|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,254.00
|
|
|
Service Code
|
HCPCS 64721
|
| Min. Negotiated Rate |
$287.34 |
| Max. Negotiated Rate |
$6,985.18 |
| Rate for Payer: Aetna Commercial |
$553.21
|
| Rate for Payer: Aetna Medicare |
$1,127.00
|
| Rate for Payer: BCBS Complete |
$301.71
|
| Rate for Payer: BCBS Trust/PPO |
$6,985.18
|
| Rate for Payer: BCN Commercial |
$656.79
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Meridian Medicaid |
$301.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.37
|
| Rate for Payer: Priority Health Narrow Network |
$760.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$472.36
|
| Rate for Payer: UHC Exchange |
$472.36
|
| Rate for Payer: UHCCP Medicaid |
$287.34
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
IP
|
$2,254.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,465.10 |
| Max. Negotiated Rate |
$2,254.00 |
| Rate for Payer: Aetna Commercial |
$2,028.60
|
| Rate for Payer: ASR ASR |
$2,186.38
|
| Rate for Payer: ASR Commercial |
$2,186.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.78
|
| Rate for Payer: BCN Commercial |
$1,747.53
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$2,118.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.20
|
| Rate for Payer: Healthscope Commercial |
$2,254.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,186.38
|
| Rate for Payer: Mclaren Commercial |
$2,028.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.90
|
| Rate for Payer: Nomi Health Commercial |
$1,848.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.52
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
OP
|
$2,254.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,025.52 |
| Max. Negotiated Rate |
$2,965.58 |
| Rate for Payer: Aetna Commercial |
$2,028.60
|
| Rate for Payer: Aetna Medicare |
$1,913.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: ASR ASR |
$2,186.38
|
| Rate for Payer: ASR Commercial |
$2,186.38
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.80
|
| Rate for Payer: BCN Commercial |
$1,747.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$2,118.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$2,254.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,186.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,913.28
|
| Rate for Payer: Mclaren Commercial |
$2,028.60
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.90
|
| Rate for Payer: Nomi Health Commercial |
$1,848.28
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$2,104.61
|
| Rate for Payer: PHP Medicaid |
$1,025.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,974.95
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,580.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$2,965.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP DNSP |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,254.00
|
|
|
Service Code
|
HCPCS 64721
|
| Hospital Charge Code |
64721
|
| Min. Negotiated Rate |
$287.34 |
| Max. Negotiated Rate |
$6,985.18 |
| Rate for Payer: Aetna Commercial |
$553.21
|
| Rate for Payer: Aetna Medicare |
$1,127.00
|
| Rate for Payer: BCBS Complete |
$301.71
|
| Rate for Payer: BCBS Trust/PPO |
$6,985.18
|
| Rate for Payer: BCN Commercial |
$656.79
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Meridian Medicaid |
$301.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.37
|
| Rate for Payer: Priority Health Narrow Network |
$760.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$472.36
|
| Rate for Payer: UHC Exchange |
$472.36
|
| Rate for Payer: UHCCP Medicaid |
$287.34
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 96132
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$2,343.54 |
| Rate for Payer: Aetna Commercial |
$117.40
|
| Rate for Payer: Aetna Medicare |
$133.00
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,343.54
|
| Rate for Payer: BCN Commercial |
$187.65
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.02
|
| Rate for Payer: Priority Health Narrow Network |
$142.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.41
|
| Rate for Payer: UHC Exchange |
$117.41
|
| Rate for Payer: UHCCP Medicaid |
$67.73
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 96133
|
| Min. Negotiated Rate |
$47.93 |
| Max. Negotiated Rate |
$150.57 |
| Rate for Payer: Aetna Commercial |
$88.51
|
| Rate for Payer: Aetna Medicare |
$101.50
|
| Rate for Payer: BCBS Complete |
$50.33
|
| Rate for Payer: BCBS Trust/PPO |
$150.57
|
| Rate for Payer: BCN Commercial |
$142.69
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Meridian Medicaid |
$50.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.22
|
| Rate for Payer: Priority Health Narrow Network |
$102.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.00
|
| Rate for Payer: UHC Exchange |
$90.00
|
| Rate for Payer: UHCCP Medicaid |
$47.93
|
|
|
PR NEUROPSYCH TESTING BY COMPUTER
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 96120
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Medicare |
$86.00
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
|
|
PR NEUROPSYCH TESTING BY PSYCH/PHYS
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 96118
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$144.95 |
| Rate for Payer: Aetna Medicare |
$111.50
|
| Rate for Payer: BCBS Complete |
$89.20
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.95
|
|
|
PR NEUROPSYCH TESTING BY TECHNICIAN
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 96119
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
|
|
PR NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC
|
Professional
|
Both
|
$2,646.00
|
|
|
Service Code
|
HCPCS 64708
|
| Min. Negotiated Rate |
$330.36 |
| Max. Negotiated Rate |
$5,401.87 |
| Rate for Payer: Aetna Commercial |
$649.68
|
| Rate for Payer: Aetna Medicare |
$1,323.00
|
| Rate for Payer: BCBS Complete |
$346.88
|
| Rate for Payer: BCBS Trust/PPO |
$5,401.87
|
| Rate for Payer: BCN Commercial |
$736.44
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Meridian Medicaid |
$346.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,719.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$879.81
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$548.59
|
| Rate for Payer: UHC Exchange |
$548.59
|
| Rate for Payer: UHCCP Medicaid |
$330.36
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 64713
|
| Min. Negotiated Rate |
$519.93 |
| Max. Negotiated Rate |
$7,702.61 |
| Rate for Payer: Aetna Commercial |
$1,010.20
|
| Rate for Payer: Aetna Medicare |
$1,387.00
|
| Rate for Payer: BCBS Complete |
$545.93
|
| Rate for Payer: BCBS Trust/PPO |
$7,702.61
|
| Rate for Payer: BCN Commercial |
$1,168.43
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Meridian Medicaid |
$545.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$519.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,381.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,381.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$882.67
|
| Rate for Payer: UHC Exchange |
$882.67
|
| Rate for Payer: UHCCP Medicaid |
$519.93
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS
|
Professional
|
Both
|
$3,408.00
|
|
|
Service Code
|
HCPCS 64714
|
| Min. Negotiated Rate |
$499.06 |
| Max. Negotiated Rate |
$5,064.28 |
| Rate for Payer: Aetna Commercial |
$974.07
|
| Rate for Payer: Aetna Medicare |
$1,704.00
|
| Rate for Payer: BCBS Complete |
$524.01
|
| Rate for Payer: BCBS Trust/PPO |
$5,064.28
|
| Rate for Payer: BCN Commercial |
$1,115.65
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Meridian Medicaid |
$524.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$499.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,215.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,320.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,320.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$767.69
|
| Rate for Payer: UHC Exchange |
$767.69
|
| Rate for Payer: UHCCP Medicaid |
$499.06
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV
|
Professional
|
Both
|
$997.00
|
|
|
Service Code
|
HCPCS 64712
|
| Min. Negotiated Rate |
$387.02 |
| Max. Negotiated Rate |
$6,738.47 |
| Rate for Payer: Aetna Commercial |
$761.95
|
| Rate for Payer: Aetna Medicare |
$498.50
|
| Rate for Payer: BCBS Complete |
$406.37
|
| Rate for Payer: BCBS Trust/PPO |
$6,738.47
|
| Rate for Payer: BCN Commercial |
$873.76
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Meridian Medicaid |
$406.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,027.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,027.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.37
|
| Rate for Payer: UHC Exchange |
$628.37
|
| Rate for Payer: UHCCP Medicaid |
$387.02
|
|
|
PR N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 93924
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$577.96 |
| Rate for Payer: Aetna Commercial |
$172.82
|
| Rate for Payer: Aetna Medicare |
$159.50
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS Trust/PPO |
$577.96
|
| Rate for Payer: BCN Commercial |
$230.66
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.66
|
| Rate for Payer: Priority Health Narrow Network |
$31.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.75
|
| Rate for Payer: UHC Exchange |
$227.75
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
|
|
PR NIPPLE/AREOLA RECONSTRUCTION
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 19350
|
| Min. Negotiated Rate |
$436.65 |
| Max. Negotiated Rate |
$1,219.25 |
| Rate for Payer: Aetna Commercial |
$725.23
|
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: BCBS Complete |
$458.48
|
| Rate for Payer: BCBS Trust/PPO |
$596.25
|
| Rate for Payer: BCN Commercial |
$1,219.25
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Meridian Medicaid |
$458.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.12
|
| Rate for Payer: Priority Health Narrow Network |
$916.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$708.38
|
| Rate for Payer: UHC Exchange |
$708.38
|
| Rate for Payer: UHCCP Medicaid |
$436.65
|
|
|
PR NIPPLE EXPLORATION
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 19110
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$717.37 |
| Rate for Payer: Aetna Commercial |
$381.31
|
| Rate for Payer: Aetna Medicare |
$384.00
|
| Rate for Payer: BCBS Complete |
$241.32
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$717.37
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Meridian Medicaid |
$241.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.13
|
| Rate for Payer: Priority Health Narrow Network |
$483.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.79
|
| Rate for Payer: UHC Exchange |
$343.79
|
| Rate for Payer: UHCCP Medicaid |
$229.83
|
|
|
PR NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 95012
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$19.38
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$27.36
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Narrow Network |
$26.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
| Rate for Payer: UHC Exchange |
$20.72
|
|
|
PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 64455
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$730.11 |
| Rate for Payer: Aetna Commercial |
$43.68
|
| Rate for Payer: Aetna Medicare |
$158.50
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$730.11
|
| Rate for Payer: BCN Commercial |
$72.33
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.29
|
| Rate for Payer: Priority Health Narrow Network |
$56.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.70
|
| Rate for Payer: UHC Exchange |
$46.70
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
|
|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 64479
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$1,300.67 |
| Rate for Payer: Aetna Commercial |
$167.75
|
| Rate for Payer: Aetna Commercial |
$167.75
|
| Rate for Payer: Aetna Medicare |
$446.50
|
| Rate for Payer: Aetna Medicare |
$158.50
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.67
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.23
|
| Rate for Payer: Priority Health Narrow Network |
$221.23
|
| Rate for Payer: Priority Health Narrow Network |
$221.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.31
|
| Rate for Payer: UHC Exchange |
$147.31
|
| Rate for Payer: UHC Exchange |
$147.31
|
| Rate for Payer: UHCCP Medicaid |
$83.50
|
| Rate for Payer: UHCCP Medicaid |
$83.50
|
|
|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 64480
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$967.32 |
| Rate for Payer: Aetna Commercial |
$80.46
|
| Rate for Payer: Aetna Medicare |
$173.00
|
| Rate for Payer: BCBS Complete |
$41.15
|
| Rate for Payer: BCBS Trust/PPO |
$967.32
|
| Rate for Payer: BCN Commercial |
$196.45
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Meridian Medicaid |
$41.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.94
|
| Rate for Payer: Priority Health Narrow Network |
$102.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.57
|
| Rate for Payer: UHC Exchange |
$97.57
|
| Rate for Payer: UHCCP Medicaid |
$39.19
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 64483
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$359.67 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare |
$135.00
|
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS Trust/PPO |
$96.15
|
| Rate for Payer: BCBS Trust/PPO |
$96.15
|
| Rate for Payer: BCN Commercial |
$359.67
|
| Rate for Payer: BCN Commercial |
$359.67
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Meridian Medicaid |
$74.48
|
| Rate for Payer: Meridian Medicaid |
$74.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.81
|
| Rate for Payer: Priority Health Narrow Network |
$188.81
|
| Rate for Payer: Priority Health Narrow Network |
$188.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.28
|
| Rate for Payer: UHC Exchange |
$127.28
|
| Rate for Payer: UHC Exchange |
$127.28
|
| Rate for Payer: UHCCP Medicaid |
$70.93
|
| Rate for Payer: UHCCP Medicaid |
$70.93
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 64484
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$566.87 |
| Rate for Payer: Aetna Commercial |
$67.16
|
| Rate for Payer: Aetna Medicare |
$222.50
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$566.87
|
| Rate for Payer: BCN Commercial |
$163.22
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.01
|
| Rate for Payer: Priority Health Narrow Network |
$87.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.56
|
| Rate for Payer: UHC Exchange |
$80.56
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
PR NJX BONE SUB MATRL INTO SUBCHONDRAL BONE DEFECT
|
Professional
|
Both
|
$3,060.00
|
|
|
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: Aetna Medicare |
$1,530.00
|
| Rate for Payer: BCBS Complete |
$1,224.00
|
| Rate for Payer: BCBS Trust/PPO |
$262.22
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.39
|
| Rate for Payer: UHC Exchange |
$463.39
|
|
|
PR NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 51600
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$2,020.75 |
| Rate for Payer: Aetna Commercial |
$56.72
|
| Rate for Payer: Aetna Medicare |
$344.50
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,020.75
|
| Rate for Payer: BCN Commercial |
$313.24
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.18
|
| Rate for Payer: Priority Health Narrow Network |
$68.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.53
|
| Rate for Payer: UHC Exchange |
$53.53
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
|
|
PR NJX DRG C-CATHJ SLCTV L VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 93565
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$737.51 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS Trust/PPO |
$737.51
|
| Rate for Payer: BCN Commercial |
$38.61
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.20
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.26
|
| Rate for Payer: UHC Exchange |
$58.26
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
|
