|
PR DESTRUCTION LESIONS VULVA EXTENSIVE
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 56515
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$2,047.16 |
| Rate for Payer: Aetna Commercial |
$249.32
|
| Rate for Payer: Aetna Medicare |
$290.00
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,047.16
|
| Rate for Payer: BCN Commercial |
$409.52
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.96
|
| Rate for Payer: Priority Health Narrow Network |
$318.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.28
|
| Rate for Payer: UHC Exchange |
$224.28
|
| Rate for Payer: UHCCP Medicaid |
$136.75
|
|
|
PR DESTRUCTION LESIONS VULVA SIMPLE
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 56501
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$1,962.11 |
| Rate for Payer: Aetna Commercial |
$152.26
|
| Rate for Payer: Aetna Medicare |
$192.00
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,962.11
|
| Rate for Payer: BCN Commercial |
$229.32
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Meridian Medicaid |
$90.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.89
|
| Rate for Payer: Priority Health Narrow Network |
$200.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.40
|
| Rate for Payer: UHC Exchange |
$128.40
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
|
|
PR DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 17280
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$92.27
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$164.92
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Meridian Medicaid |
$59.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.85
|
| Rate for Payer: Priority Health Narrow Network |
$117.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.78
|
| Rate for Payer: UHC Exchange |
$95.78
|
| Rate for Payer: UHCCP Medicaid |
$56.45
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 17270
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$101.20
|
| Rate for Payer: Aetna Medicare |
$125.00
|
| Rate for Payer: BCBS Complete |
$65.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$176.70
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Meridian Medicaid |
$65.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.59
|
| Rate for Payer: Priority Health Narrow Network |
$129.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.47
|
| Rate for Payer: UHC Exchange |
$105.47
|
| Rate for Payer: UHCCP Medicaid |
$62.20
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 17271
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$5,054.50 |
| Rate for Payer: Aetna Commercial |
$111.95
|
| Rate for Payer: Aetna Medicare |
$135.50
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$5,054.50
|
| Rate for Payer: BCN Commercial |
$196.33
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.23
|
| Rate for Payer: Priority Health Narrow Network |
$142.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.32
|
| Rate for Payer: UHC Exchange |
$118.32
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 17272
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$29,358.48 |
| Rate for Payer: Aetna Commercial |
$129.04
|
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: BCBS Complete |
$81.86
|
| Rate for Payer: BCBS Trust/PPO |
$29,358.48
|
| Rate for Payer: BCN Commercial |
$222.25
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Meridian Medicaid |
$81.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.90
|
| Rate for Payer: Priority Health Narrow Network |
$163.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.80
|
| Rate for Payer: UHC Exchange |
$136.80
|
| Rate for Payer: UHCCP Medicaid |
$77.96
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 17273
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$146.89
|
| Rate for Payer: Aetna Medicare |
$172.00
|
| Rate for Payer: BCBS Complete |
$92.59
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Meridian Medicaid |
$92.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.12
|
| Rate for Payer: Priority Health Narrow Network |
$185.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.54
|
| Rate for Payer: UHC Exchange |
$154.54
|
| Rate for Payer: UHCCP Medicaid |
$88.18
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 17274
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$6,178.65 |
| Rate for Payer: Aetna Commercial |
$179.26
|
| Rate for Payer: Aetna Medicare |
$217.00
|
| Rate for Payer: BCBS Complete |
$113.39
|
| Rate for Payer: BCBS Trust/PPO |
$6,178.65
|
| Rate for Payer: BCN Commercial |
$288.21
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Meridian Medicaid |
$113.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.76
|
| Rate for Payer: Priority Health Narrow Network |
$225.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.56
|
| Rate for Payer: UHC Exchange |
$189.56
|
| Rate for Payer: UHCCP Medicaid |
$107.99
|
|
|
PR DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 17260
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$947.65 |
| Rate for Payer: Aetna Commercial |
$74.85
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$947.65
|
| Rate for Payer: BCN Commercial |
$117.80
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.72
|
| Rate for Payer: Priority Health Narrow Network |
$95.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.76
|
| Rate for Payer: UHC Exchange |
$71.76
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 17281
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$125.70
|
| Rate for Payer: Aetna Medicare |
$147.50
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$212.04
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.84
|
| Rate for Payer: Priority Health Narrow Network |
$159.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.20
|
| Rate for Payer: UHC Exchange |
$133.20
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 17282
|
| Min. Negotiated Rate |
$87.76 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$146.15
|
| Rate for Payer: Aetna Medicare |
$169.00
|
| Rate for Payer: BCBS Complete |
$92.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$242.28
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Meridian Medicaid |
$92.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.21
|
| Rate for Payer: Priority Health Narrow Network |
$184.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.53
|
| Rate for Payer: UHC Exchange |
$154.53
|
| Rate for Payer: UHCCP Medicaid |
$87.76
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 17283
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$182.60
|
| Rate for Payer: Aetna Medicare |
$202.00
|
| Rate for Payer: BCBS Complete |
$114.95
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$285.86
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Meridian Medicaid |
$114.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.28
|
| Rate for Payer: Priority Health Narrow Network |
$230.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.20
|
| Rate for Payer: UHC Exchange |
$193.20
|
| Rate for Payer: UHCCP Medicaid |
$109.48
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 17284
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$325.13 |
| Rate for Payer: Aetna Commercial |
$213.50
|
| Rate for Payer: Aetna Medicare |
$214.50
|
| Rate for Payer: BCBS Complete |
$134.19
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$325.13
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Meridian Medicaid |
$134.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.74
|
| Rate for Payer: Priority Health Narrow Network |
$267.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.83
|
| Rate for Payer: UHC Exchange |
$229.83
|
| Rate for Payer: UHCCP Medicaid |
$127.80
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 17286
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$1,823.25 |
| Rate for Payer: Aetna Commercial |
$290.59
|
| Rate for Payer: Aetna Medicare |
$1,402.50
|
| Rate for Payer: BCBS Complete |
$183.17
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$415.44
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Meridian Medicaid |
$183.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.47
|
| Rate for Payer: Priority Health Narrow Network |
$363.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.36
|
| Rate for Payer: UHC Exchange |
$309.36
|
| Rate for Payer: UHCCP Medicaid |
$174.45
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 17261
|
| Min. Negotiated Rate |
$56.66 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$92.62
|
| Rate for Payer: Aetna Medicare |
$135.00
|
| Rate for Payer: BCBS Complete |
$59.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.00
|
| Rate for Payer: BCN Commercial |
$174.34
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Meridian Medicaid |
$59.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.29
|
| Rate for Payer: Priority Health Narrow Network |
$118.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.94
|
| Rate for Payer: UHC Exchange |
$96.94
|
| Rate for Payer: UHCCP Medicaid |
$56.66
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 17262
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$4,106.85 |
| Rate for Payer: Aetna Commercial |
$117.15
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS Trust/PPO |
$4,106.85
|
| Rate for Payer: BCN Commercial |
$210.47
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Meridian Medicaid |
$74.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.45
|
| Rate for Payer: Priority Health Narrow Network |
$149.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.92
|
| Rate for Payer: UHC Exchange |
$123.92
|
| Rate for Payer: UHCCP Medicaid |
$71.14
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 17263
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$29,358.48 |
| Rate for Payer: Aetna Commercial |
$130.16
|
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$82.53
|
| Rate for Payer: BCBS Trust/PPO |
$29,358.48
|
| Rate for Payer: BCN Commercial |
$227.36
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Meridian Medicaid |
$82.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.25
|
| Rate for Payer: Priority Health Narrow Network |
$165.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.21
|
| Rate for Payer: UHC Exchange |
$137.21
|
| Rate for Payer: UHCCP Medicaid |
$78.60
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 17264
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$139.47
|
| Rate for Payer: Aetna Medicare |
$170.00
|
| Rate for Payer: BCBS Complete |
$88.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,400.00
|
| Rate for Payer: BCN Commercial |
$243.45
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Meridian Medicaid |
$88.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.54
|
| Rate for Payer: Priority Health Narrow Network |
$176.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.91
|
| Rate for Payer: UHC Exchange |
$146.91
|
| Rate for Payer: UHCCP Medicaid |
$84.35
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$1,520.45 |
| Rate for Payer: Aetna Commercial |
$188.14
|
| Rate for Payer: Aetna Medicare |
$397.00
|
| Rate for Payer: BCBS Complete |
$98.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,520.45
|
| Rate for Payer: BCN Commercial |
$568.82
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Meridian Medicaid |
$98.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.95
|
| Rate for Payer: Priority Health Narrow Network |
$247.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.54
|
| Rate for Payer: UHC Exchange |
$185.54
|
| Rate for Payer: UHCCP Medicaid |
$93.93
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$516.10 |
| Max. Negotiated Rate |
$2,965.58 |
| Rate for Payer: Aetna Commercial |
$714.60
|
| Rate for Payer: Aetna Medicare |
$1,913.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: ASR ASR |
$770.18
|
| Rate for Payer: ASR Commercial |
$770.18
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$650.21
|
| Rate for Payer: BCN Commercial |
$615.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$746.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$794.00
|
| Rate for Payer: Healthscope Whirlpool |
$770.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,913.28
|
| Rate for Payer: Mclaren Commercial |
$714.60
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.90
|
| Rate for Payer: Nomi Health Commercial |
$651.08
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$2,104.61
|
| Rate for Payer: PHP Medicaid |
$1,025.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.27
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,574.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$2,965.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP DNSP |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 64624
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$1,520.45 |
| Rate for Payer: Aetna Commercial |
$188.14
|
| Rate for Payer: Aetna Medicare |
$397.00
|
| Rate for Payer: BCBS Complete |
$98.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,520.45
|
| Rate for Payer: BCN Commercial |
$568.82
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Meridian Medicaid |
$98.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.95
|
| Rate for Payer: Priority Health Narrow Network |
$247.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.54
|
| Rate for Payer: UHC Exchange |
$185.54
|
| Rate for Payer: UHCCP Medicaid |
$93.93
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$516.10 |
| Max. Negotiated Rate |
$794.00 |
| Rate for Payer: Aetna Commercial |
$714.60
|
| Rate for Payer: ASR ASR |
$770.18
|
| Rate for Payer: ASR Commercial |
$770.18
|
| Rate for Payer: BCBS Trust/PPO |
$647.03
|
| Rate for Payer: BCN Commercial |
$615.59
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$746.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.20
|
| Rate for Payer: Healthscope Commercial |
$794.00
|
| Rate for Payer: Healthscope Whirlpool |
$770.18
|
| Rate for Payer: Mclaren Commercial |
$714.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.90
|
| Rate for Payer: Nomi Health Commercial |
$651.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.72
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 17004
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$202.15 |
| Rate for Payer: Aetna Commercial |
$104.32
|
| Rate for Payer: Aetna Medicare |
$155.50
|
| Rate for Payer: BCBS Complete |
$66.64
|
| Rate for Payer: BCBS Trust/PPO |
$39.53
|
| Rate for Payer: BCN Commercial |
$199.08
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Meridian Medicaid |
$66.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.20
|
| Rate for Payer: Priority Health Narrow Network |
$133.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.35
|
| Rate for Payer: UHC Exchange |
$142.35
|
| Rate for Payer: UHCCP Medicaid |
$63.47
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 17000
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$534.35 |
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: Aetna Medicare |
$67.50
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$534.35
|
| Rate for Payer: BCN Commercial |
$78.92
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.96
|
| Rate for Payer: Priority Health Narrow Network |
$74.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.49
|
| Rate for Payer: UHC Exchange |
$57.49
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 17003
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2,756.25 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,756.25
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Meridian Medicaid |
$1.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.71
|
| Rate for Payer: Priority Health Narrow Network |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.84
|
| Rate for Payer: UHC Exchange |
$4.84
|
| Rate for Payer: UHCCP Medicaid |
$1.28
|
|
