|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 17274
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$6,178.65 |
| Rate for Payer: Aetna Commercial |
$218.29
|
| Rate for Payer: Aetna Medicare |
$162.90
|
| Rate for Payer: BCBS Complete |
$111.82
|
| Rate for Payer: BCBS MAPPO |
$162.90
|
| Rate for Payer: BCBS Trust/PPO |
$6,178.65
|
| Rate for Payer: BCN Commercial |
$288.21
|
| Rate for Payer: BCN Medicare Advantage |
$162.90
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$234.58
|
| Rate for Payer: Cofinity Commercial |
$218.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.90
|
| Rate for Payer: Healthscope Commercial |
$195.48
|
| Rate for Payer: Healthscope Whirlpool |
$195.48
|
| Rate for Payer: Meridian Medicaid |
$111.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.04
|
| Rate for Payer: PACE SWMI |
$162.90
|
| Rate for Payer: PHP Medicare Advantage |
$162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.29
|
| Rate for Payer: Priority Health Medicare |
$162.90
|
| Rate for Payer: Priority Health Narrow Network |
$204.29
|
| Rate for Payer: UHC Medicare Advantage |
$167.79
|
|
|
PR DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 17260
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$947.65 |
| Rate for Payer: Aetna Commercial |
$91.50
|
| Rate for Payer: Aetna Medicare |
$68.28
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS MAPPO |
$68.28
|
| Rate for Payer: BCBS Trust/PPO |
$947.65
|
| Rate for Payer: BCN Commercial |
$117.80
|
| Rate for Payer: BCN Medicare Advantage |
$68.28
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$98.32
|
| Rate for Payer: Cofinity Commercial |
$91.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.28
|
| Rate for Payer: Healthscope Commercial |
$81.94
|
| Rate for Payer: Healthscope Whirlpool |
$81.94
|
| Rate for Payer: Meridian Medicaid |
$47.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.69
|
| Rate for Payer: PACE SWMI |
$68.28
|
| Rate for Payer: PHP Medicare Advantage |
$68.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.31
|
| Rate for Payer: Priority Health Medicare |
$68.28
|
| Rate for Payer: Priority Health Narrow Network |
$86.31
|
| Rate for Payer: UHC Medicare Advantage |
$70.33
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 17281
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$153.78
|
| Rate for Payer: Aetna Medicare |
$114.76
|
| Rate for Payer: BCBS Complete |
$79.17
|
| Rate for Payer: BCBS MAPPO |
$114.76
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$212.04
|
| Rate for Payer: BCN Medicare Advantage |
$114.76
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$165.25
|
| Rate for Payer: Cofinity Commercial |
$153.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.76
|
| Rate for Payer: Healthscope Commercial |
$137.71
|
| Rate for Payer: Healthscope Whirlpool |
$137.71
|
| Rate for Payer: Meridian Medicaid |
$79.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.50
|
| Rate for Payer: PACE SWMI |
$114.76
|
| Rate for Payer: PHP Medicare Advantage |
$114.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.27
|
| Rate for Payer: Priority Health Medicare |
$114.76
|
| Rate for Payer: Priority Health Narrow Network |
$144.27
|
| Rate for Payer: UHC Medicare Advantage |
$118.20
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 17282
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$177.63
|
| Rate for Payer: Aetna Medicare |
$132.56
|
| Rate for Payer: BCBS Complete |
$91.24
|
| Rate for Payer: BCBS MAPPO |
$132.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$242.28
|
| Rate for Payer: BCN Medicare Advantage |
$132.56
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$190.89
|
| Rate for Payer: Cofinity Commercial |
$177.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.56
|
| Rate for Payer: Healthscope Commercial |
$159.07
|
| Rate for Payer: Healthscope Whirlpool |
$159.07
|
| Rate for Payer: Meridian Medicaid |
$91.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$139.19
|
| Rate for Payer: PACE SWMI |
$132.56
|
| Rate for Payer: PHP Medicare Advantage |
$132.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.47
|
| Rate for Payer: Priority Health Medicare |
$132.56
|
| Rate for Payer: Priority Health Narrow Network |
$166.47
|
| Rate for Payer: UHC Medicare Advantage |
$136.54
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 17283
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$221.38
|
| Rate for Payer: Aetna Medicare |
$165.21
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS MAPPO |
$165.21
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$285.86
|
| Rate for Payer: BCN Medicare Advantage |
$165.21
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Commercial |
$221.38
|
| Rate for Payer: Cofinity Commercial |
$237.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.21
|
| Rate for Payer: Healthscope Commercial |
$198.25
|
| Rate for Payer: Healthscope Whirlpool |
$198.25
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$173.47
|
| Rate for Payer: PACE SWMI |
$165.21
|
| Rate for Payer: PHP Medicare Advantage |
$165.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.16
|
| Rate for Payer: Priority Health Medicare |
$165.21
|
| Rate for Payer: Priority Health Narrow Network |
$207.16
|
| Rate for Payer: UHC Medicare Advantage |
$170.17
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 17284
|
| Min. Negotiated Rate |
$126.31 |
| Max. Negotiated Rate |
$325.13 |
| Rate for Payer: Aetna Commercial |
$259.13
|
| Rate for Payer: Aetna Medicare |
$193.38
|
| Rate for Payer: BCBS Complete |
$132.63
|
| Rate for Payer: BCBS MAPPO |
$193.38
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$325.13
|
| Rate for Payer: BCN Medicare Advantage |
$193.38
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cofinity Commercial |
$278.47
|
| Rate for Payer: Cofinity Commercial |
$259.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.38
|
| Rate for Payer: Healthscope Commercial |
$232.06
|
| Rate for Payer: Healthscope Whirlpool |
$232.06
|
| Rate for Payer: Meridian Medicaid |
$132.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.05
|
| Rate for Payer: PACE SWMI |
$193.38
|
| Rate for Payer: PHP Medicare Advantage |
$193.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.11
|
| Rate for Payer: Priority Health Medicare |
$193.38
|
| Rate for Payer: Priority Health Narrow Network |
$242.11
|
| Rate for Payer: UHC Medicare Advantage |
$199.18
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM
|
Professional
|
Both
|
$2,750.00
|
|
|
Service Code
|
HCPCS 17286
|
| Min. Negotiated Rate |
$171.47 |
| Max. Negotiated Rate |
$1,925.00 |
| Rate for Payer: Aetna Commercial |
$350.42
|
| Rate for Payer: Aetna Medicare |
$261.51
|
| Rate for Payer: BCBS Complete |
$180.04
|
| Rate for Payer: BCBS MAPPO |
$261.51
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$415.44
|
| Rate for Payer: BCN Medicare Advantage |
$261.51
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cofinity Commercial |
$376.57
|
| Rate for Payer: Cofinity Commercial |
$350.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.51
|
| Rate for Payer: Healthscope Commercial |
$313.81
|
| Rate for Payer: Healthscope Whirlpool |
$313.81
|
| Rate for Payer: Meridian Medicaid |
$180.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$274.59
|
| Rate for Payer: PACE SWMI |
$261.51
|
| Rate for Payer: PHP Medicare Advantage |
$261.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.77
|
| Rate for Payer: Priority Health Medicare |
$261.51
|
| Rate for Payer: Priority Health Narrow Network |
$326.77
|
| Rate for Payer: UHC Medicare Advantage |
$269.36
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 17261
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$112.14
|
| Rate for Payer: Aetna Medicare |
$83.69
|
| Rate for Payer: BCBS Complete |
$58.60
|
| Rate for Payer: BCBS MAPPO |
$83.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.00
|
| Rate for Payer: BCN Commercial |
$174.34
|
| Rate for Payer: BCN Medicare Advantage |
$83.69
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$120.51
|
| Rate for Payer: Cofinity Commercial |
$112.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.69
|
| Rate for Payer: Healthscope Commercial |
$100.43
|
| Rate for Payer: Healthscope Whirlpool |
$100.43
|
| Rate for Payer: Meridian Medicaid |
$58.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.87
|
| Rate for Payer: PACE SWMI |
$83.69
|
| Rate for Payer: PHP Medicare Advantage |
$83.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.64
|
| Rate for Payer: Priority Health Medicare |
$83.69
|
| Rate for Payer: Priority Health Narrow Network |
$105.64
|
| Rate for Payer: UHC Medicare Advantage |
$86.20
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 17262
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$4,106.85 |
| Rate for Payer: Aetna Commercial |
$143.62
|
| Rate for Payer: Aetna Medicare |
$107.18
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS MAPPO |
$107.18
|
| Rate for Payer: BCBS Trust/PPO |
$4,106.85
|
| Rate for Payer: BCN Commercial |
$210.47
|
| Rate for Payer: BCN Medicare Advantage |
$107.18
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$154.34
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.18
|
| Rate for Payer: Healthscope Commercial |
$128.62
|
| Rate for Payer: Healthscope Whirlpool |
$128.62
|
| Rate for Payer: Meridian Medicaid |
$74.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.54
|
| Rate for Payer: PACE SWMI |
$107.18
|
| Rate for Payer: PHP Medicare Advantage |
$107.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.82
|
| Rate for Payer: Priority Health Medicare |
$107.18
|
| Rate for Payer: Priority Health Narrow Network |
$134.82
|
| Rate for Payer: UHC Medicare Advantage |
$110.40
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 17263
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$29,358.48 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Aetna Medicare |
$118.37
|
| Rate for Payer: BCBS Complete |
$81.86
|
| Rate for Payer: BCBS MAPPO |
$118.37
|
| Rate for Payer: BCBS Trust/PPO |
$29,358.48
|
| Rate for Payer: BCN Commercial |
$227.36
|
| Rate for Payer: BCN Medicare Advantage |
$118.37
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$170.45
|
| Rate for Payer: Cofinity Commercial |
$158.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.37
|
| Rate for Payer: Healthscope Commercial |
$142.04
|
| Rate for Payer: Healthscope Whirlpool |
$142.04
|
| Rate for Payer: Meridian Medicaid |
$81.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.29
|
| Rate for Payer: PACE SWMI |
$118.37
|
| Rate for Payer: PHP Medicare Advantage |
$118.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.79
|
| Rate for Payer: Priority Health Medicare |
$118.37
|
| Rate for Payer: Priority Health Narrow Network |
$148.79
|
| Rate for Payer: UHC Medicare Advantage |
$121.92
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 17264
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Aetna Medicare |
$126.28
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$126.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,400.00
|
| Rate for Payer: BCN Commercial |
$243.45
|
| Rate for Payer: BCN Medicare Advantage |
$126.28
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$169.22
|
| Rate for Payer: Cofinity Commercial |
$181.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.28
|
| Rate for Payer: Healthscope Commercial |
$151.54
|
| Rate for Payer: Healthscope Whirlpool |
$151.54
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$132.59
|
| Rate for Payer: PACE SWMI |
$126.28
|
| Rate for Payer: PHP Medicare Advantage |
$126.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.66
|
| Rate for Payer: Priority Health Medicare |
$126.28
|
| Rate for Payer: Priority Health Narrow Network |
$158.66
|
| Rate for Payer: UHC Medicare Advantage |
$130.07
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$2,145.29 |
| Rate for Payer: Aetna Commercial |
$700.20
|
| Rate for Payer: Aetna Medicare |
$1,716.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: ASR ASR |
$754.66
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$603.18
|
| Rate for Payer: BCN Commercial |
$603.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cofinity Commercial |
$731.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$778.00
|
| Rate for Payer: Healthscope Whirlpool |
$754.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,716.23
|
| Rate for Payer: Mclaren Commercial |
$700.20
|
| 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 |
$661.30
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Commercial |
$1,887.85
|
| Rate for Payer: PHP Medicaid |
$938.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,839.50
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,471.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 64624
|
| Min. Negotiated Rate |
$92.87 |
| Max. Negotiated Rate |
$1,520.45 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$141.88
|
| Rate for Payer: BCBS Complete |
$97.51
|
| Rate for Payer: BCBS MAPPO |
$141.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,520.45
|
| Rate for Payer: BCN Commercial |
$568.82
|
| Rate for Payer: BCN Medicare Advantage |
$141.88
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cofinity Commercial |
$204.31
|
| Rate for Payer: Cofinity Commercial |
$190.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.88
|
| Rate for Payer: Healthscope Commercial |
$170.26
|
| Rate for Payer: Healthscope Whirlpool |
$170.26
|
| Rate for Payer: Meridian Medicaid |
$97.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.97
|
| Rate for Payer: PACE SWMI |
$141.88
|
| Rate for Payer: PHP Medicare Advantage |
$141.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.04
|
| Rate for Payer: Priority Health Medicare |
$141.88
|
| Rate for Payer: Priority Health Narrow Network |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$146.14
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$92.87 |
| Max. Negotiated Rate |
$1,520.45 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$141.88
|
| Rate for Payer: BCBS Complete |
$97.51
|
| Rate for Payer: BCBS MAPPO |
$141.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,520.45
|
| Rate for Payer: BCN Commercial |
$568.82
|
| Rate for Payer: BCN Medicare Advantage |
$141.88
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cofinity Commercial |
$204.31
|
| Rate for Payer: Cofinity Commercial |
$190.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.88
|
| Rate for Payer: Healthscope Commercial |
$170.26
|
| Rate for Payer: Healthscope Whirlpool |
$170.26
|
| Rate for Payer: Meridian Medicaid |
$97.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.97
|
| Rate for Payer: PACE SWMI |
$141.88
|
| Rate for Payer: PHP Medicare Advantage |
$141.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.04
|
| Rate for Payer: Priority Health Medicare |
$141.88
|
| Rate for Payer: Priority Health Narrow Network |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$146.14
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna Commercial |
$700.20
|
| Rate for Payer: ASR ASR |
$754.66
|
| Rate for Payer: BCBS Trust/PPO |
$603.18
|
| Rate for Payer: BCN Commercial |
$603.18
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cofinity Commercial |
$731.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.40
|
| Rate for Payer: Healthscope Commercial |
$778.00
|
| Rate for Payer: Healthscope Whirlpool |
$754.66
|
| Rate for Payer: Mclaren Commercial |
$700.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$661.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.64
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 17004
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$213.50 |
| Rate for Payer: Aetna Commercial |
$128.84
|
| Rate for Payer: Aetna Medicare |
$96.15
|
| Rate for Payer: BCBS Complete |
$65.98
|
| Rate for Payer: BCBS MAPPO |
$96.15
|
| Rate for Payer: BCBS Trust/PPO |
$39.53
|
| Rate for Payer: BCN Commercial |
$199.08
|
| Rate for Payer: BCN Medicare Advantage |
$96.15
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$128.84
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.15
|
| Rate for Payer: Healthscope Commercial |
$115.38
|
| Rate for Payer: Healthscope Whirlpool |
$115.38
|
| Rate for Payer: Meridian Medicaid |
$65.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.96
|
| Rate for Payer: PACE SWMI |
$96.15
|
| Rate for Payer: PHP Medicare Advantage |
$96.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.26
|
| Rate for Payer: Priority Health Medicare |
$96.15
|
| Rate for Payer: Priority Health Narrow Network |
$121.26
|
| Rate for Payer: UHC Medicare Advantage |
$99.03
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 17000
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$534.35 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS MAPPO |
$52.50
|
| Rate for Payer: BCBS Trust/PPO |
$534.35
|
| Rate for Payer: BCN Commercial |
$78.92
|
| Rate for Payer: BCN Medicare Advantage |
$52.50
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$70.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.00
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.12
|
| Rate for Payer: PACE SWMI |
$52.50
|
| Rate for Payer: PHP Medicare Advantage |
$52.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.00
|
| Rate for Payer: Priority Health Medicare |
$52.50
|
| Rate for Payer: Priority Health Narrow Network |
$67.00
|
| Rate for Payer: UHC Medicare Advantage |
$54.08
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 17003
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2,756.25 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS MAPPO |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,756.25
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.97
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Healthscope Whirlpool |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$1.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.07
|
| Rate for Payer: PACE SWMI |
$1.97
|
| Rate for Payer: PHP Medicare Advantage |
$1.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.46
|
| Rate for Payer: Priority Health Medicare |
$1.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.46
|
| Rate for Payer: UHC Medicare Advantage |
$2.03
|
|
|
PR DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH
|
Professional
|
Both
|
$1,534.00
|
|
|
Service Code
|
HCPCS 45190
|
| Min. Negotiated Rate |
$446.66 |
| Max. Negotiated Rate |
$1,225.34 |
| Rate for Payer: Aetna Commercial |
$915.90
|
| Rate for Payer: Aetna Medicare |
$683.51
|
| Rate for Payer: BCBS Complete |
$468.99
|
| Rate for Payer: BCBS MAPPO |
$683.51
|
| Rate for Payer: BCBS Trust/PPO |
$706.34
|
| Rate for Payer: BCN Commercial |
$1,018.41
|
| Rate for Payer: BCN Medicare Advantage |
$683.51
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cofinity Commercial |
$984.25
|
| Rate for Payer: Cofinity Commercial |
$915.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.51
|
| Rate for Payer: Healthscope Commercial |
$820.21
|
| Rate for Payer: Healthscope Whirlpool |
$820.21
|
| Rate for Payer: Meridian Medicaid |
$468.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$717.69
|
| Rate for Payer: PACE SWMI |
$683.51
|
| Rate for Payer: PHP Medicare Advantage |
$683.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,225.34
|
| Rate for Payer: Priority Health Medicare |
$683.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,225.34
|
| Rate for Payer: UHC Medicare Advantage |
$704.02
|
|
|
PR DESTRUCTION VAGINAL LESIONS EXTENSIVE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 57065
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$2,603.46 |
| Rate for Payer: Aetna Commercial |
$245.64
|
| Rate for Payer: Aetna Medicare |
$183.31
|
| Rate for Payer: BCBS Complete |
$125.92
|
| Rate for Payer: BCBS MAPPO |
$183.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,603.46
|
| Rate for Payer: BCN Commercial |
$365.04
|
| Rate for Payer: BCN Medicare Advantage |
$183.31
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$245.64
|
| Rate for Payer: Cofinity Commercial |
$263.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.31
|
| Rate for Payer: Healthscope Commercial |
$219.97
|
| Rate for Payer: Healthscope Whirlpool |
$219.97
|
| Rate for Payer: Meridian Medicaid |
$125.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$192.48
|
| Rate for Payer: PACE SWMI |
$183.31
|
| Rate for Payer: PHP Medicare Advantage |
$183.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.12
|
| Rate for Payer: Priority Health Medicare |
$183.31
|
| Rate for Payer: Priority Health Narrow Network |
$265.12
|
| Rate for Payer: UHC Medicare Advantage |
$188.81
|
|
|
PR DESTRUCTION VAGINAL LESIONS SIMPLE
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 57061
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$2,929.42 |
| Rate for Payer: Aetna Commercial |
$150.86
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS MAPPO |
$112.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,929.42
|
| Rate for Payer: BCN Commercial |
$199.08
|
| Rate for Payer: BCN Medicare Advantage |
$112.58
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cofinity Commercial |
$162.12
|
| Rate for Payer: Cofinity Commercial |
$150.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.58
|
| Rate for Payer: Healthscope Commercial |
$135.10
|
| Rate for Payer: Healthscope Whirlpool |
$135.10
|
| Rate for Payer: Meridian Medicaid |
$78.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.21
|
| Rate for Payer: PACE SWMI |
$112.58
|
| Rate for Payer: PHP Medicare Advantage |
$112.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.76
|
| Rate for Payer: Priority Health Medicare |
$112.58
|
| Rate for Payer: Priority Health Narrow Network |
$164.76
|
| Rate for Payer: UHC Medicare Advantage |
$115.96
|
|
|
PR DETERMINATION REFRACTIVE STATE
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 92015
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$1,164.90 |
| Rate for Payer: Aetna Commercial |
$21.33
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.90
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Meridian Medicaid |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.08
|
| Rate for Payer: Priority Health Narrow Network |
$22.08
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 96110
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$974.19 |
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$974.19
|
| Rate for Payer: BCN Commercial |
$15.64
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Narrow Network |
$14.37
|
|
|
PR DEVELOPMENTAL TESTING W/INTERP & REPORT
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 96111
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$165.90 |
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
|
|
PR DEXAMETHASONE SODIUM PHOS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1100
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.12
|
| Rate for Payer: Healthscope Commercial |
$0.15
|
| Rate for Payer: Healthscope Whirlpool |
$0.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.13
|
| Rate for Payer: PACE SWMI |
$0.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$0.12
|
| Rate for Payer: UHC Medicare Advantage |
$0.13
|
|
