|
PR NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
HCPCS 95910
|
| Min. Negotiated Rate |
$96.57 |
| Max. Negotiated Rate |
$1,982.71 |
| Rate for Payer: Aetna Commercial |
$203.39
|
| Rate for Payer: Aetna Commercial |
$203.39
|
| Rate for Payer: BCBS Complete |
$149.60
|
| Rate for Payer: BCBS Complete |
$209.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,982.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,982.71
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.57
|
| Rate for Payer: Priority Health Narrow Network |
$96.57
|
| Rate for Payer: Priority Health Narrow Network |
$96.57
|
| Rate for Payer: Priority Health SBD |
$234.45
|
| Rate for Payer: Priority Health SBD |
$234.45
|
| Rate for Payer: UMR Bronson Commercial |
$172.04
|
| Rate for Payer: UMR Bronson Commercial |
$241.04
|
|
|
PR NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 95911
|
| Min. Negotiated Rate |
$110.94 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna Commercial |
$244.32
|
| Rate for Payer: Aetna Commercial |
$244.32
|
| Rate for Payer: BCBS Complete |
$177.60
|
| Rate for Payer: BCBS Complete |
$253.60
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.94
|
| Rate for Payer: Priority Health Narrow Network |
$110.94
|
| Rate for Payer: Priority Health Narrow Network |
$110.94
|
| Rate for Payer: Priority Health SBD |
$282.96
|
| Rate for Payer: Priority Health SBD |
$282.96
|
| Rate for Payer: UMR Bronson Commercial |
$291.64
|
| Rate for Payer: UMR Bronson Commercial |
$204.24
|
|
|
PR NERVE GRAFT 1 STRAND ARM/LEG <4 CM
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 64892
|
| Min. Negotiated Rate |
$214.49 |
| Max. Negotiated Rate |
$1,779.08 |
| Rate for Payer: Aetna Commercial |
$1,351.70
|
| Rate for Payer: BCBS Complete |
$706.95
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Meridian Medicaid |
$706.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,779.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,779.08
|
| Rate for Payer: Priority Health SBD |
$1,779.08
|
| Rate for Payer: UMR Bronson Commercial |
$968.30
|
|
|
PR NERVE GRAFT 1 STRAND ARM/LEG >4 CM
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 64893
|
| Min. Negotiated Rate |
$605.43 |
| Max. Negotiated Rate |
$1,895.71 |
| Rate for Payer: Aetna Commercial |
$1,442.60
|
| Rate for Payer: BCBS Complete |
$753.48
|
| Rate for Payer: BCBS Trust/PPO |
$605.43
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Meridian Medicaid |
$753.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$717.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,895.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,895.71
|
| Rate for Payer: Priority Health SBD |
$1,895.71
|
| Rate for Payer: UMR Bronson Commercial |
$782.00
|
|
|
PR NERVE GRAFT 1 STRAND HAND/FOOT </4 CM
|
Professional
|
Both
|
$3,638.00
|
|
|
Service Code
|
HCPCS 64890
|
| Min. Negotiated Rate |
$359.24 |
| Max. Negotiated Rate |
$2,546.60 |
| Rate for Payer: Aetna Commercial |
$1,390.93
|
| Rate for Payer: BCBS Complete |
$726.19
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: Cash Price |
$2,910.40
|
| Rate for Payer: Cash Price |
$2,910.40
|
| Rate for Payer: Meridian Medicaid |
$726.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$691.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,546.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,827.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,827.20
|
| Rate for Payer: Priority Health SBD |
$1,827.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,673.48
|
|
|
PR NERVE GRAFT EACH NERVE MULTIPLE STRANDS
|
Professional
|
Both
|
$2,886.00
|
|
|
Service Code
|
HCPCS 64902
|
| Min. Negotiated Rate |
$379.32 |
| Max. Negotiated Rate |
$2,020.20 |
| Rate for Payer: Aetna Commercial |
$890.94
|
| Rate for Payer: BCBS Complete |
$454.90
|
| Rate for Payer: BCBS Trust/PPO |
$379.32
|
| Rate for Payer: Cash Price |
$2,308.80
|
| Rate for Payer: Cash Price |
$2,308.80
|
| Rate for Payer: Meridian Medicaid |
$454.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,020.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.57
|
| Rate for Payer: Priority Health SBD |
$1,150.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,327.56
|
|
|
PR NERVE GRAFT MLT STRANDS ARM/LEG </4 CM
|
Professional
|
Both
|
$2,571.00
|
|
|
Service Code
|
HCPCS 64897
|
| Min. Negotiated Rate |
$407.32 |
| Max. Negotiated Rate |
$2,139.76 |
| Rate for Payer: Aetna Commercial |
$1,632.38
|
| Rate for Payer: BCBS Complete |
$850.09
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Meridian Medicaid |
$850.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$809.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,799.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,139.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,139.76
|
| Rate for Payer: Priority Health SBD |
$2,139.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,182.66
|
|
|
PR NERVE GRAFT MLT STRANDS ARM/LEG >4 CM
|
Professional
|
Both
|
$3,128.00
|
|
|
Service Code
|
HCPCS 64898
|
| Min. Negotiated Rate |
$367.70 |
| Max. Negotiated Rate |
$2,316.43 |
| Rate for Payer: Aetna Commercial |
$1,767.51
|
| Rate for Payer: BCBS Complete |
$920.55
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: Cash Price |
$2,502.40
|
| Rate for Payer: Cash Price |
$2,502.40
|
| Rate for Payer: Meridian Medicaid |
$920.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$876.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,316.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,316.43
|
| Rate for Payer: Priority Health SBD |
$2,316.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,438.88
|
|
|
PR NERVE GRAFT MLT STRANDS HAND/FOOT </4 CM
|
Professional
|
Both
|
$3,152.00
|
|
|
Service Code
|
HCPCS 64895
|
| Min. Negotiated Rate |
$219.77 |
| Max. Negotiated Rate |
$2,239.42 |
| Rate for Payer: Aetna Commercial |
$1,709.01
|
| Rate for Payer: BCBS Complete |
$888.78
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: Cash Price |
$2,521.60
|
| Rate for Payer: Cash Price |
$2,521.60
|
| Rate for Payer: Meridian Medicaid |
$888.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,206.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,239.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,239.42
|
| Rate for Payer: Priority Health SBD |
$2,239.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,449.92
|
|
|
PR NERVE REPAIR W/CONDUIT EACH NERVE
|
Professional
|
Both
|
$2,570.00
|
|
|
Service Code
|
HCPCS 64910
|
| Min. Negotiated Rate |
$272.60 |
| Max. Negotiated Rate |
$1,799.00 |
| Rate for Payer: Aetna Commercial |
$998.70
|
| Rate for Payer: BCBS Complete |
$513.94
|
| Rate for Payer: BCBS Trust/PPO |
$272.60
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Meridian Medicaid |
$513.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,799.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,289.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,289.86
|
| Rate for Payer: Priority Health SBD |
$1,289.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,182.20
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 64913
|
| Min. Negotiated Rate |
$109.06 |
| Max. Negotiated Rate |
$290.47 |
| Rate for Payer: Aetna Commercial |
$228.03
|
| Rate for Payer: BCBS Complete |
$114.51
|
| Rate for Payer: BCBS Trust/PPO |
$274.19
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Meridian Medicaid |
$114.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.47
|
| Rate for Payer: Priority Health Narrow Network |
$290.47
|
| Rate for Payer: Priority Health SBD |
$290.47
|
| Rate for Payer: UMR Bronson Commercial |
$146.74
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 64912
|
| Min. Negotiated Rate |
$311.17 |
| Max. Negotiated Rate |
$1,516.92 |
| Rate for Payer: Aetna Commercial |
$1,126.41
|
| Rate for Payer: BCBS Complete |
$602.96
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Meridian Medicaid |
$602.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,516.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,516.92
|
| Rate for Payer: Priority Health SBD |
$1,516.92
|
| Rate for Payer: UMR Bronson Commercial |
$718.06
|
|
|
PR NEURAXIAL LABOR ANALG/ANES PLND VAGINAL DELIVERY
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01967
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$650.00
|
| Rate for Payer: Priority Health Narrow Network |
$650.00
|
| Rate for Payer: Priority Health SBD |
$650.00
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 96116
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$1,244.67 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,244.67
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.44
|
| Rate for Payer: Priority Health Narrow Network |
$106.44
|
| Rate for Payer: Priority Health SBD |
$106.44
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
PR NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 96121
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$1,458.64 |
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.64
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.93
|
| Rate for Payer: Priority Health Narrow Network |
$88.93
|
| Rate for Payer: Priority Health SBD |
$88.93
|
| Rate for Payer: UMR Bronson Commercial |
$75.44
|
|
|
PR NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY
|
Professional
|
Both
|
$4,301.50
|
|
|
Service Code
|
HCPCS 62164
|
| Min. Negotiated Rate |
$1,230.41 |
| Max. Negotiated Rate |
$3,583.63 |
| Rate for Payer: Aetna Commercial |
$2,702.98
|
| Rate for Payer: BCBS Complete |
$1,428.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.41
|
| Rate for Payer: Cash Price |
$3,441.20
|
| Rate for Payer: Cash Price |
$3,441.20
|
| Rate for Payer: Meridian Medicaid |
$1,428.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,360.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,011.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,583.63
|
| Rate for Payer: Priority Health Narrow Network |
$3,583.63
|
| Rate for Payer: Priority Health SBD |
$3,583.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,978.69
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 95937
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$141.47 |
| Rate for Payer: Aetna Commercial |
$111.69
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$59.17
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.37
|
| Rate for Payer: Priority Health Narrow Network |
$45.37
|
| Rate for Payer: Priority Health SBD |
$141.47
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT
|
Professional
|
Both
|
$2,439.00
|
|
|
Service Code
|
HCPCS 64702
|
| Min. Negotiated Rate |
$333.77 |
| Max. Negotiated Rate |
$4,639.00 |
| Rate for Payer: Aetna Commercial |
$649.73
|
| Rate for Payer: BCBS Complete |
$350.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,639.00
|
| Rate for Payer: Cash Price |
$1,951.20
|
| Rate for Payer: Cash Price |
$1,951.20
|
| Rate for Payer: Meridian Medicaid |
$350.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,707.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$877.08
|
| Rate for Payer: Priority Health Narrow Network |
$877.08
|
| Rate for Payer: Priority Health SBD |
$877.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,121.94
|
|
|
PR NEUROPLASTY NERVE HAND/FOOT
|
Professional
|
Both
|
$1,851.00
|
|
|
Service Code
|
HCPCS 64704
|
| Min. Negotiated Rate |
$209.59 |
| Max. Negotiated Rate |
$6,889.56 |
| Rate for Payer: Aetna Commercial |
$413.18
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS Trust/PPO |
$6,889.56
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.80
|
| Rate for Payer: Priority Health Narrow Network |
$549.80
|
| Rate for Payer: Priority Health SBD |
$549.80
|
| Rate for Payer: UMR Bronson Commercial |
$851.46
|
|
|
PR NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 64716
|
| Min. Negotiated Rate |
$329.94 |
| Max. Negotiated Rate |
$5,621.64 |
| Rate for Payer: Aetna Commercial |
$656.90
|
| Rate for Payer: BCBS Complete |
$346.44
|
| Rate for Payer: BCBS Trust/PPO |
$5,621.64
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Meridian Medicaid |
$346.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.86
|
| Rate for Payer: Priority Health Narrow Network |
$870.86
|
| Rate for Payer: Priority Health SBD |
$870.86
|
| Rate for Payer: UMR Bronson Commercial |
$432.86
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$3,084.00
|
|
|
Service Code
|
HCPCS 64718
|
| Min. Negotiated Rate |
$392.13 |
| Max. Negotiated Rate |
$4,438.25 |
| Rate for Payer: Aetna Commercial |
$765.15
|
| Rate for Payer: BCBS Complete |
$411.74
|
| Rate for Payer: BCBS Trust/PPO |
$4,438.25
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Meridian Medicaid |
$411.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,158.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,030.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,030.53
|
| Rate for Payer: Priority Health SBD |
$1,030.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,418.64
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$3,084.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$392.13 |
| Max. Negotiated Rate |
$4,438.25 |
| Rate for Payer: Aetna Commercial |
$765.15
|
| Rate for Payer: BCBS Complete |
$411.74
|
| Rate for Payer: BCBS Trust/PPO |
$4,438.25
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Meridian Medicaid |
$411.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,158.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,030.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,030.53
|
| Rate for Payer: Priority Health SBD |
$1,030.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,418.64
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Facility
|
IP
|
$3,084.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$1,356.96 |
| Max. Negotiated Rate |
$2,775.60 |
| Rate for Payer: Aetna American Axle |
$2,004.60
|
| Rate for Payer: Aetna Commercial |
$2,621.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,004.60
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cofinity Commercial |
$2,158.80
|
| Rate for Payer: Cofinity Commercial |
$2,652.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,467.20
|
| Rate for Payer: Healthscope Commercial |
$2,775.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,158.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,313.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,621.40
|
| Rate for Payer: PHP Commercial |
$2,621.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,158.80
|
| Rate for Payer: Priority Health SBD |
$1,942.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,356.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,313.00
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Facility
|
OP
|
$3,084.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$602.82 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna American Axle |
$2,004.60
|
| Rate for Payer: Aetna Commercial |
$2,621.40
|
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,004.60
|
| 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: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,025.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cofinity Commercial |
$2,652.24
|
| Rate for Payer: Cofinity Commercial |
$2,158.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,467.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$2,775.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,158.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,313.00
|
| 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 |
$2,621.40
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Commercial |
$2,621.40
|
| 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 |
$2,158.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Priority Health SBD |
$1,942.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$602.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,141.08
|
| Rate for Payer: VA VA |
$1,716.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,313.00
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 64719
|
| Min. Negotiated Rate |
$265.40 |
| Max. Negotiated Rate |
$3,989.19 |
| Rate for Payer: Aetna Commercial |
$517.96
|
| Rate for Payer: BCBS Complete |
$278.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,989.19
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Meridian Medicaid |
$278.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,078.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$697.59
|
| Rate for Payer: Priority Health Narrow Network |
$697.59
|
| Rate for Payer: Priority Health SBD |
$697.59
|
| Rate for Payer: UMR Bronson Commercial |
$708.86
|
|
