|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,547.00 |
| Max. Negotiated Rate |
$2,210.00 |
| Rate for Payer: Aetna Commercial |
$1,989.00
|
| Rate for Payer: ASR ASR |
$2,143.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,713.41
|
| Rate for Payer: BCN Commercial |
$1,713.41
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Cofinity Commercial |
$2,077.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.00
|
| Rate for Payer: Healthscope Commercial |
$2,210.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,143.70
|
| Rate for Payer: Mclaren Commercial |
$1,989.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,878.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,944.80
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,210.00
|
|
|
Service Code
|
HCPCS 64721
|
| Min. Negotiated Rate |
$284.78 |
| Max. Negotiated Rate |
$6,985.18 |
| Rate for Payer: Aetna Commercial |
$573.40
|
| Rate for Payer: Aetna Medicare |
$427.91
|
| Rate for Payer: BCBS Complete |
$299.02
|
| Rate for Payer: BCBS MAPPO |
$427.91
|
| Rate for Payer: BCBS Trust/PPO |
$6,985.18
|
| Rate for Payer: BCN Commercial |
$656.79
|
| Rate for Payer: BCN Medicare Advantage |
$427.91
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Cofinity Commercial |
$616.19
|
| Rate for Payer: Cofinity Commercial |
$573.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.91
|
| Rate for Payer: Healthscope Commercial |
$513.49
|
| Rate for Payer: Healthscope Whirlpool |
$513.49
|
| Rate for Payer: Meridian Medicaid |
$299.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$449.31
|
| Rate for Payer: PACE SWMI |
$427.91
|
| Rate for Payer: PHP Medicare Advantage |
$427.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$747.41
|
| Rate for Payer: Priority Health Medicare |
$427.91
|
| Rate for Payer: Priority Health Narrow Network |
$747.41
|
| Rate for Payer: UHC Medicare Advantage |
$440.75
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$938.78 |
| Max. Negotiated Rate |
$2,210.00 |
| Rate for Payer: Aetna Commercial |
$1,989.00
|
| Rate for Payer: Aetna Medicare |
$1,716.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: ASR ASR |
$2,143.70
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,713.41
|
| Rate for Payer: BCN Commercial |
$1,713.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Cofinity Commercial |
$2,077.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$2,210.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,143.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,716.23
|
| Rate for Payer: Mclaren Commercial |
$1,989.00
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,878.50
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Commercial |
$1,887.85
|
| Rate for Payer: PHP Medicaid |
$938.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,011.10
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,569.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,944.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,210.00
|
|
|
Service Code
|
HCPCS 64721
|
| Hospital Charge Code |
64721
|
| Min. Negotiated Rate |
$284.78 |
| Max. Negotiated Rate |
$6,985.18 |
| Rate for Payer: Aetna Commercial |
$573.40
|
| Rate for Payer: Aetna Medicare |
$427.91
|
| Rate for Payer: BCBS Complete |
$299.02
|
| Rate for Payer: BCBS MAPPO |
$427.91
|
| Rate for Payer: BCBS Trust/PPO |
$6,985.18
|
| Rate for Payer: BCN Commercial |
$656.79
|
| Rate for Payer: BCN Medicare Advantage |
$427.91
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Cofinity Commercial |
$616.19
|
| Rate for Payer: Cofinity Commercial |
$573.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.91
|
| Rate for Payer: Healthscope Commercial |
$513.49
|
| Rate for Payer: Healthscope Whirlpool |
$513.49
|
| Rate for Payer: Meridian Medicaid |
$299.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$449.31
|
| Rate for Payer: PACE SWMI |
$427.91
|
| Rate for Payer: PHP Medicare Advantage |
$427.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$747.41
|
| Rate for Payer: Priority Health Medicare |
$427.91
|
| Rate for Payer: Priority Health Narrow Network |
$747.41
|
| Rate for Payer: UHC Medicare Advantage |
$440.75
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 96132
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$2,343.54 |
| Rate for Payer: Aetna Commercial |
$140.58
|
| Rate for Payer: Aetna Medicare |
$104.91
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS MAPPO |
$104.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,343.54
|
| Rate for Payer: BCN Commercial |
$187.65
|
| Rate for Payer: BCN Medicare Advantage |
$104.91
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$151.07
|
| Rate for Payer: Cofinity Commercial |
$140.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.91
|
| Rate for Payer: Healthscope Commercial |
$125.89
|
| Rate for Payer: Healthscope Whirlpool |
$125.89
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110.16
|
| Rate for Payer: PACE SWMI |
$104.91
|
| Rate for Payer: PHP Medicare Advantage |
$104.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.59
|
| Rate for Payer: Priority Health Medicare |
$104.91
|
| Rate for Payer: Priority Health Narrow Network |
$140.59
|
| Rate for Payer: UHC Medicare Advantage |
$108.06
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 96133
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$150.57 |
| Rate for Payer: Aetna Commercial |
$101.71
|
| Rate for Payer: Aetna Medicare |
$75.90
|
| Rate for Payer: BCBS Complete |
$50.55
|
| Rate for Payer: BCBS MAPPO |
$75.90
|
| Rate for Payer: BCBS Trust/PPO |
$150.57
|
| Rate for Payer: BCN Commercial |
$142.69
|
| Rate for Payer: BCN Medicare Advantage |
$75.90
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cofinity Commercial |
$109.30
|
| Rate for Payer: Cofinity Commercial |
$101.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.90
|
| Rate for Payer: Healthscope Commercial |
$91.08
|
| Rate for Payer: Healthscope Whirlpool |
$91.08
|
| Rate for Payer: Meridian Medicaid |
$50.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.70
|
| Rate for Payer: PACE SWMI |
$75.90
|
| Rate for Payer: PHP Medicare Advantage |
$75.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.51
|
| Rate for Payer: Priority Health Medicare |
$75.90
|
| Rate for Payer: Priority Health Narrow Network |
$101.51
|
| Rate for Payer: UHC Medicare Advantage |
$78.18
|
|
|
PR NEUROPSYCH TESTING BY COMPUTER
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 96120
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: BCBS Complete |
$67.60
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
|
|
PR NEUROPSYCH TESTING BY PSYCH/PHYS
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 96118
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$153.30 |
| Rate for Payer: BCBS Complete |
$87.60
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.30
|
|
|
PR NEUROPSYCH TESTING BY TECHNICIAN
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 96119
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
|
|
PR NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC
|
Professional
|
Both
|
$2,594.00
|
|
|
Service Code
|
HCPCS 64708
|
| Min. Negotiated Rate |
$329.51 |
| Max. Negotiated Rate |
$5,401.87 |
| Rate for Payer: Aetna Commercial |
$657.06
|
| Rate for Payer: Aetna Medicare |
$490.34
|
| Rate for Payer: BCBS Complete |
$345.99
|
| Rate for Payer: BCBS MAPPO |
$490.34
|
| Rate for Payer: BCBS Trust/PPO |
$5,401.87
|
| Rate for Payer: BCN Commercial |
$736.44
|
| Rate for Payer: BCN Medicare Advantage |
$490.34
|
| Rate for Payer: Cash Price |
$2,075.20
|
| Rate for Payer: Cash Price |
$2,075.20
|
| Rate for Payer: Cofinity Commercial |
$706.09
|
| Rate for Payer: Cofinity Commercial |
$657.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.34
|
| Rate for Payer: Healthscope Commercial |
$588.41
|
| Rate for Payer: Healthscope Whirlpool |
$588.41
|
| Rate for Payer: Meridian Medicaid |
$345.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.86
|
| Rate for Payer: PACE SWMI |
$490.34
|
| Rate for Payer: PHP Medicare Advantage |
$490.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,815.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$853.30
|
| Rate for Payer: Priority Health Medicare |
$490.34
|
| Rate for Payer: Priority Health Narrow Network |
$853.30
|
| Rate for Payer: UHC Medicare Advantage |
$505.05
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS
|
Professional
|
Both
|
$2,720.00
|
|
|
Service Code
|
HCPCS 64713
|
| Min. Negotiated Rate |
$517.38 |
| Max. Negotiated Rate |
$7,702.61 |
| Rate for Payer: Aetna Commercial |
$1,054.94
|
| Rate for Payer: Aetna Medicare |
$787.27
|
| Rate for Payer: BCBS Complete |
$543.25
|
| Rate for Payer: BCBS MAPPO |
$787.27
|
| Rate for Payer: BCBS Trust/PPO |
$7,702.61
|
| Rate for Payer: BCN Commercial |
$1,168.43
|
| Rate for Payer: BCN Medicare Advantage |
$787.27
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cofinity Commercial |
$1,054.94
|
| Rate for Payer: Cofinity Commercial |
$1,133.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.27
|
| Rate for Payer: Healthscope Commercial |
$944.72
|
| Rate for Payer: Healthscope Whirlpool |
$944.72
|
| Rate for Payer: Meridian Medicaid |
$543.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$826.63
|
| Rate for Payer: PACE SWMI |
$787.27
|
| Rate for Payer: PHP Medicare Advantage |
$787.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,353.84
|
| Rate for Payer: Priority Health Medicare |
$787.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,353.84
|
| Rate for Payer: UHC Medicare Advantage |
$810.89
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS
|
Professional
|
Both
|
$3,341.00
|
|
|
Service Code
|
HCPCS 64714
|
| Min. Negotiated Rate |
$494.59 |
| Max. Negotiated Rate |
$5,064.28 |
| Rate for Payer: Aetna Commercial |
$1,004.21
|
| Rate for Payer: Aetna Medicare |
$749.41
|
| Rate for Payer: BCBS Complete |
$519.32
|
| Rate for Payer: BCBS MAPPO |
$749.41
|
| Rate for Payer: BCBS Trust/PPO |
$5,064.28
|
| Rate for Payer: BCN Commercial |
$1,115.65
|
| Rate for Payer: BCN Medicare Advantage |
$749.41
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,004.21
|
| Rate for Payer: Cofinity Commercial |
$1,079.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$749.41
|
| Rate for Payer: Healthscope Commercial |
$899.29
|
| Rate for Payer: Healthscope Whirlpool |
$899.29
|
| Rate for Payer: Meridian Medicaid |
$519.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$786.88
|
| Rate for Payer: PACE SWMI |
$749.41
|
| Rate for Payer: PHP Medicare Advantage |
$749.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$494.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,338.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,292.68
|
| Rate for Payer: Priority Health Medicare |
$749.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,292.68
|
| Rate for Payer: UHC Medicare Advantage |
$771.89
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 64712
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$6,738.47 |
| Rate for Payer: Aetna Commercial |
$784.48
|
| Rate for Payer: Aetna Medicare |
$585.43
|
| Rate for Payer: BCBS Complete |
$403.91
|
| Rate for Payer: BCBS MAPPO |
$585.43
|
| Rate for Payer: BCBS Trust/PPO |
$6,738.47
|
| Rate for Payer: BCN Commercial |
$873.76
|
| Rate for Payer: BCN Medicare Advantage |
$585.43
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cofinity Commercial |
$784.48
|
| Rate for Payer: Cofinity Commercial |
$843.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$585.43
|
| Rate for Payer: Healthscope Commercial |
$702.52
|
| Rate for Payer: Healthscope Whirlpool |
$702.52
|
| Rate for Payer: Meridian Medicaid |
$403.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$614.70
|
| Rate for Payer: PACE SWMI |
$585.43
|
| Rate for Payer: PHP Medicare Advantage |
$585.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$384.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,012.40
|
| Rate for Payer: Priority Health Medicare |
$585.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.40
|
| Rate for Payer: UHC Medicare Advantage |
$602.99
|
|
|
PR N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 93924
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$577.96 |
| Rate for Payer: Aetna Commercial |
$198.03
|
| Rate for Payer: Aetna Medicare |
$147.78
|
| Rate for Payer: BCBS Complete |
$125.20
|
| Rate for Payer: BCBS MAPPO |
$147.78
|
| Rate for Payer: BCBS Trust/PPO |
$577.96
|
| Rate for Payer: BCN Commercial |
$230.66
|
| Rate for Payer: BCN Medicare Advantage |
$147.78
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cofinity Commercial |
$198.03
|
| Rate for Payer: Cofinity Commercial |
$212.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.78
|
| Rate for Payer: Healthscope Commercial |
$177.34
|
| Rate for Payer: Healthscope Whirlpool |
$177.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$155.17
|
| Rate for Payer: PACE SWMI |
$147.78
|
| Rate for Payer: PHP Medicare Advantage |
$147.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.00
|
| Rate for Payer: Priority Health Medicare |
$147.78
|
| Rate for Payer: Priority Health Narrow Network |
$212.00
|
| Rate for Payer: UHC Medicare Advantage |
$152.21
|
|
|
PR NIPPLE/AREOLA RECONSTRUCTION
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 19350
|
| Min. Negotiated Rate |
$432.18 |
| Max. Negotiated Rate |
$1,219.25 |
| Rate for Payer: Aetna Commercial |
$884.05
|
| Rate for Payer: Aetna Medicare |
$659.74
|
| Rate for Payer: BCBS Complete |
$453.79
|
| Rate for Payer: BCBS MAPPO |
$659.74
|
| Rate for Payer: BCBS Trust/PPO |
$596.25
|
| Rate for Payer: BCN Commercial |
$1,219.25
|
| Rate for Payer: BCN Medicare Advantage |
$659.74
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$884.05
|
| Rate for Payer: Cofinity Commercial |
$950.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$659.74
|
| Rate for Payer: Healthscope Commercial |
$791.69
|
| Rate for Payer: Healthscope Whirlpool |
$791.69
|
| Rate for Payer: Meridian Medicaid |
$453.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$692.73
|
| Rate for Payer: PACE SWMI |
$659.74
|
| Rate for Payer: PHP Medicare Advantage |
$659.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$432.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.47
|
| Rate for Payer: Priority Health Medicare |
$659.74
|
| Rate for Payer: Priority Health Narrow Network |
$829.47
|
| Rate for Payer: UHC Medicare Advantage |
$679.53
|
|
|
PR NIPPLE EXPLORATION
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 19110
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$717.37 |
| Rate for Payer: Aetna Commercial |
$464.27
|
| Rate for Payer: Aetna Medicare |
$346.47
|
| Rate for Payer: BCBS Complete |
$239.31
|
| Rate for Payer: BCBS MAPPO |
$346.47
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$717.37
|
| Rate for Payer: BCN Medicare Advantage |
$346.47
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cofinity Commercial |
$498.92
|
| Rate for Payer: Cofinity Commercial |
$464.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.47
|
| Rate for Payer: Healthscope Commercial |
$415.76
|
| Rate for Payer: Healthscope Whirlpool |
$415.76
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$363.79
|
| Rate for Payer: PACE SWMI |
$346.47
|
| Rate for Payer: PHP Medicare Advantage |
$346.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.30
|
| Rate for Payer: Priority Health Medicare |
$346.47
|
| Rate for Payer: Priority Health Narrow Network |
$435.30
|
| Rate for Payer: UHC Medicare Advantage |
$356.86
|
|
|
PR NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 95012
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$23.24
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$27.36
|
| Rate for Payer: BCN Medicare Advantage |
$17.34
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: PACE SWMI |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.41
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health Narrow Network |
$23.41
|
| Rate for Payer: UHC Medicare Advantage |
$17.86
|
|
|
PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 64455
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$730.11 |
| Rate for Payer: Aetna Commercial |
$44.43
|
| Rate for Payer: Aetna Medicare |
$33.16
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCBS MAPPO |
$33.16
|
| Rate for Payer: BCBS Trust/PPO |
$730.11
|
| Rate for Payer: BCN Commercial |
$72.33
|
| Rate for Payer: BCN Medicare Advantage |
$33.16
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$47.75
|
| Rate for Payer: Cofinity Commercial |
$44.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.16
|
| Rate for Payer: Healthscope Commercial |
$39.79
|
| Rate for Payer: Healthscope Whirlpool |
$39.79
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.82
|
| Rate for Payer: PACE SWMI |
$33.16
|
| Rate for Payer: PHP Medicare Advantage |
$33.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.06
|
| Rate for Payer: Priority Health Medicare |
$33.16
|
| Rate for Payer: Priority Health Narrow Network |
$56.06
|
| Rate for Payer: UHC Medicare Advantage |
$34.15
|
|
|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 64479
|
| Min. Negotiated Rate |
$82.86 |
| Max. Negotiated Rate |
$1,300.67 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Aetna Medicare |
$126.99
|
| Rate for Payer: BCBS Complete |
$87.00
|
| Rate for Payer: BCBS MAPPO |
$126.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.67
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: BCN Medicare Advantage |
$126.99
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Cofinity Commercial |
$170.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.99
|
| Rate for Payer: Healthscope Commercial |
$152.39
|
| Rate for Payer: Healthscope Whirlpool |
$152.39
|
| Rate for Payer: Meridian Medicaid |
$87.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.34
|
| Rate for Payer: PACE SWMI |
$126.99
|
| Rate for Payer: PHP Medicare Advantage |
$126.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.00
|
| Rate for Payer: Priority Health Medicare |
$126.99
|
| Rate for Payer: Priority Health Narrow Network |
$218.00
|
| Rate for Payer: UHC Medicare Advantage |
$130.80
|
|
|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 64480
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$967.32 |
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna Medicare |
$60.17
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS MAPPO |
$60.17
|
| Rate for Payer: BCBS Trust/PPO |
$967.32
|
| Rate for Payer: BCN Commercial |
$196.45
|
| Rate for Payer: BCN Medicare Advantage |
$60.17
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$86.64
|
| Rate for Payer: Cofinity Commercial |
$80.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.17
|
| Rate for Payer: Healthscope Commercial |
$72.20
|
| Rate for Payer: Healthscope Whirlpool |
$72.20
|
| Rate for Payer: Meridian Medicaid |
$40.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.18
|
| Rate for Payer: PACE SWMI |
$60.17
|
| Rate for Payer: PHP Medicare Advantage |
$60.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.49
|
| Rate for Payer: Priority Health Medicare |
$60.17
|
| Rate for Payer: Priority Health Narrow Network |
$102.49
|
| Rate for Payer: UHC Medicare Advantage |
$61.98
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 64483
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$144.30
|
| Rate for Payer: Aetna Medicare |
$107.69
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$107.69
|
| Rate for Payer: BCBS Trust/PPO |
$96.15
|
| Rate for Payer: BCN Commercial |
$359.67
|
| Rate for Payer: BCN Medicare Advantage |
$107.69
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$155.07
|
| Rate for Payer: Cofinity Commercial |
$144.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.69
|
| Rate for Payer: Healthscope Commercial |
$129.23
|
| Rate for Payer: Healthscope Whirlpool |
$129.23
|
| Rate for Payer: Meridian Medicaid |
$74.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$113.07
|
| Rate for Payer: PACE SWMI |
$107.69
|
| Rate for Payer: PHP Medicare Advantage |
$107.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.15
|
| Rate for Payer: Priority Health Medicare |
$107.69
|
| Rate for Payer: Priority Health Narrow Network |
$185.15
|
| Rate for Payer: UHC Medicare Advantage |
$110.92
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 64484
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$566.87 |
| Rate for Payer: Aetna Commercial |
$67.67
|
| Rate for Payer: Aetna Medicare |
$50.50
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$50.50
|
| Rate for Payer: BCBS Trust/PPO |
$566.87
|
| Rate for Payer: BCN Commercial |
$163.22
|
| Rate for Payer: BCN Medicare Advantage |
$50.50
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$72.72
|
| Rate for Payer: Cofinity Commercial |
$67.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.50
|
| Rate for Payer: Healthscope Commercial |
$60.60
|
| Rate for Payer: Healthscope Whirlpool |
$60.60
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.02
|
| Rate for Payer: PACE SWMI |
$50.50
|
| Rate for Payer: PHP Medicare Advantage |
$50.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.07
|
| Rate for Payer: Priority Health Medicare |
$50.50
|
| Rate for Payer: Priority Health Narrow Network |
$86.07
|
| Rate for Payer: UHC Medicare Advantage |
$52.02
|
|
|
PR NJX BONE SUB MATRL INTO SUBCHONDRAL BONE DEFECT
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 0707T
|
| Min. Negotiated Rate |
$262.22 |
| Max. Negotiated Rate |
$2,753.41 |
| Rate for Payer: Aetna Commercial |
$368.07
|
| Rate for Payer: BCBS Complete |
$1,200.00
|
| Rate for Payer: BCBS Trust/PPO |
$262.22
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,100.00
|
|
|
PR NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 54235
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$573.21 |
| Rate for Payer: Aetna Commercial |
$96.68
|
| Rate for Payer: Aetna Medicare |
$72.15
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS MAPPO |
$72.15
|
| Rate for Payer: BCBS Trust/PPO |
$573.21
|
| Rate for Payer: BCN Commercial |
$130.96
|
| Rate for Payer: BCN Medicare Advantage |
$72.15
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$96.68
|
| Rate for Payer: Cofinity Commercial |
$103.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.15
|
| Rate for Payer: Healthscope Commercial |
$86.58
|
| Rate for Payer: Healthscope Whirlpool |
$86.58
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.76
|
| Rate for Payer: PACE SWMI |
$72.15
|
| Rate for Payer: PHP Medicare Advantage |
$72.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.33
|
| Rate for Payer: Priority Health Medicare |
$72.15
|
| Rate for Payer: Priority Health Narrow Network |
$118.33
|
| Rate for Payer: UHC Medicare Advantage |
$74.31
|
|
|
PR NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 51600
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$2,020.75 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: Aetna Medicare |
$43.04
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS MAPPO |
$43.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,020.75
|
| Rate for Payer: BCN Commercial |
$313.24
|
| Rate for Payer: BCN Medicare Advantage |
$43.04
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$57.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.04
|
| Rate for Payer: Healthscope Commercial |
$51.65
|
| Rate for Payer: Healthscope Whirlpool |
$51.65
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.19
|
| Rate for Payer: PACE SWMI |
$43.04
|
| Rate for Payer: PHP Medicare Advantage |
$43.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.70
|
| Rate for Payer: Priority Health Medicare |
$43.04
|
| Rate for Payer: Priority Health Narrow Network |
$69.70
|
| Rate for Payer: UHC Medicare Advantage |
$44.33
|
|
