|
PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
|
Professional
|
Both
|
$1,679.00
|
|
|
Service Code
|
HCPCS 93454
|
| Min. Negotiated Rate |
$671.60 |
| Max. Negotiated Rate |
$2,147.01 |
| Rate for Payer: Aetna Commercial |
$1,146.34
|
| Rate for Payer: Aetna Commercial |
$1,146.34
|
| Rate for Payer: Aetna Medicare |
$855.48
|
| Rate for Payer: Aetna Medicare |
$855.48
|
| Rate for Payer: BCBS Complete |
$671.60
|
| Rate for Payer: BCBS Complete |
$306.80
|
| Rate for Payer: BCBS MAPPO |
$855.48
|
| Rate for Payer: BCBS MAPPO |
$855.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,147.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,147.01
|
| Rate for Payer: BCN Commercial |
$1,324.80
|
| Rate for Payer: BCN Commercial |
$1,324.80
|
| Rate for Payer: BCN Medicare Advantage |
$855.48
|
| Rate for Payer: BCN Medicare Advantage |
$855.48
|
| Rate for Payer: Cash Price |
$613.60
|
| Rate for Payer: Cash Price |
$1,343.20
|
| Rate for Payer: Cash Price |
$1,343.20
|
| Rate for Payer: Cash Price |
$613.60
|
| Rate for Payer: Cofinity Commercial |
$1,231.89
|
| Rate for Payer: Cofinity Commercial |
$1,146.34
|
| Rate for Payer: Cofinity Commercial |
$1,146.34
|
| Rate for Payer: Cofinity Commercial |
$1,231.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.48
|
| Rate for Payer: Healthscope Commercial |
$1,026.58
|
| Rate for Payer: Healthscope Commercial |
$1,026.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,026.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,026.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$898.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$898.25
|
| Rate for Payer: PACE SWMI |
$855.48
|
| Rate for Payer: PACE SWMI |
$855.48
|
| Rate for Payer: PHP Medicare Advantage |
$855.48
|
| Rate for Payer: PHP Medicare Advantage |
$855.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,281.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,281.94
|
| Rate for Payer: Priority Health Medicare |
$855.48
|
| Rate for Payer: Priority Health Medicare |
$855.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,281.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,281.94
|
| Rate for Payer: UHC Medicare Advantage |
$881.14
|
| Rate for Payer: UHC Medicare Advantage |
$881.14
|
|
|
PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 93459
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$1,637.56 |
| Rate for Payer: Aetna Commercial |
$1,420.95
|
| Rate for Payer: Aetna Commercial |
$1,420.95
|
| Rate for Payer: Aetna Medicare |
$1,060.41
|
| Rate for Payer: Aetna Medicare |
$1,060.41
|
| Rate for Payer: BCBS Complete |
$862.80
|
| Rate for Payer: BCBS Complete |
$435.60
|
| Rate for Payer: BCBS MAPPO |
$1,060.41
|
| Rate for Payer: BCBS MAPPO |
$1,060.41
|
| Rate for Payer: BCBS Trust/PPO |
$570.56
|
| Rate for Payer: BCBS Trust/PPO |
$570.56
|
| Rate for Payer: BCN Commercial |
$1,637.56
|
| Rate for Payer: BCN Commercial |
$1,637.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,060.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,060.41
|
| Rate for Payer: Cash Price |
$1,725.60
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$1,725.60
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$1,420.95
|
| Rate for Payer: Cofinity Commercial |
$1,526.99
|
| Rate for Payer: Cofinity Commercial |
$1,420.95
|
| Rate for Payer: Cofinity Commercial |
$1,526.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,060.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,060.41
|
| Rate for Payer: Healthscope Commercial |
$1,272.49
|
| Rate for Payer: Healthscope Commercial |
$1,272.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,272.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,272.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,113.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,113.43
|
| Rate for Payer: PACE SWMI |
$1,060.41
|
| Rate for Payer: PACE SWMI |
$1,060.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,060.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,060.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$762.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,584.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,584.58
|
| Rate for Payer: Priority Health Medicare |
$1,060.41
|
| Rate for Payer: Priority Health Medicare |
$1,060.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,584.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,584.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,092.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,092.22
|
|
|
PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$951.00
|
|
|
Service Code
|
HCPCS 93458
|
| Min. Negotiated Rate |
$380.40 |
| Max. Negotiated Rate |
$1,522.23 |
| Rate for Payer: Aetna Commercial |
$1,319.24
|
| Rate for Payer: Aetna Commercial |
$1,319.24
|
| Rate for Payer: Aetna Medicare |
$984.51
|
| Rate for Payer: Aetna Medicare |
$984.51
|
| Rate for Payer: BCBS Complete |
$380.40
|
| Rate for Payer: BCBS Complete |
$778.00
|
| Rate for Payer: BCBS MAPPO |
$984.51
|
| Rate for Payer: BCBS MAPPO |
$984.51
|
| Rate for Payer: BCBS Trust/PPO |
$545.73
|
| Rate for Payer: BCBS Trust/PPO |
$545.73
|
| Rate for Payer: BCN Commercial |
$1,522.23
|
| Rate for Payer: BCN Commercial |
$1,522.23
|
| Rate for Payer: BCN Medicare Advantage |
$984.51
|
| Rate for Payer: BCN Medicare Advantage |
$984.51
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cofinity Commercial |
$1,319.24
|
| Rate for Payer: Cofinity Commercial |
$1,417.69
|
| Rate for Payer: Cofinity Commercial |
$1,417.69
|
| Rate for Payer: Cofinity Commercial |
$1,319.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$984.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$984.51
|
| Rate for Payer: Healthscope Commercial |
$1,181.41
|
| Rate for Payer: Healthscope Commercial |
$1,181.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,033.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,033.74
|
| Rate for Payer: PACE SWMI |
$984.51
|
| Rate for Payer: PACE SWMI |
$984.51
|
| Rate for Payer: PHP Medicare Advantage |
$984.51
|
| Rate for Payer: PHP Medicare Advantage |
$984.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,361.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,472.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,472.99
|
| Rate for Payer: Priority Health Medicare |
$984.51
|
| Rate for Payer: Priority Health Medicare |
$984.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,472.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,472.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.05
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 93455
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$1,475.81 |
| Rate for Payer: Aetna Commercial |
$1,278.24
|
| Rate for Payer: Aetna Medicare |
$953.91
|
| Rate for Payer: BCBS Complete |
$228.40
|
| Rate for Payer: BCBS MAPPO |
$953.91
|
| Rate for Payer: BCBS Trust/PPO |
$472.30
|
| Rate for Payer: BCN Commercial |
$1,475.81
|
| Rate for Payer: BCN Medicare Advantage |
$953.91
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cofinity Commercial |
$1,373.63
|
| Rate for Payer: Cofinity Commercial |
$1,278.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.91
|
| Rate for Payer: Healthscope Commercial |
$1,144.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,144.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,001.61
|
| Rate for Payer: PACE SWMI |
$953.91
|
| Rate for Payer: PHP Medicare Advantage |
$953.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,428.06
|
| Rate for Payer: Priority Health Medicare |
$953.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,428.06
|
| Rate for Payer: UHC Medicare Advantage |
$982.53
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$2,379.00
|
|
|
Service Code
|
HCPCS 93457
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$1,795.89 |
| Rate for Payer: Aetna Commercial |
$1,556.45
|
| Rate for Payer: Aetna Medicare |
$1,161.53
|
| Rate for Payer: BCBS Complete |
$951.60
|
| Rate for Payer: BCBS MAPPO |
$1,161.53
|
| Rate for Payer: BCBS Trust/PPO |
$542.56
|
| Rate for Payer: BCN Commercial |
$1,795.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,161.53
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cofinity Commercial |
$1,556.45
|
| Rate for Payer: Cofinity Commercial |
$1,672.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,161.53
|
| Rate for Payer: Healthscope Commercial |
$1,393.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,393.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,219.61
|
| Rate for Payer: PACE SWMI |
$1,161.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,161.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,737.78
|
| Rate for Payer: Priority Health Medicare |
$1,161.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,737.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,196.38
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,128.00
|
|
|
Service Code
|
HCPCS 93456
|
| Min. Negotiated Rate |
$503.47 |
| Max. Negotiated Rate |
$1,648.31 |
| Rate for Payer: Aetna Commercial |
$1,427.56
|
| Rate for Payer: Aetna Medicare |
$1,065.34
|
| Rate for Payer: BCBS Complete |
$851.20
|
| Rate for Payer: BCBS MAPPO |
$1,065.34
|
| Rate for Payer: BCBS Trust/PPO |
$503.47
|
| Rate for Payer: BCN Commercial |
$1,648.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.34
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cofinity Commercial |
$1,427.56
|
| Rate for Payer: Cofinity Commercial |
$1,534.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.34
|
| Rate for Payer: Healthscope Commercial |
$1,278.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,278.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,118.61
|
| Rate for Payer: PACE SWMI |
$1,065.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,489.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,594.99
|
| Rate for Payer: Priority Health Medicare |
$1,065.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,594.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,097.30
|
|
|
PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
HCPCS 58340
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$441.70 |
| Rate for Payer: Aetna Commercial |
$75.35
|
| Rate for Payer: Aetna Medicare |
$56.23
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$56.23
|
| Rate for Payer: BCBS Trust/PPO |
$441.13
|
| Rate for Payer: BCN Commercial |
$362.60
|
| Rate for Payer: BCN Medicare Advantage |
$56.23
|
| Rate for Payer: Cash Price |
$504.80
|
| Rate for Payer: Cash Price |
$504.80
|
| Rate for Payer: Cofinity Commercial |
$75.35
|
| Rate for Payer: Cofinity Commercial |
$80.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.23
|
| Rate for Payer: Healthscope Commercial |
$67.48
|
| Rate for Payer: Healthscope Whirlpool |
$67.48
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.04
|
| Rate for Payer: PACE SWMI |
$56.23
|
| Rate for Payer: PHP Medicare Advantage |
$56.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.96
|
| Rate for Payer: Priority Health Medicare |
$56.23
|
| Rate for Payer: Priority Health Narrow Network |
$80.96
|
| Rate for Payer: UHC Medicare Advantage |
$57.92
|
|
|
PR CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 57511
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna Commercial |
$193.46
|
| Rate for Payer: Aetna Medicare |
$144.37
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$144.37
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$236.77
|
| Rate for Payer: BCN Medicare Advantage |
$144.37
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cofinity Commercial |
$207.89
|
| Rate for Payer: Cofinity Commercial |
$193.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.37
|
| Rate for Payer: Healthscope Commercial |
$173.24
|
| Rate for Payer: Healthscope Whirlpool |
$173.24
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.59
|
| Rate for Payer: PACE SWMI |
$144.37
|
| Rate for Payer: PHP Medicare Advantage |
$144.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.73
|
| Rate for Payer: Priority Health Medicare |
$144.37
|
| Rate for Payer: Priority Health Narrow Network |
$209.73
|
| Rate for Payer: UHC Medicare Advantage |
$148.70
|
|
|
PR CAUTERY CERVIX ELECTRO/THERMAL
|
Professional
|
Both
|
$471.00
|
|
|
Service Code
|
HCPCS 57510
|
| Min. Negotiated Rate |
$72.63 |
| Max. Negotiated Rate |
$689.96 |
| Rate for Payer: Aetna Commercial |
$148.93
|
| Rate for Payer: Aetna Medicare |
$111.14
|
| Rate for Payer: BCBS Complete |
$76.26
|
| Rate for Payer: BCBS MAPPO |
$111.14
|
| Rate for Payer: BCBS Trust/PPO |
$689.96
|
| Rate for Payer: BCN Commercial |
$246.78
|
| Rate for Payer: BCN Medicare Advantage |
$111.14
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cofinity Commercial |
$160.04
|
| Rate for Payer: Cofinity Commercial |
$148.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.14
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Healthscope Whirlpool |
$133.37
|
| Rate for Payer: Meridian Medicaid |
$76.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$116.70
|
| Rate for Payer: PACE SWMI |
$111.14
|
| Rate for Payer: PHP Medicare Advantage |
$111.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.07
|
| Rate for Payer: Priority Health Medicare |
$111.14
|
| Rate for Payer: Priority Health Narrow Network |
$159.07
|
| Rate for Payer: UHC Medicare Advantage |
$114.47
|
|
|
PR CAUTERY CERVIX LASER ABLATION
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
HCPCS 57513
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$646.64 |
| Rate for Payer: Aetna Commercial |
$193.05
|
| Rate for Payer: Aetna Medicare |
$144.07
|
| Rate for Payer: BCBS Complete |
$99.53
|
| Rate for Payer: BCBS MAPPO |
$144.07
|
| Rate for Payer: BCBS Trust/PPO |
$646.64
|
| Rate for Payer: BCN Commercial |
$304.45
|
| Rate for Payer: BCN Medicare Advantage |
$144.07
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cofinity Commercial |
$207.46
|
| Rate for Payer: Cofinity Commercial |
$193.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.07
|
| Rate for Payer: Healthscope Commercial |
$172.88
|
| Rate for Payer: Healthscope Whirlpool |
$172.88
|
| Rate for Payer: Meridian Medicaid |
$99.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.27
|
| Rate for Payer: PACE SWMI |
$144.07
|
| Rate for Payer: PHP Medicare Advantage |
$144.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.25
|
| Rate for Payer: Priority Health Medicare |
$144.07
|
| Rate for Payer: Priority Health Narrow Network |
$209.25
|
| Rate for Payer: UHC Medicare Advantage |
$148.39
|
|
|
PR CBHC CONSULT FEE
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00585
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR CBHC IN HOUSE REPAIR
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 00580
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
|
|
PR CBHC IN-HOUSE REPAIR
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 00590
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
|
|
PR CBHC LOSS AND DAMAGE FEE
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 00581
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
|
|
PR CBHC MAILING CHARGE
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 00584
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
|
|
PR CBHC RECASE BTE
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 00582
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
|
|
PR CBHC RECASE ITE
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 00583
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
|
|
PR CBHC REPAIR 5 YRS AND OLDER
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 00589
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
|
|
PR CBHC REPAIR DIGITAL/CIC
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00588
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR CBHC REPAIR RECEIVER
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00587
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE
|
Professional
|
Both
|
$66.69
|
|
|
Service Code
|
HCPCS 90756
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$46.68 |
| Rate for Payer: Aetna Commercial |
$40.98
|
| Rate for Payer: Aetna Medicare |
$30.58
|
| Rate for Payer: BCBS Complete |
$26.68
|
| Rate for Payer: BCBS MAPPO |
$30.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Medicare Advantage |
$30.58
|
| Rate for Payer: Cash Price |
$53.35
|
| Rate for Payer: Cash Price |
$53.35
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$40.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.58
|
| Rate for Payer: Healthscope Commercial |
$36.70
|
| Rate for Payer: Healthscope Whirlpool |
$36.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.11
|
| Rate for Payer: PACE SWMI |
$30.58
|
| Rate for Payer: PHP Medicare Advantage |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.68
|
| Rate for Payer: Priority Health Medicare |
$30.58
|
| Rate for Payer: UHC Medicare Advantage |
$31.50
|
|
|
PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE
|
Professional
|
Both
|
$71.40
|
|
|
Service Code
|
HCPCS 90674
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$49.98 |
| Rate for Payer: Aetna Commercial |
$43.25
|
| Rate for Payer: Aetna Medicare |
$32.28
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS MAPPO |
$32.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.98
|
| Rate for Payer: BCN Commercial |
$33.98
|
| Rate for Payer: BCN Medicare Advantage |
$32.28
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.28
|
| Rate for Payer: Healthscope Commercial |
$38.73
|
| Rate for Payer: Healthscope Whirlpool |
$38.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.89
|
| Rate for Payer: PACE SWMI |
$32.28
|
| Rate for Payer: PHP Medicare Advantage |
$32.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health Medicare |
$32.28
|
| Rate for Payer: UHC Medicare Advantage |
$33.25
|
|
|
PR Ccm/bhi by rhc/fqhc 20min mo
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS G0511
|
| Min. Negotiated Rate |
$56.54 |
| Max. Negotiated Rate |
$589.58 |
| Rate for Payer: Aetna Commercial |
$63.19
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS Trust/PPO |
$589.58
|
| Rate for Payer: BCN Commercial |
$112.40
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.54
|
| Rate for Payer: Priority Health Narrow Network |
$56.54
|
|
|
PR CEFTRIAXONE SODIUM INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0696
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$0.76
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.57
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.57
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$0.76
|
| Rate for Payer: Cofinity Commercial |
$0.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.57
|
| Rate for Payer: Healthscope Commercial |
$0.68
|
| Rate for Payer: Healthscope Whirlpool |
$0.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.57
|
| Rate for Payer: PHP Medicare Advantage |
$0.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Medicare |
$0.57
|
| Rate for Payer: UHC Medicare Advantage |
$0.59
|
|
|
PR CERCLAGE CERVIX PREGNANCY VAGINAL
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 59320
|
| Min. Negotiated Rate |
$97.13 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$202.55
|
| Rate for Payer: Aetna Medicare |
$151.16
|
| Rate for Payer: BCBS Complete |
$101.99
|
| Rate for Payer: BCBS MAPPO |
$151.16
|
| Rate for Payer: BCBS Trust/PPO |
$213.43
|
| Rate for Payer: BCN Commercial |
$220.88
|
| Rate for Payer: BCN Medicare Advantage |
$151.16
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$217.67
|
| Rate for Payer: Cofinity Commercial |
$202.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.16
|
| Rate for Payer: Healthscope Commercial |
$181.39
|
| Rate for Payer: Healthscope Whirlpool |
$181.39
|
| Rate for Payer: Meridian Medicaid |
$101.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.72
|
| Rate for Payer: PACE SWMI |
$151.16
|
| Rate for Payer: PHP Medicare Advantage |
$151.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.42
|
| Rate for Payer: Priority Health Medicare |
$151.16
|
| Rate for Payer: Priority Health Narrow Network |
$213.42
|
| Rate for Payer: UHC Medicare Advantage |
$155.69
|
|
