|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
11444
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$242.15
|
| Rate for Payer: Aetna Medicare |
$288.50
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$333.37
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.58
|
| Rate for Payer: Priority Health Narrow Network |
$306.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.21
|
| Rate for Payer: UHC Exchange |
$236.21
|
| Rate for Payer: UHCCP Medicaid |
$146.76
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$375.05 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$559.69
|
| Rate for Payer: ASR Commercial |
$559.69
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$472.51
|
| Rate for Payer: BCN Commercial |
$447.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$542.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$577.00
|
| Rate for Payer: Healthscope Whirlpool |
$559.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$519.30
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: Nomi Health Commercial |
$473.14
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$505.57
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$404.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN
|
Professional
|
Both
|
$7,984.00
|
|
|
Service Code
|
HCPCS 61563
|
| Min. Negotiated Rate |
$382.49 |
| Max. Negotiated Rate |
$5,189.60 |
| Rate for Payer: Aetna Commercial |
$2,563.18
|
| Rate for Payer: Aetna Medicare |
$3,992.00
|
| Rate for Payer: BCBS Complete |
$1,355.99
|
| Rate for Payer: BCBS Trust/PPO |
$382.49
|
| Rate for Payer: BCN Commercial |
$4,057.43
|
| Rate for Payer: Cash Price |
$6,387.20
|
| Rate for Payer: Cash Price |
$6,387.20
|
| Rate for Payer: Meridian Medicaid |
$1,355.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,291.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,189.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,434.47
|
| Rate for Payer: Priority Health Narrow Network |
$3,434.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,298.85
|
| Rate for Payer: UHC Exchange |
$2,298.85
|
| Rate for Payer: UHCCP Medicaid |
$1,291.42
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT
|
Professional
|
Both
|
$2,311.00
|
|
|
Service Code
|
HCPCS 21048
|
| Min. Negotiated Rate |
$642.62 |
| Max. Negotiated Rate |
$3,701.02 |
| Rate for Payer: Aetna Commercial |
$1,361.18
|
| Rate for Payer: Aetna Medicare |
$1,155.50
|
| Rate for Payer: BCBS Complete |
$674.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,701.02
|
| Rate for Payer: BCN Commercial |
$1,452.35
|
| Rate for Payer: Cash Price |
$1,848.80
|
| Rate for Payer: Cash Price |
$1,848.80
|
| Rate for Payer: Meridian Medicaid |
$674.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,502.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,517.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,258.93
|
| Rate for Payer: UHC Exchange |
$1,258.93
|
| Rate for Payer: UHCCP Medicaid |
$642.62
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
HCPCS 21030
|
| Min. Negotiated Rate |
$234.73 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$488.49
|
| Rate for Payer: Aetna Medicare |
$512.00
|
| Rate for Payer: BCBS Complete |
$246.47
|
| Rate for Payer: BCBS Trust/PPO |
$998.90
|
| Rate for Payer: BCN Commercial |
$672.42
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Meridian Medicaid |
$246.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$551.61
|
| Rate for Payer: Priority Health Narrow Network |
$551.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.17
|
| Rate for Payer: UHC Exchange |
$461.17
|
| Rate for Payer: UHCCP Medicaid |
$234.73
|
|
|
PR EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42815
|
| Min. Negotiated Rate |
$278.41 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Commercial |
$718.44
|
| Rate for Payer: Aetna Medicare |
$827.50
|
| Rate for Payer: BCBS Complete |
$364.33
|
| Rate for Payer: BCBS Trust/PPO |
$278.41
|
| Rate for Payer: BCN Commercial |
$796.55
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Meridian Medicaid |
$364.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.85
|
| Rate for Payer: Priority Health Narrow Network |
$971.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$671.83
|
| Rate for Payer: UHC Exchange |
$671.83
|
| Rate for Payer: UHCCP Medicaid |
$346.98
|
|
|
PR EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 42810
|
| Min. Negotiated Rate |
$183.82 |
| Max. Negotiated Rate |
$575.66 |
| Rate for Payer: Aetna Commercial |
$370.11
|
| Rate for Payer: Aetna Medicare |
$433.50
|
| Rate for Payer: BCBS Complete |
$193.01
|
| Rate for Payer: BCBS Trust/PPO |
$196.53
|
| Rate for Payer: BCN Commercial |
$575.66
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Meridian Medicaid |
$193.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.07
|
| Rate for Payer: Priority Health Narrow Network |
$513.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.86
|
| Rate for Payer: UHC Exchange |
$342.86
|
| Rate for Payer: UHCCP Medicaid |
$183.82
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,263.00
|
|
|
Service Code
|
HCPCS 19125
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$840.53 |
| Rate for Payer: Aetna Commercial |
$503.32
|
| Rate for Payer: Aetna Medicare |
$631.50
|
| Rate for Payer: BCBS Complete |
$315.57
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$840.53
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Meridian Medicaid |
$315.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.13
|
| Rate for Payer: Priority Health Narrow Network |
$632.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$469.99
|
| Rate for Payer: UHC Exchange |
$469.99
|
| Rate for Payer: UHCCP Medicaid |
$300.54
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$569.78 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$1,136.70
|
| Rate for Payer: Aetna Medicare |
$3,751.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: ASR ASR |
$1,225.11
|
| Rate for Payer: ASR Commercial |
$1,225.11
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.27
|
| Rate for Payer: BCCCP Commercial |
$569.78
|
| Rate for Payer: BCN Commercial |
$979.20
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cofinity Commercial |
$1,187.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,263.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,225.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$1,136.70
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.55
|
| Rate for Payer: Nomi Health Commercial |
$1,035.66
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$4,127.04
|
| Rate for Payer: PHP Medicaid |
$2,010.99
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,106.64
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$885.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$5,815.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP DNSP |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$820.95 |
| Max. Negotiated Rate |
$1,263.00 |
| Rate for Payer: Aetna Commercial |
$1,136.70
|
| Rate for Payer: ASR ASR |
$1,225.11
|
| Rate for Payer: ASR Commercial |
$1,225.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,029.22
|
| Rate for Payer: BCN Commercial |
$979.20
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cofinity Commercial |
$1,187.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.40
|
| Rate for Payer: Healthscope Commercial |
$1,263.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,225.11
|
| Rate for Payer: Mclaren Commercial |
$1,136.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.55
|
| Rate for Payer: Nomi Health Commercial |
$1,035.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.44
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,263.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
19125
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$840.53 |
| Rate for Payer: Aetna Commercial |
$503.32
|
| Rate for Payer: Aetna Medicare |
$631.50
|
| Rate for Payer: BCBS Complete |
$315.57
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$840.53
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Meridian Medicaid |
$315.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.13
|
| Rate for Payer: Priority Health Narrow Network |
$632.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$469.99
|
| Rate for Payer: UHC Exchange |
$469.99
|
| Rate for Payer: UHCCP Medicaid |
$300.54
|
|
|
PR EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 19126
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$232.12 |
| Rate for Payer: Aetna Commercial |
$177.60
|
| Rate for Payer: Aetna Medicare |
$136.00
|
| Rate for Payer: BCBS Complete |
$106.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$232.12
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Meridian Medicaid |
$106.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.37
|
| Rate for Payer: Priority Health Narrow Network |
$215.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.94
|
| Rate for Payer: UHC Exchange |
$174.94
|
| Rate for Payer: UHCCP Medicaid |
$101.81
|
|
|
PR EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY
|
Professional
|
Both
|
$2,765.00
|
|
|
Service Code
|
HCPCS 60600
|
| Min. Negotiated Rate |
$529.36 |
| Max. Negotiated Rate |
$2,189.00 |
| Rate for Payer: Aetna Commercial |
$1,763.47
|
| Rate for Payer: Aetna Medicare |
$1,382.50
|
| Rate for Payer: BCBS Complete |
$902.43
|
| Rate for Payer: BCBS Trust/PPO |
$529.36
|
| Rate for Payer: BCN Commercial |
$1,977.68
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Meridian Medicaid |
$902.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$859.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,189.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,659.91
|
| Rate for Payer: UHC Exchange |
$1,659.91
|
| Rate for Payer: UHCCP Medicaid |
$859.46
|
|
|
PR EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 26596
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$1,265.54 |
| Rate for Payer: Aetna Commercial |
$1,076.67
|
| Rate for Payer: Aetna Medicare |
$663.50
|
| Rate for Payer: BCBS Complete |
$556.67
|
| Rate for Payer: BCBS Trust/PPO |
$72.17
|
| Rate for Payer: BCN Commercial |
$1,213.39
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Meridian Medicaid |
$556.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$530.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,265.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,265.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$831.67
|
| Rate for Payer: UHC Exchange |
$831.67
|
| Rate for Payer: UHCCP Medicaid |
$530.16
|
|
|
PR EXC CRV STUMP VAG APPR W/RPR NTRCL
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 57556
|
| Min. Negotiated Rate |
$377.44 |
| Max. Negotiated Rate |
$1,301.73 |
| Rate for Payer: Aetna Commercial |
$698.98
|
| Rate for Payer: Aetna Medicare |
$641.00
|
| Rate for Payer: BCBS Complete |
$396.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,301.73
|
| Rate for Payer: BCN Commercial |
$864.96
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Meridian Medicaid |
$396.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.48
|
| Rate for Payer: Priority Health Narrow Network |
$881.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$650.41
|
| Rate for Payer: UHC Exchange |
$650.41
|
| Rate for Payer: UHCCP Medicaid |
$377.44
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ
|
Professional
|
Both
|
$4,205.00
|
|
|
Service Code
|
HCPCS 38555
|
| Min. Negotiated Rate |
$556.83 |
| Max. Negotiated Rate |
$2,733.25 |
| Rate for Payer: Aetna Commercial |
$1,274.21
|
| Rate for Payer: Aetna Medicare |
$2,102.50
|
| Rate for Payer: BCBS Complete |
$695.77
|
| Rate for Payer: BCBS Trust/PPO |
$556.83
|
| Rate for Payer: BCN Commercial |
$1,501.71
|
| Rate for Payer: Cash Price |
$3,364.00
|
| Rate for Payer: Cash Price |
$3,364.00
|
| Rate for Payer: Meridian Medicaid |
$695.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$662.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,733.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,057.84
|
| Rate for Payer: Priority Health Narrow Network |
$2,057.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,114.66
|
| Rate for Payer: UHC Exchange |
$1,114.66
|
| Rate for Payer: UHCCP Medicaid |
$662.64
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38550
|
| Min. Negotiated Rate |
$339.95 |
| Max. Negotiated Rate |
$1,053.88 |
| Rate for Payer: Aetna Commercial |
$643.88
|
| Rate for Payer: Aetna Medicare |
$788.50
|
| Rate for Payer: BCBS Complete |
$356.95
|
| Rate for Payer: BCBS Trust/PPO |
$608.07
|
| Rate for Payer: BCN Commercial |
$766.24
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Meridian Medicaid |
$356.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,053.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,053.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$540.57
|
| Rate for Payer: UHC Exchange |
$540.57
|
| Rate for Payer: UHCCP Medicaid |
$339.95
|
|
|
PR EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT
|
Professional
|
Both
|
$2,361.00
|
|
|
Service Code
|
HCPCS 26205
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$1,534.65 |
| Rate for Payer: Aetna Commercial |
$808.63
|
| Rate for Payer: Aetna Medicare |
$1,180.50
|
| Rate for Payer: BCBS Complete |
$417.33
|
| Rate for Payer: BCBS Trust/PPO |
$32.23
|
| Rate for Payer: BCN Commercial |
$895.26
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Meridian Medicaid |
$417.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$940.89
|
| Rate for Payer: Priority Health Narrow Network |
$940.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.67
|
| Rate for Payer: UHC Exchange |
$682.67
|
| Rate for Payer: UHCCP Medicaid |
$397.46
|
|
|
PR EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT
|
Professional
|
Both
|
$1,782.00
|
|
|
Service Code
|
HCPCS 26215
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$1,158.30 |
| Rate for Payer: Aetna Commercial |
$756.96
|
| Rate for Payer: Aetna Medicare |
$891.00
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS Trust/PPO |
$119.40
|
| Rate for Payer: BCN Commercial |
$841.01
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$883.89
|
| Rate for Payer: Priority Health Narrow Network |
$883.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$631.70
|
| Rate for Payer: UHC Exchange |
$631.70
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 27637
|
| Min. Negotiated Rate |
$489.05 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Aetna Commercial |
$989.60
|
| Rate for Payer: Aetna Medicare |
$1,387.50
|
| Rate for Payer: BCBS Complete |
$513.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.18
|
| Rate for Payer: BCN Commercial |
$1,089.26
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Meridian Medicaid |
$513.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,154.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,154.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$865.09
|
| Rate for Payer: UHC Exchange |
$865.09
|
| Rate for Payer: UHCCP Medicaid |
$489.05
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 27638
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$1,612.37 |
| Rate for Payer: Aetna Commercial |
$1,011.80
|
| Rate for Payer: Aetna Medicare |
$1,106.50
|
| Rate for Payer: BCBS Complete |
$509.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,612.37
|
| Rate for Payer: BCN Commercial |
$1,097.08
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Meridian Medicaid |
$509.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,144.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,144.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.47
|
| Rate for Payer: UHC Exchange |
$897.47
|
| Rate for Payer: UHCCP Medicaid |
$485.00
|
|
|
PR EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 28104
|
| Min. Negotiated Rate |
$232.17 |
| Max. Negotiated Rate |
$1,143.77 |
| Rate for Payer: Aetna Commercial |
$469.02
|
| Rate for Payer: Aetna Medicare |
$484.50
|
| Rate for Payer: BCBS Complete |
$243.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,143.77
|
| Rate for Payer: BCN Commercial |
$761.85
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Meridian Medicaid |
$243.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$547.02
|
| Rate for Payer: Priority Health Narrow Network |
$547.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$406.43
|
| Rate for Payer: UHC Exchange |
$406.43
|
| Rate for Payer: UHCCP Medicaid |
$232.17
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 24116
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$1,327.62 |
| Rate for Payer: Aetna Commercial |
$1,149.88
|
| Rate for Payer: Aetna Medicare |
$867.00
|
| Rate for Payer: BCBS Complete |
$587.75
|
| Rate for Payer: BCBS Trust/PPO |
$82.41
|
| Rate for Payer: BCN Commercial |
$1,264.70
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Meridian Medicaid |
$587.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$559.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,327.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,327.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.20
|
| Rate for Payer: UHC Exchange |
$988.20
|
| Rate for Payer: UHCCP Medicaid |
$559.76
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 23140
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$865.07 |
| Rate for Payer: Aetna Commercial |
$740.39
|
| Rate for Payer: Aetna Medicare |
$470.50
|
| Rate for Payer: BCBS Complete |
$383.56
|
| Rate for Payer: BCBS Trust/PPO |
$27.17
|
| Rate for Payer: BCN Commercial |
$821.96
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Meridian Medicaid |
$383.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$865.07
|
| Rate for Payer: Priority Health Narrow Network |
$865.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$589.20
|
| Rate for Payer: UHC Exchange |
$589.20
|
| Rate for Payer: UHCCP Medicaid |
$365.30
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 24120
|
| Min. Negotiated Rate |
$114.64 |
| Max. Negotiated Rate |
$829.95 |
| Rate for Payer: Aetna Commercial |
$709.53
|
| Rate for Payer: Aetna Medicare |
$626.50
|
| Rate for Payer: BCBS Complete |
$369.24
|
| Rate for Payer: BCBS Trust/PPO |
$114.64
|
| Rate for Payer: BCN Commercial |
$788.73
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Meridian Medicaid |
$369.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.95
|
| Rate for Payer: Priority Health Narrow Network |
$829.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$590.77
|
| Rate for Payer: UHC Exchange |
$590.77
|
| Rate for Payer: UHCCP Medicaid |
$351.66
|
|
