|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$534.11 |
| Rate for Payer: Aetna Commercial |
$318.43
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCBS Trust/PPO |
$534.11
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.23
|
| Rate for Payer: Priority Health Narrow Network |
$429.23
|
| Rate for Payer: Priority Health SBD |
$429.23
|
| Rate for Payer: UMR Bronson Commercial |
$267.26
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$169.34 |
| Max. Negotiated Rate |
$569.51 |
| Rate for Payer: Aetna Commercial |
$350.99
|
| Rate for Payer: BCBS Complete |
$177.81
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Meridian Medicaid |
$177.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$467.43
|
| Rate for Payer: Priority Health Narrow Network |
$467.43
|
| Rate for Payer: Priority Health SBD |
$467.43
|
| Rate for Payer: UMR Bronson Commercial |
$341.32
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$398.95 |
| Max. Negotiated Rate |
$1,097.17 |
| Rate for Payer: Aetna Commercial |
$810.36
|
| Rate for Payer: BCBS Complete |
$418.90
|
| Rate for Payer: BCBS Trust/PPO |
$515.09
|
| Rate for Payer: Cash Price |
$905.60
|
| Rate for Payer: Cash Price |
$905.60
|
| Rate for Payer: Meridian Medicaid |
$418.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,097.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,097.17
|
| Rate for Payer: Priority Health SBD |
$1,097.17
|
| Rate for Payer: UMR Bronson Commercial |
$520.72
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$184.88 |
| Max. Negotiated Rate |
$529.88 |
| Rate for Payer: Aetna Commercial |
$383.32
|
| Rate for Payer: BCBS Complete |
$194.12
|
| Rate for Payer: BCBS Trust/PPO |
$529.88
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Meridian Medicaid |
$194.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$505.07
|
| Rate for Payer: Priority Health Narrow Network |
$505.07
|
| Rate for Payer: Priority Health SBD |
$505.07
|
| Rate for Payer: UMR Bronson Commercial |
$320.62
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$339.70 |
| Rate for Payer: Aetna Commercial |
$156.16
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$339.70
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Meridian Medicaid |
$82.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.43
|
| Rate for Payer: Priority Health Narrow Network |
$213.43
|
| Rate for Payer: Priority Health SBD |
$213.43
|
| Rate for Payer: UMR Bronson Commercial |
$189.52
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$667.79 |
| Rate for Payer: Aetna Commercial |
$159.38
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS Trust/PPO |
$667.79
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.96
|
| Rate for Payer: Priority Health Narrow Network |
$216.96
|
| Rate for Payer: Priority Health SBD |
$216.96
|
| Rate for Payer: UMR Bronson Commercial |
$166.52
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$355.28 |
| Max. Negotiated Rate |
$1,360.80 |
| Rate for Payer: Aetna Commercial |
$731.34
|
| Rate for Payer: BCBS Complete |
$373.04
|
| Rate for Payer: BCBS Trust/PPO |
$774.49
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Meridian Medicaid |
$373.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$973.09
|
| Rate for Payer: Priority Health Narrow Network |
$973.09
|
| Rate for Payer: Priority Health SBD |
$973.09
|
| Rate for Payer: UMR Bronson Commercial |
$894.24
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$225.14 |
| Max. Negotiated Rate |
$615.02 |
| Rate for Payer: Aetna Commercial |
$459.97
|
| Rate for Payer: BCBS Complete |
$236.40
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Meridian Medicaid |
$236.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.02
|
| Rate for Payer: Priority Health Narrow Network |
$615.02
|
| Rate for Payer: Priority Health SBD |
$615.02
|
| Rate for Payer: UMR Bronson Commercial |
$327.52
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,161.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$230.04 |
| Max. Negotiated Rate |
$812.70 |
| Rate for Payer: Aetna Commercial |
$468.59
|
| Rate for Payer: BCBS Complete |
$241.54
|
| Rate for Payer: BCBS Trust/PPO |
$423.17
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Meridian Medicaid |
$241.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.08
|
| Rate for Payer: Priority Health Narrow Network |
$632.08
|
| Rate for Payer: Priority Health SBD |
$632.08
|
| Rate for Payer: UMR Bronson Commercial |
$534.06
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,807.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$785.76 |
| Max. Negotiated Rate |
$2,153.75 |
| Rate for Payer: Aetna Commercial |
$1,652.07
|
| Rate for Payer: BCBS Complete |
$825.05
|
| Rate for Payer: BCBS Trust/PPO |
$787.17
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Meridian Medicaid |
$825.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$785.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,264.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,153.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,153.75
|
| Rate for Payer: Priority Health SBD |
$2,153.75
|
| Rate for Payer: UMR Bronson Commercial |
$831.22
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$625.37 |
| Max. Negotiated Rate |
$2,167.90 |
| Rate for Payer: Aetna Commercial |
$1,326.15
|
| Rate for Payer: BCBS Complete |
$656.64
|
| Rate for Payer: BCBS Trust/PPO |
$686.26
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Meridian Medicaid |
$656.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$625.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,167.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,720.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,720.41
|
| Rate for Payer: Priority Health SBD |
$1,720.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,424.62
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$80.73 |
| Max. Negotiated Rate |
$1,025.43 |
| Rate for Payer: Aetna Commercial |
$175.64
|
| Rate for Payer: BCBS Complete |
$84.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.43
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Meridian Medicaid |
$84.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.21
|
| Rate for Payer: Priority Health Narrow Network |
$203.21
|
| Rate for Payer: Priority Health SBD |
$203.21
|
| Rate for Payer: UMR Bronson Commercial |
$131.56
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,082.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$656.04 |
| Max. Negotiated Rate |
$5,381.79 |
| Rate for Payer: Aetna Commercial |
$1,400.04
|
| Rate for Payer: BCBS Complete |
$688.84
|
| Rate for Payer: BCBS Trust/PPO |
$5,381.79
|
| Rate for Payer: Cash Price |
$1,665.60
|
| Rate for Payer: Cash Price |
$1,665.60
|
| Rate for Payer: Meridian Medicaid |
$688.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$656.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,629.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,629.91
|
| Rate for Payer: Priority Health SBD |
$1,629.91
|
| Rate for Payer: UMR Bronson Commercial |
$957.72
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,073.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$1,451.10 |
| Rate for Payer: Aetna Commercial |
$1,037.13
|
| Rate for Payer: BCBS Complete |
$523.79
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Meridian Medicaid |
$523.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,363.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,363.50
|
| Rate for Payer: Priority Health SBD |
$1,363.50
|
| Rate for Payer: UMR Bronson Commercial |
$953.58
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$912.12 |
| Max. Negotiated Rate |
$1,865.70 |
| Rate for Payer: Aetna American Axle |
$1,347.45
|
| Rate for Payer: Aetna Commercial |
$1,762.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.45
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cofinity Commercial |
$1,451.10
|
| Rate for Payer: Cofinity Commercial |
$1,782.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.40
|
| Rate for Payer: Healthscope Commercial |
$1,865.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,451.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,554.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,762.05
|
| Rate for Payer: PHP Commercial |
$1,762.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.10
|
| Rate for Payer: Priority Health SBD |
$1,305.99
|
| Rate for Payer: UMR Bronson Commercial |
$912.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,554.75
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$766.87 |
| Max. Negotiated Rate |
$2,668.37 |
| Rate for Payer: Aetna American Axle |
$1,347.45
|
| Rate for Payer: Aetna Commercial |
$1,762.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.45
|
| Rate for Payer: BCBS Complete |
$829.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,668.37
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cofinity Commercial |
$1,451.10
|
| Rate for Payer: Cofinity Commercial |
$1,782.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.40
|
| Rate for Payer: Healthscope Commercial |
$1,865.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,451.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,554.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,762.05
|
| Rate for Payer: PHP Commercial |
$1,762.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.10
|
| Rate for Payer: Priority Health SBD |
$1,305.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$843.56
|
| Rate for Payer: UHC Exchange |
$766.87
|
| Rate for Payer: UMR Bronson Commercial |
$767.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,554.75
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,073.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$1,451.10 |
| Rate for Payer: Aetna Commercial |
$1,037.13
|
| Rate for Payer: BCBS Complete |
$523.79
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Meridian Medicaid |
$523.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,363.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,363.50
|
| Rate for Payer: Priority Health SBD |
$1,363.50
|
| Rate for Payer: UMR Bronson Commercial |
$953.58
|
|
|
PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$170.19 |
| Max. Negotiated Rate |
$762.87 |
| Rate for Payer: Aetna Commercial |
$357.02
|
| Rate for Payer: BCBS Complete |
$178.70
|
| Rate for Payer: BCBS Trust/PPO |
$762.87
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Meridian Medicaid |
$178.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.79
|
| Rate for Payer: Priority Health Narrow Network |
$469.79
|
| Rate for Payer: Priority Health SBD |
$469.79
|
| Rate for Payer: UMR Bronson Commercial |
$263.12
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,868.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$161.13 |
| Max. Negotiated Rate |
$1,307.60 |
| Rate for Payer: Aetna Commercial |
$515.29
|
| Rate for Payer: BCBS Complete |
$278.22
|
| Rate for Payer: BCBS Trust/PPO |
$161.13
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Meridian Medicaid |
$278.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,307.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.67
|
| Rate for Payer: Priority Health Narrow Network |
$689.67
|
| Rate for Payer: Priority Health SBD |
$689.67
|
| Rate for Payer: UMR Bronson Commercial |
$859.28
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$1,964.00
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$209.74 |
| Max. Negotiated Rate |
$1,806.82 |
| Rate for Payer: Aetna Commercial |
$1,376.32
|
| Rate for Payer: BCBS Complete |
$727.53
|
| Rate for Payer: BCBS Trust/PPO |
$209.74
|
| Rate for Payer: Cash Price |
$1,571.20
|
| Rate for Payer: Cash Price |
$1,571.20
|
| Rate for Payer: Meridian Medicaid |
$727.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,806.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,806.82
|
| Rate for Payer: Priority Health SBD |
$1,806.82
|
| Rate for Payer: UMR Bronson Commercial |
$903.44
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$2,334.00
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$160.07 |
| Max. Negotiated Rate |
$1,633.80 |
| Rate for Payer: Aetna Commercial |
$1,074.60
|
| Rate for Payer: BCBS Complete |
$576.12
|
| Rate for Payer: BCBS Trust/PPO |
$160.07
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Meridian Medicaid |
$576.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$548.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,633.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,441.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,441.04
|
| Rate for Payer: Priority Health SBD |
$1,441.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,073.64
|
|
|
PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,194.00
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$266.26 |
| Max. Negotiated Rate |
$835.80 |
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: BCBS Complete |
$290.97
|
| Rate for Payer: BCBS Trust/PPO |
$266.26
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Meridian Medicaid |
$290.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$727.03
|
| Rate for Payer: Priority Health Narrow Network |
$727.03
|
| Rate for Payer: Priority Health SBD |
$727.03
|
| Rate for Payer: UMR Bronson Commercial |
$549.24
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$262.20 |
| Max. Negotiated Rate |
$863.80 |
| Rate for Payer: Aetna Commercial |
$501.13
|
| Rate for Payer: BCBS Complete |
$275.31
|
| Rate for Payer: BCBS Trust/PPO |
$302.19
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Meridian Medicaid |
$275.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$677.77
|
| Rate for Payer: Priority Health Narrow Network |
$677.77
|
| Rate for Payer: Priority Health SBD |
$677.77
|
| Rate for Payer: UMR Bronson Commercial |
$567.64
|
|
|
PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,661.00
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$293.73 |
| Max. Negotiated Rate |
$1,162.70 |
| Rate for Payer: Aetna Commercial |
$586.40
|
| Rate for Payer: BCBS Complete |
$308.42
|
| Rate for Payer: BCBS Trust/PPO |
$306.94
|
| Rate for Payer: Cash Price |
$1,328.80
|
| Rate for Payer: Cash Price |
$1,328.80
|
| Rate for Payer: Meridian Medicaid |
$308.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$772.33
|
| Rate for Payer: Priority Health Narrow Network |
$772.33
|
| Rate for Payer: Priority Health SBD |
$772.33
|
| Rate for Payer: UMR Bronson Commercial |
$764.06
|
|
|
PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$2,440.00
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$937.29
|
| Rate for Payer: BCBS Complete |
$489.57
|
| Rate for Payer: BCBS Trust/PPO |
$128.38
|
| Rate for Payer: Cash Price |
$1,952.00
|
| Rate for Payer: Cash Price |
$1,952.00
|
| Rate for Payer: Meridian Medicaid |
$489.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$466.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,232.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,232.11
|
| Rate for Payer: Priority Health SBD |
$1,232.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,122.40
|
|
