|
PR CAST SUP SHT ARM PED FBRGLAS
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$8.18
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCN Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.27
|
| Rate for Payer: UHC Exchange |
$5.27
|
|
|
PR CAST SUP SHT ARM SPLINT FBRG
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$10.18
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCN Commercial |
$11.97
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.58
|
| Rate for Payer: UHC Exchange |
$6.58
|
|
|
PR CAST SUP SHT ARM SPLNT PED F
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Commercial |
$5.11
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCN Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
| Rate for Payer: UHC Exchange |
$3.29
|
|
|
PR CAST SUP SHT LEG SPLNT FBRGL
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$15.64
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCN Commercial |
$18.37
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.10
|
| Rate for Payer: UHC Exchange |
$10.10
|
|
|
PR CAST SUP SHT LEG SPLNT PED F
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$7.83
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCN Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.05
|
| Rate for Payer: UHC Exchange |
$5.05
|
|
|
PR CAST SUP SHT LEG SPLNT PED P
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q4047
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCN Commercial |
$5.69
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.13
|
| Rate for Payer: UHC Exchange |
$3.13
|
|
|
PR CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 36660
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$738.56 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS Trust/PPO |
$738.56
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.90
|
| Rate for Payer: Priority Health Narrow Network |
$106.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.86
|
| Rate for Payer: UHC Exchange |
$89.86
|
| Rate for Payer: UHCCP Medicaid |
$42.81
|
|
|
PR CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 31717
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$1,013.81 |
| Rate for Payer: Aetna Commercial |
$136.71
|
| Rate for Payer: Aetna Medicare |
$265.00
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,013.81
|
| Rate for Payer: BCN Commercial |
$420.26
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Meridian Medicaid |
$69.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.61
|
| Rate for Payer: Priority Health Narrow Network |
$144.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.01
|
| Rate for Payer: UHC Exchange |
$126.01
|
| Rate for Payer: UHCCP Medicaid |
$66.24
|
|
|
PR CATHETERIZE FOR URINE SPEC
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS P9612
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1,574.33 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,574.33
|
| Rate for Payer: BCN Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
PR CATHJ UMBILICAL VEIN DX/THER NB
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 36510
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$947.77 |
| Rate for Payer: Aetna Commercial |
$70.85
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: BCBS Complete |
$34.67
|
| Rate for Payer: BCBS Trust/PPO |
$947.77
|
| Rate for Payer: BCN Commercial |
$124.62
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Meridian Medicaid |
$34.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.49
|
| Rate for Payer: Priority Health Narrow Network |
$83.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.96
|
| Rate for Payer: UHC Exchange |
$76.96
|
| Rate for Payer: UHCCP Medicaid |
$33.02
|
|
|
PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
|
Professional
|
Both
|
$782.00
|
|
|
Service Code
|
HCPCS 93454
|
| Min. Negotiated Rate |
$148.25 |
| Max. Negotiated Rate |
$2,147.01 |
| Rate for Payer: Aetna Commercial |
$1,231.58
|
| Rate for Payer: Aetna Commercial |
$1,231.58
|
| Rate for Payer: Aetna Medicare |
$391.00
|
| Rate for Payer: Aetna Medicare |
$856.50
|
| Rate for Payer: BCBS Complete |
$155.66
|
| Rate for Payer: BCBS Complete |
$155.66
|
| 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: Cash Price |
$1,370.40
|
| 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: Meridian Medicaid |
$155.66
|
| Rate for Payer: Meridian Medicaid |
$155.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.25
|
| 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 HMO/PPO/Tiered Network |
$327.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.70
|
| Rate for Payer: Priority Health Narrow Network |
$327.70
|
| Rate for Payer: Priority Health Narrow Network |
$327.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,155.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,155.33
|
| Rate for Payer: UHC Exchange |
$1,155.33
|
| Rate for Payer: UHC Exchange |
$1,155.33
|
| Rate for Payer: UHCCP Medicaid |
$148.25
|
| Rate for Payer: UHCCP Medicaid |
$148.25
|
|
|
PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
|
Professional
|
Both
|
$1,111.00
|
|
|
Service Code
|
HCPCS 93459
|
| Min. Negotiated Rate |
$207.25 |
| Max. Negotiated Rate |
$1,637.56 |
| Rate for Payer: Aetna Commercial |
$1,542.00
|
| Rate for Payer: Aetna Commercial |
$1,542.00
|
| Rate for Payer: Aetna Medicare |
$555.50
|
| Rate for Payer: Aetna Medicare |
$1,100.00
|
| Rate for Payer: BCBS Complete |
$217.61
|
| Rate for Payer: BCBS Complete |
$217.61
|
| 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: 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: Meridian Medicaid |
$217.61
|
| Rate for Payer: Meridian Medicaid |
$217.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.25
|
| 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 HMO/PPO/Tiered Network |
$458.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$458.13
|
| Rate for Payer: Priority Health Narrow Network |
$458.13
|
| Rate for Payer: Priority Health Narrow Network |
$458.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,540.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,540.16
|
| Rate for Payer: UHC Exchange |
$1,540.16
|
| Rate for Payer: UHC Exchange |
$1,540.16
|
| Rate for Payer: UHCCP Medicaid |
$207.25
|
| Rate for Payer: UHCCP Medicaid |
$207.25
|
|
|
PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$1,984.00
|
|
|
Service Code
|
HCPCS 93458
|
| Min. Negotiated Rate |
$182.75 |
| Max. Negotiated Rate |
$1,522.23 |
| Rate for Payer: Aetna Commercial |
$1,424.59
|
| Rate for Payer: Aetna Commercial |
$1,424.59
|
| Rate for Payer: Aetna Medicare |
$992.00
|
| Rate for Payer: Aetna Medicare |
$485.00
|
| Rate for Payer: BCBS Complete |
$191.89
|
| Rate for Payer: BCBS Complete |
$191.89
|
| 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: 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: Meridian Medicaid |
$191.89
|
| Rate for Payer: Meridian Medicaid |
$191.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.75
|
| 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 HMO/PPO/Tiered Network |
$404.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.45
|
| Rate for Payer: Priority Health Narrow Network |
$404.45
|
| Rate for Payer: Priority Health Narrow Network |
$404.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,394.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,394.41
|
| Rate for Payer: UHC Exchange |
$1,394.41
|
| Rate for Payer: UHC Exchange |
$1,394.41
|
| Rate for Payer: UHCCP Medicaid |
$182.75
|
| Rate for Payer: UHCCP Medicaid |
$182.75
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 93455
|
| Min. Negotiated Rate |
$173.17 |
| Max. Negotiated Rate |
$1,475.81 |
| Rate for Payer: Aetna Commercial |
$1,384.11
|
| Rate for Payer: Aetna Medicare |
$291.00
|
| Rate for Payer: BCBS Complete |
$181.83
|
| Rate for Payer: BCBS Trust/PPO |
$472.30
|
| Rate for Payer: BCN Commercial |
$1,475.81
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Meridian Medicaid |
$181.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$381.85
|
| Rate for Payer: Priority Health Narrow Network |
$381.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,347.75
|
| Rate for Payer: UHC Exchange |
$1,347.75
|
| Rate for Payer: UHCCP Medicaid |
$173.17
|
|
|
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 |
$217.47 |
| Max. Negotiated Rate |
$1,795.89 |
| Rate for Payer: Aetna Commercial |
$1,695.32
|
| Rate for Payer: Aetna Medicare |
$1,213.50
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS Trust/PPO |
$542.56
|
| Rate for Payer: BCN Commercial |
$1,795.89
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Meridian Medicaid |
$228.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.32
|
| Rate for Payer: Priority Health Narrow Network |
$479.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,638.61
|
| Rate for Payer: UHC Exchange |
$1,638.61
|
| Rate for Payer: UHCCP Medicaid |
$217.47
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,171.00
|
|
|
Service Code
|
HCPCS 93456
|
| Min. Negotiated Rate |
$193.40 |
| Max. Negotiated Rate |
$1,648.31 |
| Rate for Payer: Aetna Commercial |
$1,544.51
|
| Rate for Payer: Aetna Medicare |
$1,085.50
|
| Rate for Payer: BCBS Complete |
$203.07
|
| Rate for Payer: BCBS Trust/PPO |
$503.47
|
| Rate for Payer: BCN Commercial |
$1,648.31
|
| Rate for Payer: Cash Price |
$1,736.80
|
| Rate for Payer: Cash Price |
$1,736.80
|
| Rate for Payer: Meridian Medicaid |
$203.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,411.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$427.05
|
| Rate for Payer: Priority Health Narrow Network |
$427.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,446.15
|
| Rate for Payer: UHC Exchange |
$1,446.15
|
| Rate for Payer: UHCCP Medicaid |
$193.40
|
|
|
PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 58340
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$441.13 |
| Rate for Payer: Aetna Commercial |
$67.35
|
| Rate for Payer: Aetna Medicare |
$322.00
|
| Rate for Payer: BCBS Complete |
$39.14
|
| Rate for Payer: BCBS Trust/PPO |
$441.13
|
| Rate for Payer: BCN Commercial |
$362.60
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Meridian Medicaid |
$39.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.82
|
| Rate for Payer: Priority Health Narrow Network |
$85.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.33
|
| Rate for Payer: UHC Exchange |
$66.33
|
| Rate for Payer: UHCCP Medicaid |
$37.28
|
|
|
PR CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 57511
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna Commercial |
$171.03
|
| Rate for Payer: Aetna Medicare |
$230.00
|
| Rate for Payer: BCBS Complete |
$99.53
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$236.77
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Meridian Medicaid |
$99.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.74
|
| Rate for Payer: Priority Health Narrow Network |
$221.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.78
|
| Rate for Payer: UHC Exchange |
$148.78
|
| Rate for Payer: UHCCP Medicaid |
$94.79
|
|
|
PR CAUTERY CERVIX ELECTRO/THERMAL
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 57510
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$689.96 |
| Rate for Payer: Aetna Commercial |
$134.58
|
| Rate for Payer: Aetna Medicare |
$240.00
|
| Rate for Payer: BCBS Complete |
$76.04
|
| Rate for Payer: BCBS Trust/PPO |
$689.96
|
| Rate for Payer: BCN Commercial |
$246.78
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Meridian Medicaid |
$76.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.15
|
| Rate for Payer: Priority Health Narrow Network |
$169.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.51
|
| Rate for Payer: UHC Exchange |
$131.51
|
| Rate for Payer: UHCCP Medicaid |
$72.42
|
|
|
PR CAUTERY CERVIX LASER ABLATION
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
HCPCS 57513
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$646.64 |
| Rate for Payer: Aetna Commercial |
$170.65
|
| Rate for Payer: Aetna Medicare |
$277.00
|
| Rate for Payer: BCBS Complete |
$99.08
|
| Rate for Payer: BCBS Trust/PPO |
$646.64
|
| Rate for Payer: BCN Commercial |
$304.45
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Meridian Medicaid |
$99.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.74
|
| Rate for Payer: Priority Health Narrow Network |
$220.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.59
|
| Rate for Payer: UHC Exchange |
$149.59
|
| Rate for Payer: UHCCP Medicaid |
$94.36
|
|
|
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
|
|
|
PR CBHC CONSULT FEE $300
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00585
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR CBHC IN HOUSE REPAIR
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00580
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR CBHC IN-HOUSE REPAIR
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 00590
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
|
|
PR CBHC LOSS AND DAMAGE FEE
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 00581
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
