|
PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 54056
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$1,380.45 |
| Rate for Payer: Aetna Commercial |
$137.02
|
| Rate for Payer: Aetna Medicare |
$135.00
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.45
|
| Rate for Payer: BCN Commercial |
$169.24
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Meridian Medicaid |
$76.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.02
|
| Rate for Payer: Priority Health Narrow Network |
$180.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.05
|
| Rate for Payer: UHC Exchange |
$121.05
|
| Rate for Payer: UHCCP Medicaid |
$73.27
|
|
|
PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 54055
|
| Min. Negotiated Rate |
$62.84 |
| Max. Negotiated Rate |
$1,009.58 |
| Rate for Payer: Aetna Commercial |
$119.53
|
| Rate for Payer: Aetna Medicare |
$105.50
|
| Rate for Payer: BCBS Complete |
$65.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: BCN Commercial |
$201.34
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Meridian Medicaid |
$65.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.45
|
| Rate for Payer: Priority Health Narrow Network |
$154.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.91
|
| Rate for Payer: UHC Exchange |
$104.91
|
| Rate for Payer: UHCCP Medicaid |
$62.84
|
|
|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$2,378.41 |
| Rate for Payer: Aetna Commercial |
$121.38
|
| Rate for Payer: Aetna Medicare |
$124.50
|
| Rate for Payer: BCBS Complete |
$65.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.41
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Meridian Medicaid |
$65.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.65
|
| Rate for Payer: Priority Health Narrow Network |
$157.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.01
|
| Rate for Payer: UHC Exchange |
$109.01
|
| Rate for Payer: UHCCP Medicaid |
$62.41
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$1,575.39 |
| Rate for Payer: Aetna Commercial |
$165.73
|
| Rate for Payer: Aetna Medicare |
$183.50
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.39
|
| Rate for Payer: BCN Commercial |
$284.41
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Meridian Medicaid |
$89.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.44
|
| Rate for Payer: Priority Health Narrow Network |
$211.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.90
|
| Rate for Payer: UHC Exchange |
$152.90
|
| Rate for Payer: UHCCP Medicaid |
$85.41
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$963.62 |
| Rate for Payer: Aetna Commercial |
$221.49
|
| Rate for Payer: Aetna Medicare |
$234.50
|
| Rate for Payer: BCBS Complete |
$111.15
|
| Rate for Payer: BCBS Trust/PPO |
$963.62
|
| Rate for Payer: BCN Commercial |
$380.68
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Meridian Medicaid |
$111.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.89
|
| Rate for Payer: Priority Health Narrow Network |
$298.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.61
|
| Rate for Payer: UHC Exchange |
$198.61
|
| Rate for Payer: UHCCP Medicaid |
$105.86
|
|
|
PR DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 17276
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$216.11
|
| Rate for Payer: Aetna Medicare |
$284.00
|
| Rate for Payer: BCBS Complete |
$136.21
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$334.54
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Meridian Medicaid |
$136.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.26
|
| Rate for Payer: Priority Health Narrow Network |
$272.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.96
|
| Rate for Payer: UHC Exchange |
$227.96
|
| Rate for Payer: UHCCP Medicaid |
$129.72
|
|
|
PR DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR
|
Professional
|
Both
|
$1,212.00
|
|
|
Service Code
|
HCPCS 64610
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$1,151.81 |
| Rate for Payer: Aetna Commercial |
$624.37
|
| Rate for Payer: Aetna Medicare |
$606.00
|
| Rate for Payer: BCBS Complete |
$326.31
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: BCN Commercial |
$1,151.81
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Meridian Medicaid |
$326.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.35
|
| Rate for Payer: Priority Health Narrow Network |
$826.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$566.27
|
| Rate for Payer: UHC Exchange |
$566.27
|
| Rate for Payer: UHCCP Medicaid |
$310.77
|
|
|
PR DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 64620
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$1,271.09 |
| Rate for Payer: Aetna Commercial |
$225.82
|
| Rate for Payer: Aetna Medicare |
$386.00
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$304.45
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Meridian Medicaid |
$120.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.56
|
| Rate for Payer: Priority Health Narrow Network |
$302.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.68
|
| Rate for Payer: UHC Exchange |
$196.68
|
| Rate for Payer: UHCCP Medicaid |
$114.59
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$395.20 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$547.20
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$589.76
|
| Rate for Payer: ASR Commercial |
$589.76
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$497.89
|
| Rate for Payer: BCN Commercial |
$471.38
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$571.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$608.00
|
| Rate for Payer: Healthscope Whirlpool |
$589.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$547.20
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.80
|
| Rate for Payer: Nomi Health Commercial |
$498.56
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$532.73
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$426.21
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$535.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$151.56
|
| Rate for Payer: Aetna Medicare |
$304.00
|
| Rate for Payer: BCBS Complete |
$80.97
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$360.16
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Meridian Medicaid |
$80.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.46
|
| Rate for Payer: Priority Health Narrow Network |
$202.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.37
|
| Rate for Payer: UHC Exchange |
$199.37
|
| Rate for Payer: UHCCP Medicaid |
$77.11
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 64640
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$151.56
|
| Rate for Payer: Aetna Medicare |
$304.00
|
| Rate for Payer: BCBS Complete |
$80.97
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$360.16
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Meridian Medicaid |
$80.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.46
|
| Rate for Payer: Priority Health Narrow Network |
$202.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.37
|
| Rate for Payer: UHC Exchange |
$199.37
|
| Rate for Payer: UHCCP Medicaid |
$77.11
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$395.20 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna Commercial |
$547.20
|
| Rate for Payer: ASR ASR |
$589.76
|
| Rate for Payer: ASR Commercial |
$589.76
|
| Rate for Payer: BCBS Trust/PPO |
$495.46
|
| Rate for Payer: BCN Commercial |
$471.38
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$571.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.40
|
| Rate for Payer: Healthscope Commercial |
$608.00
|
| Rate for Payer: Healthscope Whirlpool |
$589.76
|
| Rate for Payer: Mclaren Commercial |
$547.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.80
|
| Rate for Payer: Nomi Health Commercial |
$498.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$535.04
|
|
|
PR DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 64632
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$130.96 |
| Rate for Payer: Aetna Commercial |
$85.44
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCN Commercial |
$130.96
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.32
|
| Rate for Payer: Priority Health Narrow Network |
$114.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.87
|
| Rate for Payer: UHC Exchange |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$43.45
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$1,009.58 |
| Rate for Payer: Aetna Commercial |
$206.19
|
| Rate for Payer: Aetna Medicare |
$343.00
|
| Rate for Payer: BCBS Complete |
$108.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Meridian Medicaid |
$108.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.42
|
| Rate for Payer: Priority Health Narrow Network |
$272.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.55
|
| Rate for Payer: UHC Exchange |
$189.55
|
| Rate for Payer: UHCCP Medicaid |
$103.31
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$288.28
|
| Rate for Payer: Aetna Medicare |
$456.50
|
| Rate for Payer: BCBS Complete |
$148.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Meridian Medicaid |
$148.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.79
|
| Rate for Payer: Priority Health Narrow Network |
$370.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.94
|
| Rate for Payer: UHC Exchange |
$239.94
|
| Rate for Payer: UHCCP Medicaid |
$141.65
|
|
|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$3,486.25 |
| Rate for Payer: Aetna Commercial |
$292.11
|
| Rate for Payer: Aetna Medicare |
$449.50
|
| Rate for Payer: BCBS Complete |
$163.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,486.25
|
| Rate for Payer: BCN Commercial |
$682.69
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Meridian Medicaid |
$163.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.64
|
| Rate for Payer: Priority Health Narrow Network |
$406.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.14
|
| Rate for Payer: UHC Exchange |
$253.14
|
| Rate for Payer: UHCCP Medicaid |
$155.28
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Meridian Medicaid |
$44.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.17
|
| Rate for Payer: Priority Health Narrow Network |
$113.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.92
|
| Rate for Payer: UHC Exchange |
$90.92
|
| Rate for Payer: UHCCP Medicaid |
$42.60
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$654.04 |
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: Aetna Medicare |
$168.00
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.96
|
| Rate for Payer: Priority Health Narrow Network |
$98.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.06
|
| Rate for Payer: UHC Exchange |
$79.06
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$2,965.58 |
| Rate for Payer: Aetna Commercial |
$559.80
|
| 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 |
$603.34
|
| Rate for Payer: ASR Commercial |
$603.34
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$509.36
|
| Rate for Payer: BCN Commercial |
$482.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$584.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$622.00
|
| Rate for Payer: Healthscope Whirlpool |
$603.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,913.28
|
| Rate for Payer: Mclaren Commercial |
$559.80
|
| 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 |
$528.70
|
| Rate for Payer: Nomi Health Commercial |
$510.04
|
| 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 |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.00
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$436.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.36
|
| 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 DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$287.73
|
| Rate for Payer: Aetna Medicare |
$311.00
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.44
|
| Rate for Payer: Priority Health Narrow Network |
$326.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.78
|
| Rate for Payer: UHC Exchange |
$302.78
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$622.00 |
| Rate for Payer: Aetna Commercial |
$559.80
|
| Rate for Payer: ASR ASR |
$603.34
|
| Rate for Payer: ASR Commercial |
$603.34
|
| Rate for Payer: BCBS Trust/PPO |
$506.87
|
| Rate for Payer: BCN Commercial |
$482.24
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$584.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Healthscope Commercial |
$622.00
|
| Rate for Payer: Healthscope Whirlpool |
$603.34
|
| Rate for Payer: Mclaren Commercial |
$559.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.70
|
| Rate for Payer: Nomi Health Commercial |
$510.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.36
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$287.73
|
| Rate for Payer: Aetna Medicare |
$311.00
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.44
|
| Rate for Payer: Priority Health Narrow Network |
$326.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.78
|
| Rate for Payer: UHC Exchange |
$302.78
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,965.58 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| 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 |
$596.55
|
| Rate for Payer: ASR Commercial |
$596.55
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$503.62
|
| Rate for Payer: BCN Commercial |
$476.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$578.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$615.00
|
| Rate for Payer: Healthscope Whirlpool |
$596.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,913.28
|
| Rate for Payer: Mclaren Commercial |
$553.50
|
| 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 |
$522.75
|
| Rate for Payer: Nomi Health Commercial |
$504.30
|
| 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 |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.86
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$431.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.20
|
| 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 DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: ASR ASR |
$596.55
|
| Rate for Payer: ASR Commercial |
$596.55
|
| Rate for Payer: BCBS Trust/PPO |
$501.16
|
| Rate for Payer: BCN Commercial |
$476.81
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$578.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Healthscope Commercial |
$615.00
|
| Rate for Payer: Healthscope Whirlpool |
$596.55
|
| Rate for Payer: Mclaren Commercial |
$553.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.75
|
| Rate for Payer: Nomi Health Commercial |
$504.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.20
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$283.74
|
| Rate for Payer: Aetna Medicare |
$307.50
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.01
|
| Rate for Payer: Priority Health Narrow Network |
$327.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.66
|
| Rate for Payer: UHC Exchange |
$296.66
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
|
