
$1,047.84
|
| Rate for Payer: Cofinity Commercial |
$1,126.04
|
| Rate for Payer: Cofinity Commercial |
$1,047.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$821.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$821.07
|
| Rate for Payer: Nomi Health Commercial |
$938.36
|
| Rate for Payer: Nomi Health Commercial |
$938.36
|
| Rate for Payer: PACE SWMI |
$781.97
|
| Rate for Payer: PACE SWMI |
$781.97
|
| Rate for Payer: PHP Medicare Advantage |
$781.97
|
| Rate for Payer: PHP Medicare Advantage |
$781.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.30
|
| Rate for Payer: Priority Health Medicare |
$789.79
|
| Rate for Payer: Priority Health Medicare |
$789.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$781.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$781.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$781.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$781.97
|
| Rate for Payer: UHC Exchange |
$781.97
|
| Rate for Payer: UHC Exchange |
$781.97
|
| Rate for Payer: UHC Medicare Advantage |
$781.97
|
| Rate for Payer: UHC Medicare Advantage |
$781.97
|
|
|
PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
|
Professional
|
Both
|
$1,111.00
|
|
|
Service Code
|
HCPCS 93459
|
| Min. Negotiated Rate |
$444.40 |
| Max. Negotiated Rate |
$1,401.32 |
| Rate for Payer: Aetna Commercial |
$1,304.01
|
| Rate for Payer: Aetna Commercial |
$1,304.01
|
| Rate for Payer: Aetna Medicare |
$1,012.07
|
| Rate for Payer: Aetna Medicare |
$1,012.07
|
| Rate for Payer: BCBS Complete |
$444.40
|
| Rate for Payer: BCBS Complete |
$880.00
|
| Rate for Payer: BCBS MAPPO |
$973.14
|
| Rate for Payer: BCBS MAPPO |
$973.14
|
| Rate for Payer: BCN Medicare Advantage |
$973.14
|
| Rate for Payer: BCN Medicare Advantage |
$973.14
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$888.80
|
| Rate for Payer: Cash Price |
$888.80
|
| Rate for Payer: Cofinity Commercial |
$1,401.32
|
| Rate for Payer: Cofinity Commercial |
$1,304.01
|
| Rate for Payer: Cofinity Commercial |
$1,401.32
|
| Rate for Payer: Cofinity Commercial |
$1,304.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$973.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$973.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,021.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,021.80
|
| Rate for Payer: Nomi Health Commercial |
$1,167.77
|
| Rate for Payer: Nomi Health Commercial |
$1,167.77
|
| Rate for Payer: PACE SWMI |
$973.14
|
| Rate for Payer: PACE SWMI |
$973.14
|
| Rate for Payer: PHP Medicare Advantage |
$973.14
|
| Rate for Payer: PHP Medicare Advantage |
$973.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.00
|
| Rate for Payer: Priority Health Medicare |
$982.87
|
| Rate for Payer: Priority Health Medicare |
$982.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$973.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$973.14
|
| Rate for Payer: UHC Exchange |
$973.14
|
| Rate for Payer: UHC Exchange |
$973.14
|
| Rate for Payer: UHC Medicare Advantage |
$973.14
|
| Rate for Payer: UHC Medicare Advantage |
$973.14
|
|
|
PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$1,984.00
|
|
|
Service Code
|
HCPCS 93458
|
| Min. Negotiated Rate |
$793.60 |
| Max. Negotiated Rate |
$1,299.76 |
| Rate for Payer: Aetna Commercial |
$1,209.50
|
| Rate for Payer: Aetna Commercial |
$1,209.50
|
| Rate for Payer: Aetna Medicare |
$938.71
|
| Rate for Payer: Aetna Medicare |
$938.71
|
| Rate for Payer: BCBS Complete |
$793.60
|
| Rate for Payer: BCBS Complete |
$388.00
|
| Rate for Payer: BCBS MAPPO |
$902.61
|
| Rate for Payer: BCBS MAPPO |
$902.61
|
| Rate for Payer: BCN Medicare Advantage |
$902.61
|
| Rate for Payer: BCN Medicare Advantage |
$902.61
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cofinity Commercial |
$1,299.76
|
| Rate for Payer: Cofinity Commercial |
$1,209.50
|
| Rate for Payer: Cofinity Commercial |
$1,299.76
|
| Rate for Payer: Cofinity Commercial |
$1,209.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.74
|
| Rate for Payer: Nomi Health Commercial |
$1,083.13
|
| Rate for Payer: Nomi Health Commercial |
$1,083.13
|
| Rate for Payer: PACE SWMI |
$902.61
|
| Rate for Payer: PACE SWMI |
$902.61
|
| Rate for Payer: PHP Medicare Advantage |
$902.61
|
| Rate for Payer: PHP Medicare Advantage |
$902.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,289.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.50
|
| Rate for Payer: Priority Health Medicare |
$911.64
|
| Rate for Payer: Priority Health Medicare |
$911.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$902.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$902.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$902.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$902.61
|
| Rate for Payer: UHC Exchange |
$902.61
|
| Rate for Payer: UHC Exchange |
$902.61
|
| Rate for Payer: UHC Medicare Advantage |
$902.61
|
| Rate for Payer: UHC Medicare Advantage |
$902.61
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 93455
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$1,258.82 |
| Rate for Payer: Aetna Commercial |
$1,171.40
|
| Rate for Payer: Aetna Medicare |
$909.15
|
| Rate for Payer: BCBS Complete |
$232.80
|
| Rate for Payer: BCBS MAPPO |
$874.18
|
| Rate for Payer: BCN Medicare Advantage |
$874.18
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$1,258.82
|
| Rate for Payer: Cofinity Commercial |
$1,171.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.89
|
| Rate for Payer: Nomi Health Commercial |
$1,049.02
|
| Rate for Payer: PACE SWMI |
$874.18
|
| Rate for Payer: PHP Medicare Advantage |
$874.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.30
|
| Rate for Payer: Priority Health Medicare |
$882.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$874.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.18
|
| Rate for Payer: UHC Exchange |
$874.18
|
| Rate for Payer: UHC Medicare Advantage |
$874.18
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$2,427.00
|
|
|
Service Code
|
HCPCS 93457
|
| Min. Negotiated Rate |
$970.80 |
| Max. Negotiated Rate |
$1,577.55 |
| Rate for Payer: Aetna Commercial |
$1,426.75
|
| Rate for Payer: Aetna Medicare |
$1,107.33
|
| Rate for Payer: BCBS Complete |
$970.80
|
| Rate for Payer: BCBS MAPPO |
$1,064.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,064.74
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cofinity Commercial |
$1,533.23
|
| Rate for Payer: Cofinity Commercial |
$1,426.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,064.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,117.98
|
| Rate for Payer: Nomi Health Commercial |
$1,277.69
|
| Rate for Payer: PACE SWMI |
$1,064.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,064.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.55
|
| Rate for Payer: Priority Health Medicare |
$1,075.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,064.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,064.74
|
| Rate for Payer: UHC Exchange |
$1,064.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,064.74
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,171.00
|
|
|
Service Code
|
HCPCS 93456
|
| Min. Negotiated Rate |
$868.40 |
| Max. Negotiated Rate |
$1,411.15 |
| Rate for Payer: Aetna Commercial |
$1,306.11
|
| Rate for Payer: Aetna Medicare |
$1,013.70
|
| Rate for Payer: BCBS Complete |
$868.40
|
| Rate for Payer: BCBS MAPPO |
$974.71
|
| Rate for Payer: BCN Medicare Advantage |
$974.71
|
| Rate for Payer: Cash Price |
$1,736.80
|
| Rate for Payer: Cash Price |
$1,736.80
|
| Rate for Payer: Cofinity Commercial |
$1,403.58
|
| Rate for Payer: Cofinity Commercial |
$1,306.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,023.45
|
| Rate for Payer: Nomi Health Commercial |
$1,169.65
|
| Rate for Payer: PACE SWMI |
$974.71
|
| Rate for Payer: PHP Medicare Advantage |
$974.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,411.15
|
| Rate for Payer: Priority Health Medicare |
$984.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.71
|
| Rate for Payer: UHC Exchange |
$974.71
|
| Rate for Payer: UHC Medicare Advantage |
$974.71
|
|
|
PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 58340
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$418.60 |
| Rate for Payer: Aetna Commercial |
$74.20
|
| Rate for Payer: Aetna Medicare |
$57.58
|
| Rate for Payer: BCBS Complete |
$257.60
|
| Rate for Payer: BCBS MAPPO |
$55.37
|
| Rate for Payer: BCN Medicare Advantage |
$55.37
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cofinity Commercial |
$79.73
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.14
|
| Rate for Payer: Nomi Health Commercial |
$66.44
|
| Rate for Payer: PACE SWMI |
$55.37
|
| Rate for Payer: PHP Medicare Advantage |
$55.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.60
|
| Rate for Payer: Priority Health Medicare |
$55.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.37
|
| Rate for Payer: UHC Exchange |
$55.37
|
| Rate for Payer: UHC Medicare Advantage |
$55.37
|
|
|
PR CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 57511
|
| Min. Negotiated Rate |
$139.54 |
| Max. Negotiated Rate |
$299.00 |
| Rate for Payer: Aetna Commercial |
$186.98
|
| Rate for Payer: Aetna Medicare |
$145.12
|
| Rate for Payer: BCBS Complete |
$184.00
|
| Rate for Payer: BCBS MAPPO |
$139.54
|
| Rate for Payer: BCN Medicare Advantage |
$139.54
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cofinity Commercial |
$200.94
|
| Rate for Payer: Cofinity Commercial |
$186.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.52
|
| Rate for Payer: Nomi Health Commercial |
$167.45
|
| Rate for Payer: PACE SWMI |
$139.54
|
| Rate for Payer: PHP Medicare Advantage |
$139.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.00
|
| Rate for Payer: Priority Health Medicare |
$140.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.54
|
| Rate for Payer: UHC Exchange |
$139.54
|
| Rate for Payer: UHC Medicare Advantage |
$139.54
|
|
|
PR CAUTERY CERVIX ELECTRO/THERMAL
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 57510
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$144.99
|
| Rate for Payer: Aetna Medicare |
$112.53
|
| Rate for Payer: BCBS Complete |
$192.00
|
| Rate for Payer: BCBS MAPPO |
$108.20
|
| Rate for Payer: BCN Medicare Advantage |
$108.20
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$155.81
|
| Rate for Payer: Cofinity Commercial |
$144.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.61
|
| Rate for Payer: Nomi Health Commercial |
$129.84
|
| Rate for Payer: PACE SWMI |
$108.20
|
| Rate for Payer: PHP Medicare Advantage |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.00
|
| Rate for Payer: Priority Health Medicare |
$109.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.20
|
| Rate for Payer: UHC Exchange |
$108.20
|
| Rate for Payer: UHC Medicare Advantage |
$108.20
|
|
|
PR CAUTERY CERVIX LASER ABLATION
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
HCPCS 57513
|
| Min. Negotiated Rate |
$138.95 |
| Max. Negotiated Rate |
$360.10 |
| Rate for Payer: Aetna Commercial |
$186.19
|
| Rate for Payer: Aetna Medicare |
$144.51
|
| Rate for Payer: BCBS Complete |
$221.60
|
| Rate for Payer: BCBS MAPPO |
$138.95
|
| Rate for Payer: BCN Medicare Advantage |
$138.95
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cofinity Commercial |
$186.19
|
| Rate for Payer: Cofinity Commercial |
$200.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.90
|
| Rate for Payer: Nomi Health Commercial |
$166.74
|
| Rate for Payer: PACE SWMI |
$138.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.10
|
| Rate for Payer: Priority Health Medicare |
$140.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.95
|
| Rate for Payer: UHC Exchange |
$138.95
|
| Rate for Payer: UHC Medicare Advantage |
$138.95
|
|
|
PR CBHC CONSULT FEE $150
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00678
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
