|
PR SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
HCPCS 31805
|
| Min. Negotiated Rate |
$518.66 |
| Max. Negotiated Rate |
$1,619.77 |
| Rate for Payer: Aetna Commercial |
$1,078.70
|
| Rate for Payer: Aetna Medicare |
$837.20
|
| Rate for Payer: BCBS Complete |
$544.59
|
| Rate for Payer: BCBS MAPPO |
$805.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,619.77
|
| Rate for Payer: BCN Commercial |
$1,181.62
|
| Rate for Payer: BCN Medicare Advantage |
$805.00
|
| Rate for Payer: Cash Price |
$1,310.40
|
| Rate for Payer: Cash Price |
$1,310.40
|
| Rate for Payer: Cofinity Commercial |
$1,159.20
|
| Rate for Payer: Cofinity Commercial |
$1,078.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.00
|
| Rate for Payer: Mclaren Medicaid |
$518.66
|
| Rate for Payer: Meridian Medicaid |
$544.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$845.25
|
| Rate for Payer: PACE SWMI |
$805.00
|
| Rate for Payer: PHP Medicare Advantage |
$805.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$518.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,119.64
|
| Rate for Payer: Priority Health Medicare |
$805.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,119.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$805.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.00
|
| Rate for Payer: UHC Medicare Advantage |
$829.15
|
|
|
PR SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 99058
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$773.43 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$773.43
|
| Rate for Payer: BCN Commercial |
$42.19
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.75
|
|
|
PR SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 99051
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$556.30 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$556.30
|
| Rate for Payer: BCN Commercial |
$20.16
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.25
|
|
|
PR SYMPATHECTOMY CERVICAL
|
Professional
|
Both
|
$1,695.00
|
|
|
Service Code
|
HCPCS 64802
|
| Min. Negotiated Rate |
$206.04 |
| Max. Negotiated Rate |
$1,453.49 |
| Rate for Payer: Aetna Commercial |
$1,135.27
|
| Rate for Payer: Aetna Medicare |
$881.11
|
| Rate for Payer: BCBS Complete |
$581.27
|
| Rate for Payer: BCBS MAPPO |
$847.22
|
| Rate for Payer: BCBS Trust/PPO |
$206.04
|
| Rate for Payer: BCN Commercial |
$1,254.44
|
| Rate for Payer: BCN Medicare Advantage |
$847.22
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cofinity Commercial |
$1,135.27
|
| Rate for Payer: Cofinity Commercial |
$1,220.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$847.22
|
| Rate for Payer: Mclaren Medicaid |
$553.59
|
| Rate for Payer: Meridian Medicaid |
$581.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$889.58
|
| Rate for Payer: PACE SWMI |
$847.22
|
| Rate for Payer: PHP Medicare Advantage |
$847.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,453.49
|
| Rate for Payer: Priority Health Medicare |
$847.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,453.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$847.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$847.22
|
| Rate for Payer: UHC Medicare Advantage |
$872.64
|
|
|
PR SYMPATHECTOMY LUMBAR
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 64818
|
| Min. Negotiated Rate |
$219.10 |
| Max. Negotiated Rate |
$1,322.69 |
| Rate for Payer: Aetna Commercial |
$1,029.33
|
| Rate for Payer: Aetna Medicare |
$798.89
|
| Rate for Payer: BCBS Complete |
$526.03
|
| Rate for Payer: BCBS MAPPO |
$768.16
|
| Rate for Payer: BCBS Trust/PPO |
$668.83
|
| Rate for Payer: BCN Commercial |
$1,141.55
|
| Rate for Payer: BCN Medicare Advantage |
$768.16
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cofinity Commercial |
$1,106.15
|
| Rate for Payer: Cofinity Commercial |
$1,029.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$768.16
|
| Rate for Payer: Mclaren Medicaid |
$500.98
|
| Rate for Payer: Meridian Medicaid |
$526.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$806.57
|
| Rate for Payer: PACE SWMI |
$768.16
|
| Rate for Payer: PHP Medicare Advantage |
$768.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,322.69
|
| Rate for Payer: Priority Health Medicare |
$768.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,322.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$768.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$768.16
|
| Rate for Payer: UHC Medicare Advantage |
$791.20
|
|
|
PR SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
HCPCS 50540
|
| Min. Negotiated Rate |
$726.33 |
| Max. Negotiated Rate |
$2,068.29 |
| Rate for Payer: Aetna Commercial |
$1,498.50
|
| Rate for Payer: Aetna Medicare |
$1,163.01
|
| Rate for Payer: BCBS Complete |
$762.65
|
| Rate for Payer: BCBS MAPPO |
$1,118.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,068.29
|
| Rate for Payer: BCN Commercial |
$1,647.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,118.28
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cofinity Commercial |
$1,498.50
|
| Rate for Payer: Cofinity Commercial |
$1,610.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,118.28
|
| Rate for Payer: Mclaren Medicaid |
$726.33
|
| Rate for Payer: Meridian Medicaid |
$762.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,174.19
|
| Rate for Payer: PACE SWMI |
$1,118.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,118.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$726.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,821.55
|
| Rate for Payer: Priority Health Medicare |
$1,118.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,821.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,118.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,118.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,151.83
|
|
|
PR SYNDACTYLIZATION TOES
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 28280
|
| Min. Negotiated Rate |
$222.37 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$454.65
|
| Rate for Payer: Aetna Medicare |
$352.86
|
| Rate for Payer: BCBS Complete |
$233.49
|
| Rate for Payer: BCBS MAPPO |
$339.29
|
| Rate for Payer: BCBS Trust/PPO |
$756.00
|
| Rate for Payer: BCN Commercial |
$741.32
|
| Rate for Payer: BCN Medicare Advantage |
$339.29
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$488.58
|
| Rate for Payer: Cofinity Commercial |
$454.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.29
|
| Rate for Payer: Mclaren Medicaid |
$222.37
|
| Rate for Payer: Meridian Medicaid |
$233.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$356.25
|
| Rate for Payer: PACE SWMI |
$339.29
|
| Rate for Payer: PHP Medicare Advantage |
$339.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$529.54
|
| Rate for Payer: Priority Health Medicare |
$339.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$529.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.29
|
| Rate for Payer: UHC Medicare Advantage |
$349.47
|
|
|
PR SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT
|
Professional
|
Both
|
$1,251.00
|
|
|
Service Code
|
HCPCS 25118
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$875.70 |
| Rate for Payer: Aetna Commercial |
$505.89
|
| Rate for Payer: Aetna Medicare |
$392.63
|
| Rate for Payer: BCBS Complete |
$263.91
|
| Rate for Payer: BCBS MAPPO |
$377.53
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$568.82
|
| Rate for Payer: BCN Medicare Advantage |
$377.53
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cofinity Commercial |
$543.64
|
| Rate for Payer: Cofinity Commercial |
$505.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$377.53
|
| Rate for Payer: Mclaren Medicaid |
$251.34
|
| Rate for Payer: Meridian Medicaid |
$263.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$396.41
|
| Rate for Payer: PACE SWMI |
$377.53
|
| Rate for Payer: PHP Medicare Advantage |
$377.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$875.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$594.40
|
| Rate for Payer: Priority Health Medicare |
$377.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$377.53
|
| Rate for Payer: UHC Medicare Advantage |
$388.86
|
|
|
PR SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$996.00
|
|
|
Service Code
|
HCPCS 28072
|
| Min. Negotiated Rate |
$210.23 |
| Max. Negotiated Rate |
$712.98 |
| Rate for Payer: Aetna Commercial |
$424.39
|
| Rate for Payer: Aetna Medicare |
$329.38
|
| Rate for Payer: BCBS Complete |
$220.74
|
| Rate for Payer: BCBS MAPPO |
$316.71
|
| Rate for Payer: BCBS Trust/PPO |
$567.39
|
| Rate for Payer: BCN Commercial |
$712.98
|
| Rate for Payer: BCN Medicare Advantage |
$316.71
|
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cofinity Commercial |
$456.06
|
| Rate for Payer: Cofinity Commercial |
$424.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.71
|
| Rate for Payer: Mclaren Medicaid |
$210.23
|
| Rate for Payer: Meridian Medicaid |
$220.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$332.55
|
| Rate for Payer: PACE SWMI |
$316.71
|
| Rate for Payer: PHP Medicare Advantage |
$316.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.34
|
| Rate for Payer: Priority Health Medicare |
$316.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$495.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.71
|
| Rate for Payer: UHC Medicare Advantage |
$326.21
|
|
|
PR SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
HCPCS 26135
|
| Min. Negotiated Rate |
$295.85 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$733.68
|
| Rate for Payer: Aetna Medicare |
$569.42
|
| Rate for Payer: BCBS Complete |
$378.86
|
| Rate for Payer: BCBS MAPPO |
$547.52
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$820.97
|
| Rate for Payer: BCN Medicare Advantage |
$547.52
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cofinity Commercial |
$788.43
|
| Rate for Payer: Cofinity Commercial |
$733.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.52
|
| Rate for Payer: Mclaren Medicaid |
$360.82
|
| Rate for Payer: Meridian Medicaid |
$378.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$574.90
|
| Rate for Payer: PACE SWMI |
$547.52
|
| Rate for Payer: PHP Medicare Advantage |
$547.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,184.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$857.88
|
| Rate for Payer: Priority Health Medicare |
$547.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$857.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$547.52
|
| Rate for Payer: UHC Medicare Advantage |
$563.95
|
|
|
PR SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT
|
Professional
|
Both
|
$1,447.00
|
|
|
Service Code
|
HCPCS 26140
|
| Min. Negotiated Rate |
$332.07 |
| Max. Negotiated Rate |
$1,012.90 |
| Rate for Payer: Aetna Commercial |
$671.30
|
| Rate for Payer: Aetna Medicare |
$521.01
|
| Rate for Payer: BCBS Complete |
$348.67
|
| Rate for Payer: BCBS MAPPO |
$500.97
|
| Rate for Payer: BCBS Trust/PPO |
$497.66
|
| Rate for Payer: BCN Commercial |
$752.56
|
| Rate for Payer: BCN Medicare Advantage |
$500.97
|
| Rate for Payer: Cash Price |
$1,157.60
|
| Rate for Payer: Cash Price |
$1,157.60
|
| Rate for Payer: Cofinity Commercial |
$721.40
|
| Rate for Payer: Cofinity Commercial |
$671.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.97
|
| Rate for Payer: Mclaren Medicaid |
$332.07
|
| Rate for Payer: Meridian Medicaid |
$348.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$526.02
|
| Rate for Payer: PACE SWMI |
$500.97
|
| Rate for Payer: PHP Medicare Advantage |
$500.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.40
|
| Rate for Payer: Priority Health Medicare |
$500.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$786.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$500.97
|
| Rate for Payer: UHC Medicare Advantage |
$516.00
|
|
|
PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 26145
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$1,152.90 |
| Rate for Payer: Aetna Commercial |
$682.62
|
| Rate for Payer: Aetna Medicare |
$529.80
|
| Rate for Payer: BCBS Complete |
$353.82
|
| Rate for Payer: BCBS MAPPO |
$509.42
|
| Rate for Payer: BCBS Trust/PPO |
$273.13
|
| Rate for Payer: BCN Commercial |
$764.78
|
| Rate for Payer: BCN Medicare Advantage |
$509.42
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$733.56
|
| Rate for Payer: Cofinity Commercial |
$682.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.42
|
| Rate for Payer: Mclaren Medicaid |
$336.97
|
| Rate for Payer: Meridian Medicaid |
$353.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$534.89
|
| Rate for Payer: PACE SWMI |
$509.42
|
| Rate for Payer: PHP Medicare Advantage |
$509.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$799.16
|
| Rate for Payer: Priority Health Medicare |
$509.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$799.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.42
|
| Rate for Payer: UHC Medicare Advantage |
$524.70
|
|
|
PR SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 25119
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$1,232.70 |
| Rate for Payer: Aetna Commercial |
$665.31
|
| Rate for Payer: Aetna Medicare |
$516.36
|
| Rate for Payer: BCBS Complete |
$344.64
|
| Rate for Payer: BCBS MAPPO |
$496.50
|
| Rate for Payer: BCBS Trust/PPO |
$39.09
|
| Rate for Payer: BCN Commercial |
$745.24
|
| Rate for Payer: BCN Medicare Advantage |
$496.50
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cofinity Commercial |
$714.96
|
| Rate for Payer: Cofinity Commercial |
$665.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.50
|
| Rate for Payer: Mclaren Medicaid |
$328.23
|
| Rate for Payer: Meridian Medicaid |
$344.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$521.32
|
| Rate for Payer: PACE SWMI |
$496.50
|
| Rate for Payer: PHP Medicare Advantage |
$496.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$778.74
|
| Rate for Payer: Priority Health Medicare |
$496.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$778.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.50
|
| Rate for Payer: UHC Medicare Advantage |
$511.40
|
|
|
PR SYNVISC OR SYNVISC-ONE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS J7325
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$12.89
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$9.29
|
| Rate for Payer: BCN Commercial |
$10.87
|
| Rate for Payer: BCN Medicare Advantage |
$9.62
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$12.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.10
|
| Rate for Payer: PACE SWMI |
$9.62
|
| Rate for Payer: PHP Medicare Advantage |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health Medicare |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.62
|
| Rate for Payer: UHC Medicare Advantage |
$9.91
|
|
|
PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 11103
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$28.31
|
| Rate for Payer: Aetna Medicare |
$21.98
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS MAPPO |
$21.13
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$59.29
|
| Rate for Payer: BCN Medicare Advantage |
$21.13
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Cofinity Commercial |
$28.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.13
|
| Rate for Payer: Mclaren Medicaid |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$14.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.19
|
| Rate for Payer: PACE SWMI |
$21.13
|
| Rate for Payer: PHP Medicare Advantage |
$21.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.31
|
| Rate for Payer: Priority Health Medicare |
$21.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.13
|
| Rate for Payer: UHC Medicare Advantage |
$21.76
|
|
|
PR TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 11102
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$285.54 |
| Rate for Payer: Aetna Commercial |
$49.53
|
| Rate for Payer: Aetna Medicare |
$38.44
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$36.96
|
| Rate for Payer: BCBS Trust/PPO |
$285.54
|
| Rate for Payer: BCN Commercial |
$119.76
|
| Rate for Payer: BCN Medicare Advantage |
$36.96
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$49.53
|
| Rate for Payer: Cofinity Commercial |
$53.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.96
|
| Rate for Payer: Mclaren Medicaid |
$23.86
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.81
|
| Rate for Payer: PACE SWMI |
$36.96
|
| Rate for Payer: PHP Medicare Advantage |
$36.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.03
|
| Rate for Payer: Priority Health Medicare |
$36.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.96
|
| Rate for Payer: UHC Medicare Advantage |
$38.07
|
|
|
PR TAP BLOCK UNILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 64486
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$164.20 |
| Rate for Payer: Aetna Commercial |
$73.39
|
| Rate for Payer: Aetna Medicare |
$56.96
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$54.77
|
| Rate for Payer: BCBS Trust/PPO |
$92.98
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: BCN Medicare Advantage |
$54.77
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Cofinity Commercial |
$73.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.77
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.51
|
| Rate for Payer: PACE SWMI |
$54.77
|
| Rate for Payer: PHP Medicare Advantage |
$54.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.30
|
| Rate for Payer: Priority Health Medicare |
$54.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.77
|
| Rate for Payer: UHC Medicare Advantage |
$56.41
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 11920
|
| Min. Negotiated Rate |
$72.63 |
| Max. Negotiated Rate |
$630.49 |
| Rate for Payer: Aetna Commercial |
$142.48
|
| Rate for Payer: Aetna Medicare |
$110.58
|
| Rate for Payer: BCBS Complete |
$76.26
|
| Rate for Payer: BCBS MAPPO |
$106.33
|
| Rate for Payer: BCBS Trust/PPO |
$630.49
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Medicare Advantage |
$106.33
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$142.48
|
| Rate for Payer: Cofinity Commercial |
$153.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.33
|
| Rate for Payer: Mclaren Medicaid |
$72.63
|
| Rate for Payer: Meridian Medicaid |
$76.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.65
|
| Rate for Payer: PACE SWMI |
$106.33
|
| Rate for Payer: PHP Medicare Advantage |
$106.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.17
|
| Rate for Payer: Priority Health Medicare |
$106.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.33
|
| Rate for Payer: UHC Medicare Advantage |
$109.52
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 11921
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$2,064.94 |
| Rate for Payer: Aetna Commercial |
$171.76
|
| Rate for Payer: Aetna Medicare |
$133.31
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$128.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.94
|
| Rate for Payer: BCN Commercial |
$327.90
|
| Rate for Payer: BCN Medicare Advantage |
$128.18
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cofinity Commercial |
$184.58
|
| Rate for Payer: Cofinity Commercial |
$171.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.18
|
| Rate for Payer: Mclaren Medicaid |
$83.28
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.59
|
| Rate for Payer: PACE SWMI |
$128.18
|
| Rate for Payer: PHP Medicare Advantage |
$128.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.31
|
| Rate for Payer: Priority Health Medicare |
$128.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.18
|
| Rate for Payer: UHC Medicare Advantage |
$132.03
|
|
|
PR TATTOOING INCL MICROPIGMENTATION EA 20.0 CM
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 11922
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$89.43 |
| Rate for Payer: Aetna Commercial |
$38.71
|
| Rate for Payer: Aetna Medicare |
$30.05
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS MAPPO |
$28.89
|
| Rate for Payer: BCBS Trust/PPO |
$62.82
|
| Rate for Payer: BCN Commercial |
$89.43
|
| Rate for Payer: BCN Medicare Advantage |
$28.89
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$38.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.89
|
| Rate for Payer: Mclaren Medicaid |
$18.32
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.33
|
| Rate for Payer: PACE SWMI |
$28.89
|
| Rate for Payer: PHP Medicare Advantage |
$28.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.76
|
| Rate for Payer: Priority Health Medicare |
$28.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$29.76
|
|
|
PR TC99M DISOFENIN
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS A9510
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$1,959.99 |
| Rate for Payer: Aetna Commercial |
$67.20
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.99
|
| Rate for Payer: BCN Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR TC99M MEBROFENIN
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS A9537
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$2,874.48 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: BCBS Complete |
$95.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,874.48
|
| Rate for Payer: BCN Commercial |
$69.79
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.60
|
|
|
PR TC99M MEDRONATE
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS A9503
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$1,603.92 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.92
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
|
|
PR TC99M PERTECHNETATE
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS A9512
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1,517.81 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.81
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
|
PR TC99M SESTAMIBI
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS A9500
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$1,830.03 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: BCBS Complete |
$125.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,830.03
|
| Rate for Payer: BCN Commercial |
$128.10
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.80
|
|
