|
PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 93458
|
| Min. Negotiated Rate |
$946.19 |
| Max. Negotiated Rate |
$1,649.69 |
| Rate for Payer: Aetna Commercial |
$1,267.89
|
| Rate for Payer: Aetna Commercial |
$1,267.89
|
| Rate for Payer: Aetna Medicare |
$946.19
|
| Rate for Payer: Aetna Medicare |
$946.19
|
| Rate for Payer: BCBS MAPPO |
$946.19
|
| Rate for Payer: BCBS MAPPO |
$946.19
|
| Rate for Payer: BCN Commercial |
$1,482.49
|
| Rate for Payer: BCN Commercial |
$1,482.49
|
| Rate for Payer: BCN Medicare Advantage |
$946.19
|
| Rate for Payer: BCN Medicare Advantage |
$946.19
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cofinity Commercial |
$1,267.89
|
| Rate for Payer: Cofinity Commercial |
$1,362.51
|
| Rate for Payer: Cofinity Commercial |
$1,267.89
|
| Rate for Payer: Cofinity Commercial |
$1,362.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.19
|
| Rate for Payer: Healthscope Commercial |
$1,135.43
|
| Rate for Payer: Healthscope Commercial |
$1,135.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,040.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,040.81
|
| Rate for Payer: Nomi Health Commercial |
$1,135.43
|
| Rate for Payer: Nomi Health Commercial |
$1,135.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$749.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,533.00
|
| Rate for Payer: PACE SWMI |
$946.19
|
| Rate for Payer: PACE SWMI |
$946.19
|
| Rate for Payer: PHP Medicare Advantage |
$946.19
|
| Rate for Payer: PHP Medicare Advantage |
$946.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,409.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,409.04
|
| Rate for Payer: Priority Health Medicare |
$946.19
|
| Rate for Payer: Priority Health Medicare |
$946.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,409.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,409.04
|
| Rate for Payer: Railroad Medicare Medicare |
$946.19
|
| Rate for Payer: Railroad Medicare Medicare |
$946.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,649.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,649.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$946.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$946.19
|
| Rate for Payer: UHC Exchange |
$1,649.69
|
| Rate for Payer: UHC Exchange |
$1,649.69
|
| Rate for Payer: UHCCP DNSP |
$946.19
|
| Rate for Payer: UHCCP DNSP |
$946.19
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
HCPCS 93455
|
| Min. Negotiated Rate |
$449.25 |
| Max. Negotiated Rate |
$1,599.97 |
| Rate for Payer: Aetna Commercial |
$1,228.65
|
| Rate for Payer: Aetna Medicare |
$916.90
|
| Rate for Payer: BCBS MAPPO |
$916.90
|
| Rate for Payer: BCN Commercial |
$1,436.67
|
| Rate for Payer: BCN Medicare Advantage |
$916.90
|
| Rate for Payer: Cash Price |
$479.20
|
| Rate for Payer: Cash Price |
$479.20
|
| Rate for Payer: Cofinity Commercial |
$1,228.65
|
| Rate for Payer: Cofinity Commercial |
$1,320.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$916.90
|
| Rate for Payer: Healthscope Commercial |
$1,100.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,100.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$962.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,008.59
|
| Rate for Payer: Nomi Health Commercial |
$1,100.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$449.25
|
| Rate for Payer: PACE SWMI |
$916.90
|
| Rate for Payer: PHP Medicare Advantage |
$916.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,365.49
|
| Rate for Payer: Priority Health Medicare |
$916.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,365.49
|
| Rate for Payer: Railroad Medicare Medicare |
$916.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,599.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$916.90
|
| Rate for Payer: UHC Exchange |
$1,599.97
|
| Rate for Payer: UHCCP DNSP |
$916.90
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 93457
|
| Min. Negotiated Rate |
$1,117.98 |
| Max. Negotiated Rate |
$1,974.31 |
| Rate for Payer: Aetna Commercial |
$1,498.09
|
| Rate for Payer: Aetna Medicare |
$1,117.98
|
| Rate for Payer: BCBS MAPPO |
$1,117.98
|
| Rate for Payer: BCN Commercial |
$1,748.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,117.98
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cofinity Commercial |
$1,498.09
|
| Rate for Payer: Cofinity Commercial |
$1,609.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,117.98
|
| Rate for Payer: Healthscope Commercial |
$1,341.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,341.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,173.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,229.78
|
| Rate for Payer: Nomi Health Commercial |
$1,341.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,875.00
|
| Rate for Payer: PACE SWMI |
$1,117.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,117.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,661.78
|
| Rate for Payer: Priority Health Medicare |
$1,117.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,661.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,117.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,974.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,117.98
|
| Rate for Payer: UHC Exchange |
$1,974.31
|
| Rate for Payer: UHCCP DNSP |
$1,117.98
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 93456
|
| Min. Negotiated Rate |
$1,023.48 |
| Max. Negotiated Rate |
$1,782.16 |
| Rate for Payer: Aetna Commercial |
$1,371.46
|
| Rate for Payer: Aetna Medicare |
$1,023.48
|
| Rate for Payer: BCBS MAPPO |
$1,023.48
|
| Rate for Payer: BCN Commercial |
$1,602.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.48
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cofinity Commercial |
$1,371.46
|
| Rate for Payer: Cofinity Commercial |
$1,473.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.48
|
| Rate for Payer: Healthscope Commercial |
$1,228.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,228.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,125.83
|
| Rate for Payer: Nomi Health Commercial |
$1,228.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,677.00
|
| Rate for Payer: PACE SWMI |
$1,023.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,522.63
|
| Rate for Payer: Priority Health Medicare |
$1,023.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,522.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,023.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,782.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,023.48
|
| Rate for Payer: UHC Exchange |
$1,782.16
|
| Rate for Payer: UHCCP DNSP |
$1,023.48
|
|
|
PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
HCPCS 58340
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$68.45
|
| Rate for Payer: Aetna Medicare |
$51.08
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$51.08
|
| Rate for Payer: BCN Commercial |
$87.15
|
| Rate for Payer: BCN Medicare Advantage |
$51.08
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.08
|
| Rate for Payer: Healthscope Commercial |
$61.30
|
| Rate for Payer: Healthscope Whirlpool |
$61.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.63
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.19
|
| Rate for Payer: Nomi Health Commercial |
$61.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.25
|
| Rate for Payer: PACE SWMI |
$51.08
|
| Rate for Payer: PHP Medicare Advantage |
$51.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.27
|
| Rate for Payer: Priority Health Medicare |
$51.08
|
| Rate for Payer: Priority Health Narrow Network |
$88.27
|
| Rate for Payer: Railroad Medicare Medicare |
$51.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.08
|
| Rate for Payer: UHC Exchange |
$100.14
|
| Rate for Payer: UHC Medicaid |
$33.23
|
| Rate for Payer: UHCCP DNSP |
$51.08
|
| Rate for Payer: UHCCP Medicaid |
$33.23
|
|
|
PR CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 57511
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Aetna Commercial |
$171.68
|
| Rate for Payer: Aetna Medicare |
$128.12
|
| Rate for Payer: BCBS Complete |
$88.12
|
| Rate for Payer: BCBS MAPPO |
$128.12
|
| Rate for Payer: BCN Commercial |
$174.75
|
| Rate for Payer: BCN Medicare Advantage |
$128.12
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Commercial |
$184.49
|
| Rate for Payer: Cofinity Commercial |
$171.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.12
|
| Rate for Payer: Healthscope Commercial |
$153.74
|
| Rate for Payer: Healthscope Whirlpool |
$153.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.53
|
| Rate for Payer: Meridian Medicaid |
$88.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.93
|
| Rate for Payer: Nomi Health Commercial |
$153.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.50
|
| Rate for Payer: PACE SWMI |
$128.12
|
| Rate for Payer: PHP Medicare Advantage |
$128.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$224.43
|
| Rate for Payer: Priority Health Medicare |
$128.12
|
| Rate for Payer: Priority Health Narrow Network |
$224.43
|
| Rate for Payer: Railroad Medicare Medicare |
$128.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.12
|
| Rate for Payer: UHC Exchange |
$245.32
|
| Rate for Payer: UHC Medicaid |
$83.92
|
| Rate for Payer: UHCCP DNSP |
$128.12
|
| Rate for Payer: UHCCP Medicaid |
$83.92
|
|
|
PR CAUTERY CERVIX ELECTRO/THERMAL
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
HCPCS 57510
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna Commercial |
$135.53
|
| Rate for Payer: Aetna Medicare |
$101.14
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$101.14
|
| Rate for Payer: BCN Commercial |
$169.31
|
| Rate for Payer: BCN Medicare Advantage |
$101.14
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Cofinity Commercial |
$145.64
|
| Rate for Payer: Cofinity Commercial |
$135.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.14
|
| Rate for Payer: Healthscope Commercial |
$121.37
|
| Rate for Payer: Healthscope Whirlpool |
$121.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.20
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.25
|
| Rate for Payer: Nomi Health Commercial |
$121.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.50
|
| Rate for Payer: PACE SWMI |
$101.14
|
| Rate for Payer: PHP Medicare Advantage |
$101.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$171.48
|
| Rate for Payer: Priority Health Medicare |
$101.14
|
| Rate for Payer: Priority Health Narrow Network |
$171.48
|
| Rate for Payer: Railroad Medicare Medicare |
$101.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.14
|
| Rate for Payer: UHC Exchange |
$200.76
|
| Rate for Payer: UHC Medicaid |
$65.18
|
| Rate for Payer: UHCCP DNSP |
$101.14
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
|
PR CAUTERY CERVIX LASER ABLATION
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 57513
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$428.25 |
| Rate for Payer: Aetna Commercial |
$170.86
|
| Rate for Payer: Aetna Medicare |
$127.51
|
| Rate for Payer: BCBS Complete |
$87.67
|
| Rate for Payer: BCBS MAPPO |
$127.51
|
| Rate for Payer: BCN Commercial |
$220.60
|
| Rate for Payer: BCN Medicare Advantage |
$127.51
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cofinity Commercial |
$170.86
|
| Rate for Payer: Cofinity Commercial |
$183.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.51
|
| Rate for Payer: Healthscope Commercial |
$153.01
|
| Rate for Payer: Healthscope Whirlpool |
$153.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.89
|
| Rate for Payer: Meridian Medicaid |
$87.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.26
|
| Rate for Payer: Nomi Health Commercial |
$153.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.25
|
| Rate for Payer: PACE SWMI |
$127.51
|
| Rate for Payer: PHP Medicare Advantage |
$127.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$223.42
|
| Rate for Payer: Priority Health Medicare |
$127.51
|
| Rate for Payer: Priority Health Narrow Network |
$223.42
|
| Rate for Payer: Railroad Medicare Medicare |
$127.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.51
|
| Rate for Payer: UHC Exchange |
$244.75
|
| Rate for Payer: UHC Medicaid |
$83.50
|
| Rate for Payer: UHCCP DNSP |
$127.51
|
| Rate for Payer: UHCCP Medicaid |
$83.50
|
|
|
PR CBHC CONSULT FEE $150
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
|
|
PR CBHC CONSULT FEE $300
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
|
|
PR CBHC IN HOUSE REPAIR
|
Professional
|
Both
|
$37.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
|
|
PR CBHC IN-HOUSE REPAIR
|
Professional
|
Both
|
$28.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
|
|
PR CBHC LOSS AND DAMAGE FEE
|
Professional
|
Both
|
$289.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
|
|
PR CBHC MAILING CHARGE
|
Professional
|
Both
|
$47.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
|
|
PR CBHC RECASE BTE
|
Professional
|
Both
|
$63.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
|
|
PR CBHC RECASE ITE
|
Professional
|
Both
|
$184.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
|
|
PR CBHC REPAIR 5 YRS AND OLDER
|
Professional
|
Both
|
$447.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: BCBS Complete |
$178.80
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.25
|
|
|
PR CBHC REPAIR DIGITAL/CIC
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
|
|
PR CBHC REPAIR RECEIVER
|
Professional
|
Both
|
$132.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
|
|
PR CCIIV3 VACCINE ABX FREE 0.5 ML FOR IM USE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 90661
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: BCBS MAPPO |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$43.54
|
| Rate for Payer: BCN Commercial |
$31.80
|
| Rate for Payer: BCN Medicare Advantage |
$49.50
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$66.33
|
| Rate for Payer: Cofinity Commercial |
$71.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Healthscope Whirlpool |
$59.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.45
|
| Rate for Payer: Nomi Health Commercial |
$59.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE SWMI |
$49.50
|
| Rate for Payer: PHP Medicare Advantage |
$49.50
|
| Rate for Payer: Priority Health Medicare |
$49.50
|
| Rate for Payer: Railroad Medicare Medicare |
$49.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.50
|
| Rate for Payer: UHC Exchange |
$43.54
|
| Rate for Payer: UHCCP DNSP |
$49.50
|
|
|
PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 90756
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$32.37
|
| Rate for Payer: BCBS Trust/PPO |
$28.52
|
| Rate for Payer: BCN Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.38
|
| Rate for Payer: UHC Exchange |
$32.38
|
|
|
PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 90674
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna Commercial |
$34.17
|
| Rate for Payer: BCBS Trust/PPO |
$30.10
|
| Rate for Payer: BCN Commercial |
$29.49
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.17
|
| Rate for Payer: UHC Exchange |
$34.17
|
|
|
PR CCM/BHI BY RHC/FQHC 20MIN MO
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS G0511
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$63.19
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCN Commercial |
$48.30
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
|
|
PR CDP-SOT 6 CONDITIONS W/I&R W/MCT & ADT
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 92549
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Aetna Commercial |
$79.92
|
| Rate for Payer: Aetna Medicare |
$59.64
|
| Rate for Payer: BCBS MAPPO |
$59.64
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: BCN Medicare Advantage |
$59.64
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$85.88
|
| Rate for Payer: Cofinity Commercial |
$79.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.64
|
| Rate for Payer: Healthscope Commercial |
$71.57
|
| Rate for Payer: Healthscope Whirlpool |
$71.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.60
|
| Rate for Payer: Nomi Health Commercial |
$71.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.25
|
| Rate for Payer: PACE SWMI |
$59.64
|
| Rate for Payer: PHP Medicare Advantage |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.09
|
| Rate for Payer: Priority Health Medicare |
$59.64
|
| Rate for Payer: Priority Health Narrow Network |
$89.09
|
| Rate for Payer: Railroad Medicare Medicare |
$59.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.64
|
| Rate for Payer: UHC Exchange |
$100.14
|
| Rate for Payer: UHCCP DNSP |
$59.64
|
|
|
PR CEFTRIAXONE SODIUM INJECTION
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J0696
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$0.58
|
| Rate for Payer: Aetna Medicare |
$0.43
|
| Rate for Payer: BCBS MAPPO |
$0.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Medicare Advantage |
$0.43
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$0.58
|
| Rate for Payer: Cofinity Commercial |
$0.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.43
|
| Rate for Payer: Healthscope Commercial |
$0.52
|
| Rate for Payer: Healthscope Whirlpool |
$0.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.47
|
| Rate for Payer: Nomi Health Commercial |
$0.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: PACE SWMI |
$0.43
|
| Rate for Payer: PHP Medicare Advantage |
$0.43
|
| Rate for Payer: Priority Health Medicare |
$0.43
|
| Rate for Payer: Railroad Medicare Medicare |
$0.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.46
|
| Rate for Payer: UHCCP DNSP |
$0.43
|
|
