|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$154.21
|
| Rate for Payer: Aetna Medicare |
$115.08
|
| Rate for Payer: BCBS Complete |
$79.62
|
| Rate for Payer: BCBS MAPPO |
$115.08
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$360.16
|
| Rate for Payer: BCN Medicare Advantage |
$115.08
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$154.21
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.08
|
| Rate for Payer: Healthscope Commercial |
$138.10
|
| Rate for Payer: Healthscope Whirlpool |
$138.10
|
| Rate for Payer: Meridian Medicaid |
$79.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.83
|
| Rate for Payer: PACE SWMI |
$115.08
|
| Rate for Payer: PHP Medicare Advantage |
$115.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.19
|
| Rate for Payer: Priority Health Medicare |
$115.08
|
| Rate for Payer: Priority Health Narrow Network |
$198.19
|
| Rate for Payer: UHC Medicare Advantage |
$118.53
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$1,009.58 |
| Rate for Payer: Aetna Commercial |
$210.89
|
| Rate for Payer: Aetna Medicare |
$157.38
|
| Rate for Payer: BCBS Complete |
$107.13
|
| Rate for Payer: BCBS MAPPO |
$157.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$157.38
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$210.89
|
| Rate for Payer: Cofinity Commercial |
$226.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.38
|
| Rate for Payer: Healthscope Commercial |
$188.86
|
| Rate for Payer: Healthscope Whirlpool |
$188.86
|
| Rate for Payer: Meridian Medicaid |
$107.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.25
|
| Rate for Payer: PACE SWMI |
$157.38
|
| Rate for Payer: PHP Medicare Advantage |
$157.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.22
|
| Rate for Payer: Priority Health Medicare |
$157.38
|
| Rate for Payer: Priority Health Narrow Network |
$271.22
|
| Rate for Payer: UHC Medicare Advantage |
$162.10
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$138.88 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$290.74
|
| Rate for Payer: Aetna Medicare |
$216.97
|
| Rate for Payer: BCBS Complete |
$145.82
|
| Rate for Payer: BCBS MAPPO |
$216.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: BCN Medicare Advantage |
$216.97
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$312.44
|
| Rate for Payer: Cofinity Commercial |
$290.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.97
|
| Rate for Payer: Healthscope Commercial |
$260.36
|
| Rate for Payer: Healthscope Whirlpool |
$260.36
|
| Rate for Payer: Meridian Medicaid |
$145.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.82
|
| Rate for Payer: PACE SWMI |
$216.97
|
| Rate for Payer: PHP Medicare Advantage |
$216.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.15
|
| Rate for Payer: Priority Health Medicare |
$216.97
|
| Rate for Payer: Priority Health Narrow Network |
$373.15
|
| Rate for Payer: UHC Medicare Advantage |
$223.48
|
|
|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$881.00
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$3,486.25 |
| Rate for Payer: Aetna Commercial |
$305.35
|
| Rate for Payer: Aetna Medicare |
$227.87
|
| Rate for Payer: BCBS Complete |
$159.92
|
| Rate for Payer: BCBS MAPPO |
$227.87
|
| Rate for Payer: BCBS Trust/PPO |
$3,486.25
|
| Rate for Payer: BCN Commercial |
$682.69
|
| Rate for Payer: BCN Medicare Advantage |
$227.87
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cofinity Commercial |
$305.35
|
| Rate for Payer: Cofinity Commercial |
$328.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.87
|
| Rate for Payer: Healthscope Commercial |
$273.44
|
| Rate for Payer: Healthscope Whirlpool |
$273.44
|
| Rate for Payer: Meridian Medicaid |
$159.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$239.26
|
| Rate for Payer: PACE SWMI |
$227.87
|
| Rate for Payer: PHP Medicare Advantage |
$227.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.26
|
| Rate for Payer: Priority Health Medicare |
$227.87
|
| Rate for Payer: Priority Health Narrow Network |
$391.26
|
| Rate for Payer: UHC Medicare Advantage |
$234.71
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$87.73
|
| Rate for Payer: Aetna Medicare |
$65.47
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS MAPPO |
$65.47
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: BCN Medicare Advantage |
$65.47
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$94.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.47
|
| Rate for Payer: Healthscope Commercial |
$78.56
|
| Rate for Payer: Healthscope Whirlpool |
$78.56
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.74
|
| Rate for Payer: PACE SWMI |
$65.47
|
| Rate for Payer: PHP Medicare Advantage |
$65.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.55
|
| Rate for Payer: Priority Health Medicare |
$65.47
|
| Rate for Payer: Priority Health Narrow Network |
$111.55
|
| Rate for Payer: UHC Medicare Advantage |
$67.43
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$654.04 |
| Rate for Payer: Aetna Commercial |
$77.49
|
| Rate for Payer: Aetna Medicare |
$57.83
|
| Rate for Payer: BCBS Complete |
$38.91
|
| Rate for Payer: BCBS MAPPO |
$57.83
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$57.83
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$83.28
|
| Rate for Payer: Cofinity Commercial |
$77.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.83
|
| Rate for Payer: Healthscope Commercial |
$69.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.40
|
| Rate for Payer: Meridian Medicaid |
$38.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.72
|
| Rate for Payer: PACE SWMI |
$57.83
|
| Rate for Payer: PHP Medicare Advantage |
$57.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.52
|
| Rate for Payer: Priority Health Medicare |
$57.83
|
| Rate for Payer: Priority Health Narrow Network |
$98.52
|
| Rate for Payer: UHC Medicare Advantage |
$59.56
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$249.39
|
| Rate for Payer: Aetna Medicare |
$186.11
|
| Rate for Payer: BCBS Complete |
$128.37
|
| Rate for Payer: BCBS MAPPO |
$186.11
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$186.11
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$249.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.11
|
| Rate for Payer: Healthscope Commercial |
$223.33
|
| Rate for Payer: Healthscope Whirlpool |
$223.33
|
| Rate for Payer: Meridian Medicaid |
$128.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.42
|
| Rate for Payer: PACE SWMI |
$186.11
|
| Rate for Payer: PHP Medicare Advantage |
$186.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.91
|
| Rate for Payer: Priority Health Medicare |
$186.11
|
| Rate for Payer: Priority Health Narrow Network |
$319.91
|
| Rate for Payer: UHC Medicare Advantage |
$191.69
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$427.00 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: ASR ASR |
$591.70
|
| Rate for Payer: BCBS Trust/PPO |
$472.93
|
| Rate for Payer: BCN Commercial |
$472.93
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$573.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.00
|
| Rate for Payer: Healthscope Commercial |
$610.00
|
| Rate for Payer: Healthscope Whirlpool |
$591.70
|
| Rate for Payer: Mclaren Commercial |
$549.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$518.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$536.80
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$427.00 |
| Max. Negotiated Rate |
$2,145.29 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| 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 |
$591.70
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$472.93
|
| Rate for Payer: BCN Commercial |
$472.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$573.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$610.00
|
| Rate for Payer: Healthscope Whirlpool |
$591.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,716.23
|
| Rate for Payer: Mclaren Commercial |
$549.00
|
| 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 |
$518.50
|
| 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 |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.10
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$433.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$536.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$249.39
|
| Rate for Payer: Aetna Medicare |
$186.11
|
| Rate for Payer: BCBS Complete |
$128.37
|
| Rate for Payer: BCBS MAPPO |
$186.11
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$186.11
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$249.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.11
|
| Rate for Payer: Healthscope Commercial |
$223.33
|
| Rate for Payer: Healthscope Whirlpool |
$223.33
|
| Rate for Payer: Meridian Medicaid |
$128.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.42
|
| Rate for Payer: PACE SWMI |
$186.11
|
| Rate for Payer: PHP Medicare Advantage |
$186.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.91
|
| Rate for Payer: Priority Health Medicare |
$186.11
|
| Rate for Payer: Priority Health Narrow Network |
$319.91
|
| Rate for Payer: UHC Medicare Advantage |
$191.69
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$422.10 |
| Max. Negotiated Rate |
$2,145.29 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| 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 |
$584.91
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$467.51
|
| Rate for Payer: BCN Commercial |
$467.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$566.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$603.00
|
| Rate for Payer: Healthscope Whirlpool |
$584.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,716.23
|
| Rate for Payer: Mclaren Commercial |
$542.70
|
| 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 |
$512.55
|
| 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 |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.73
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$428.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$530.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$422.10 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: ASR ASR |
$584.91
|
| Rate for Payer: BCBS Trust/PPO |
$467.51
|
| Rate for Payer: BCN Commercial |
$467.51
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$566.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.40
|
| Rate for Payer: Healthscope Commercial |
$603.00
|
| Rate for Payer: Healthscope Whirlpool |
$584.91
|
| Rate for Payer: Mclaren Commercial |
$542.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$512.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$530.64
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 64635
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$249.80
|
| Rate for Payer: Aetna Medicare |
$186.42
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$186.42
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.42
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$268.44
|
| Rate for Payer: Cofinity Commercial |
$249.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.42
|
| Rate for Payer: Healthscope Commercial |
$223.70
|
| Rate for Payer: Healthscope Whirlpool |
$223.70
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.74
|
| Rate for Payer: PACE SWMI |
$186.42
|
| Rate for Payer: PHP Medicare Advantage |
$186.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$186.42
|
| Rate for Payer: Priority Health Narrow Network |
$320.48
|
| Rate for Payer: UHC Medicare Advantage |
$192.01
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$249.80
|
| Rate for Payer: Aetna Medicare |
$186.42
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$186.42
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.42
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$249.80
|
| Rate for Payer: Cofinity Commercial |
$268.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.42
|
| Rate for Payer: Healthscope Commercial |
$223.70
|
| Rate for Payer: Healthscope Whirlpool |
$223.70
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.74
|
| Rate for Payer: PACE SWMI |
$186.42
|
| Rate for Payer: PHP Medicare Advantage |
$186.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$186.42
|
| Rate for Payer: Priority Health Narrow Network |
$320.48
|
| Rate for Payer: UHC Medicare Advantage |
$192.01
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$95.50 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.92
|
| Rate for Payer: BCN Commercial |
$88.25
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
|
|
PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 90697
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$175.01 |
| Rate for Payer: Aetna Commercial |
$154.01
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$175.01
|
| Rate for Payer: BCN Commercial |
$175.01
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
|
|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 90698
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$118.20 |
| Rate for Payer: Aetna Commercial |
$118.20
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCBS Trust/PPO |
$109.23
|
| Rate for Payer: BCN Commercial |
$109.23
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
|
|
PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 90696
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$62.89 |
| Rate for Payer: Aetna Commercial |
$62.89
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS Trust/PPO |
$59.91
|
| Rate for Payer: BCN Commercial |
$59.91
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
|
|
PR DTP/HIB VACCINE,IM
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 90720
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
|
|
PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 90702
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.01 |
| Rate for Payer: Aetna Commercial |
$67.16
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$79.01
|
| Rate for Payer: BCN Commercial |
$79.01
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
|
|
PR DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 43756
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$409.52 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$194.41
|
| Rate for Payer: BCN Commercial |
$409.52
|
| Rate for Payer: BCN Medicare Advantage |
$49.50
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$71.28
|
| Rate for Payer: Cofinity Commercial |
$66.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Healthscope Whirlpool |
$59.40
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.98
|
| Rate for Payer: PACE SWMI |
$49.50
|
| Rate for Payer: PHP Medicare Advantage |
$49.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.78
|
| Rate for Payer: Priority Health Medicare |
$49.50
|
| Rate for Payer: Priority Health Narrow Network |
$88.78
|
| Rate for Payer: UHC Medicare Advantage |
$50.98
|
|
|
PR DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,878.00
|
|
|
Service Code
|
HCPCS 44010
|
| Min. Negotiated Rate |
$542.30 |
| Max. Negotiated Rate |
$2,014.60 |
| Rate for Payer: Aetna Commercial |
$1,124.69
|
| Rate for Payer: Aetna Medicare |
$839.32
|
| Rate for Payer: BCBS Complete |
$569.42
|
| Rate for Payer: BCBS MAPPO |
$839.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,969.50
|
| Rate for Payer: BCN Commercial |
$1,237.34
|
| Rate for Payer: BCN Medicare Advantage |
$839.32
|
| Rate for Payer: Cash Price |
$2,302.40
|
| Rate for Payer: Cash Price |
$2,302.40
|
| Rate for Payer: Cofinity Commercial |
$1,124.69
|
| Rate for Payer: Cofinity Commercial |
$1,208.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$839.32
|
| Rate for Payer: Healthscope Commercial |
$1,007.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,007.18
|
| Rate for Payer: Meridian Medicaid |
$569.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$881.29
|
| Rate for Payer: PACE SWMI |
$839.32
|
| Rate for Payer: PHP Medicare Advantage |
$839.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,014.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,488.74
|
| Rate for Payer: Priority Health Medicare |
$839.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,488.74
|
| Rate for Payer: UHC Medicare Advantage |
$864.50
|
|
|
PR DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ
|
Professional
|
Both
|
$6,158.00
|
|
|
Service Code
|
HCPCS 48547
|
| Min. Negotiated Rate |
$749.66 |
| Max. Negotiated Rate |
$4,310.60 |
| Rate for Payer: Aetna Commercial |
$2,391.38
|
| Rate for Payer: Aetna Medicare |
$1,784.61
|
| Rate for Payer: BCBS Complete |
$1,200.11
|
| Rate for Payer: BCBS MAPPO |
$1,784.61
|
| Rate for Payer: BCBS Trust/PPO |
$749.66
|
| Rate for Payer: BCN Commercial |
$2,612.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.61
|
| Rate for Payer: Cash Price |
$4,926.40
|
| Rate for Payer: Cash Price |
$4,926.40
|
| Rate for Payer: Cofinity Commercial |
$2,391.38
|
| Rate for Payer: Cofinity Commercial |
$2,569.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.61
|
| Rate for Payer: Healthscope Commercial |
$2,141.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,141.53
|
| Rate for Payer: Meridian Medicaid |
$1,200.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,873.84
|
| Rate for Payer: PACE SWMI |
$1,784.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,142.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,310.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,143.30
|
| Rate for Payer: Priority Health Medicare |
$1,784.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,143.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,838.15
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 93985
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$363.58 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Medicare |
$232.99
|
| Rate for Payer: BCBS Complete |
$30.40
|
| Rate for Payer: BCBS MAPPO |
$232.99
|
| Rate for Payer: BCBS Trust/PPO |
$243.55
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: BCN Medicare Advantage |
$232.99
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$335.51
|
| Rate for Payer: Cofinity Commercial |
$312.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.99
|
| Rate for Payer: Healthscope Commercial |
$279.59
|
| Rate for Payer: Healthscope Whirlpool |
$279.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$244.64
|
| Rate for Payer: PACE SWMI |
$232.99
|
| Rate for Payer: PHP Medicare Advantage |
$232.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.16
|
| Rate for Payer: Priority Health Medicare |
$232.99
|
| Rate for Payer: Priority Health Narrow Network |
$334.16
|
| Rate for Payer: UHC Medicare Advantage |
$239.98
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 93986
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$216.49 |
| Rate for Payer: Aetna Commercial |
$185.95
|
| Rate for Payer: Aetna Medicare |
$138.77
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$138.77
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: BCN Commercial |
$216.49
|
| Rate for Payer: BCN Medicare Advantage |
$138.77
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$199.83
|
| Rate for Payer: Cofinity Commercial |
$185.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.77
|
| Rate for Payer: Healthscope Commercial |
$166.52
|
| Rate for Payer: Healthscope Whirlpool |
$166.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.71
|
| Rate for Payer: PACE SWMI |
$138.77
|
| Rate for Payer: PHP Medicare Advantage |
$138.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.97
|
| Rate for Payer: Priority Health Medicare |
$138.77
|
| Rate for Payer: Priority Health Narrow Network |
$198.97
|
| Rate for Payer: UHC Medicare Advantage |
$142.93
|
|
