|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$814.45 |
| Max. Negotiated Rate |
$1,253.00 |
| Rate for Payer: Aetna Commercial |
$1,127.70
|
| Rate for Payer: ASR ASR |
$1,215.41
|
| Rate for Payer: ASR Commercial |
$1,215.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.07
|
| Rate for Payer: BCN Commercial |
$971.45
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$1,177.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.40
|
| Rate for Payer: Healthscope Commercial |
$1,253.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,215.41
|
| Rate for Payer: Mclaren Commercial |
$1,127.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.05
|
| Rate for Payer: Nomi Health Commercial |
$1,027.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,102.64
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
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
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$814.45 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$1,127.70
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$1,215.41
|
| Rate for Payer: ASR Commercial |
$1,215.41
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,026.08
|
| Rate for Payer: BCN Commercial |
$971.45
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$1,177.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,253.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,215.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$1,127.70
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.05
|
| Rate for Payer: Nomi Health Commercial |
$1,027.46
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,097.88
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$878.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,102.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 23155
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$1,233.98 |
| Rate for Payer: Aetna Commercial |
$1,063.91
|
| Rate for Payer: Aetna Medicare |
$705.50
|
| Rate for Payer: BCBS Complete |
$547.49
|
| Rate for Payer: BCBS Trust/PPO |
$59.01
|
| Rate for Payer: BCN Commercial |
$1,175.76
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Meridian Medicaid |
$547.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$521.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,233.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,233.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$901.82
|
| Rate for Payer: UHC Exchange |
$901.82
|
| Rate for Payer: UHCCP Medicaid |
$521.42
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 23156
|
| Min. Negotiated Rate |
$32.26 |
| Max. Negotiated Rate |
$1,053.34 |
| Rate for Payer: Aetna Commercial |
$906.58
|
| Rate for Payer: Aetna Medicare |
$649.50
|
| Rate for Payer: BCBS Complete |
$467.88
|
| Rate for Payer: BCBS Trust/PPO |
$32.26
|
| Rate for Payer: BCN Commercial |
$1,002.76
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Meridian Medicaid |
$467.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,053.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,053.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$766.86
|
| Rate for Payer: UHC Exchange |
$766.86
|
| Rate for Payer: UHCCP Medicaid |
$445.60
|
|
|
PR EXC/CURTG CST/B9 TUM PHALANGES FOOT
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 28108
|
| Min. Negotiated Rate |
$188.51 |
| Max. Negotiated Rate |
$630.40 |
| Rate for Payer: Aetna Commercial |
$378.46
|
| Rate for Payer: Aetna Medicare |
$266.00
|
| Rate for Payer: BCBS Complete |
$197.94
|
| Rate for Payer: BCBS Trust/PPO |
$252.00
|
| Rate for Payer: BCN Commercial |
$630.40
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Meridian Medicaid |
$197.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.26
|
| Rate for Payer: Priority Health Narrow Network |
$445.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.21
|
| Rate for Payer: UHC Exchange |
$335.21
|
| Rate for Payer: UHCCP Medicaid |
$188.51
|
|
|
PR EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT
|
Professional
|
Both
|
$961.00
|
|
|
Service Code
|
HCPCS 28106
|
| Min. Negotiated Rate |
$276.05 |
| Max. Negotiated Rate |
$907.62 |
| Rate for Payer: Aetna Commercial |
$566.51
|
| Rate for Payer: Aetna Medicare |
$480.50
|
| Rate for Payer: BCBS Complete |
$289.85
|
| Rate for Payer: BCBS Trust/PPO |
$907.62
|
| Rate for Payer: BCN Commercial |
$617.20
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Meridian Medicaid |
$289.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.88
|
| Rate for Payer: Priority Health Narrow Network |
$653.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.32
|
| Rate for Payer: UHC Exchange |
$528.32
|
| Rate for Payer: UHCCP Medicaid |
$276.05
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 25136
|
| Min. Negotiated Rate |
$328.66 |
| Max. Negotiated Rate |
$1,019.62 |
| Rate for Payer: Aetna Commercial |
$663.57
|
| Rate for Payer: Aetna Medicare |
$501.50
|
| Rate for Payer: BCBS Complete |
$345.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,019.62
|
| Rate for Payer: BCN Commercial |
$738.88
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Meridian Medicaid |
$345.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$777.53
|
| Rate for Payer: Priority Health Narrow Network |
$777.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.23
|
| Rate for Payer: UHC Exchange |
$558.23
|
| Rate for Payer: UHCCP Medicaid |
$328.66
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 25135
|
| Min. Negotiated Rate |
$370.19 |
| Max. Negotiated Rate |
$1,158.03 |
| Rate for Payer: Aetna Commercial |
$747.91
|
| Rate for Payer: Aetna Medicare |
$505.50
|
| Rate for Payer: BCBS Complete |
$388.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.03
|
| Rate for Payer: BCN Commercial |
$829.77
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Meridian Medicaid |
$388.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.75
|
| Rate for Payer: Priority Health Narrow Network |
$875.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.68
|
| Rate for Payer: UHC Exchange |
$639.68
|
| Rate for Payer: UHCCP Medicaid |
$370.19
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
HCPCS 25126
|
| Min. Negotiated Rate |
$394.48 |
| Max. Negotiated Rate |
$1,153.28 |
| Rate for Payer: Aetna Commercial |
$799.55
|
| Rate for Payer: Aetna Medicare |
$608.00
|
| Rate for Payer: BCBS Complete |
$414.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,153.28
|
| Rate for Payer: BCN Commercial |
$887.44
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Meridian Medicaid |
$414.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$934.27
|
| Rate for Payer: Priority Health Narrow Network |
$934.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$721.36
|
| Rate for Payer: UHC Exchange |
$721.36
|
| Rate for Payer: UHCCP Medicaid |
$394.48
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$2,319.00
|
|
|
Service Code
|
HCPCS 25125
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$1,507.35 |
| Rate for Payer: Aetna Commercial |
$793.59
|
| Rate for Payer: Aetna Medicare |
$1,159.50
|
| Rate for Payer: BCBS Complete |
$411.52
|
| Rate for Payer: BCBS Trust/PPO |
$87.17
|
| Rate for Payer: BCN Commercial |
$881.57
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Meridian Medicaid |
$411.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$391.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,507.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$927.65
|
| Rate for Payer: Priority Health Narrow Network |
$927.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$719.05
|
| Rate for Payer: UHC Exchange |
$719.05
|
| Rate for Payer: UHCCP Medicaid |
$391.92
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
19120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$683.80 |
| Max. Negotiated Rate |
$1,052.00 |
| Rate for Payer: Aetna Commercial |
$946.80
|
| Rate for Payer: ASR ASR |
$1,020.44
|
| Rate for Payer: ASR Commercial |
$1,020.44
|
| Rate for Payer: BCBS Trust/PPO |
$857.27
|
| Rate for Payer: BCN Commercial |
$815.62
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$988.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.60
|
| Rate for Payer: Healthscope Commercial |
$1,052.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.44
|
| Rate for Payer: Mclaren Commercial |
$946.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.20
|
| Rate for Payer: Nomi Health Commercial |
$862.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.76
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
HCPCS 19120
|
| Min. Negotiated Rate |
$271.79 |
| Max. Negotiated Rate |
$762.83 |
| Rate for Payer: Aetna Commercial |
$453.99
|
| Rate for Payer: Aetna Medicare |
$526.00
|
| Rate for Payer: BCBS Complete |
$285.38
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$762.83
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Meridian Medicaid |
$285.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.62
|
| Rate for Payer: Priority Health Narrow Network |
$571.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.77
|
| Rate for Payer: UHC Exchange |
$421.77
|
| Rate for Payer: UHCCP Medicaid |
$271.79
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
19120
|
| Min. Negotiated Rate |
$271.79 |
| Max. Negotiated Rate |
$762.83 |
| Rate for Payer: Aetna Commercial |
$453.99
|
| Rate for Payer: Aetna Medicare |
$526.00
|
| Rate for Payer: BCBS Complete |
$285.38
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$762.83
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Meridian Medicaid |
$285.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.62
|
| Rate for Payer: Priority Health Narrow Network |
$571.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.77
|
| Rate for Payer: UHC Exchange |
$421.77
|
| Rate for Payer: UHCCP Medicaid |
$271.79
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
19120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$515.37 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$946.80
|
| 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 |
$1,020.44
|
| Rate for Payer: ASR Commercial |
$1,020.44
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$861.48
|
| Rate for Payer: BCCCP Commercial |
$515.37
|
| Rate for Payer: BCN Commercial |
$815.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$988.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,052.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$946.80
|
| 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 |
$894.20
|
| Rate for Payer: Nomi Health Commercial |
$862.64
|
| 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 |
$683.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,870.48
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$3,096.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.76
|
| 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 CYST/ADENOMA THYROID/TRANSECTION ISTHMUS
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 60200
|
| Min. Negotiated Rate |
$217.13 |
| Max. Negotiated Rate |
$1,088.30 |
| Rate for Payer: Aetna Commercial |
$855.88
|
| Rate for Payer: Aetna Medicare |
$705.50
|
| Rate for Payer: BCBS Complete |
$453.56
|
| Rate for Payer: BCBS Trust/PPO |
$217.13
|
| Rate for Payer: BCN Commercial |
$981.75
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Meridian Medicaid |
$453.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,088.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.34
|
| Rate for Payer: UHC Exchange |
$732.34
|
| Rate for Payer: UHCCP Medicaid |
$431.96
|
|
|
PR EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM
|
Professional
|
Both
|
$3,970.00
|
|
|
Service Code
|
HCPCS 49204
|
| Min. Negotiated Rate |
$624.45 |
| Max. Negotiated Rate |
$2,580.50 |
| Rate for Payer: Aetna Commercial |
$2,046.13
|
| Rate for Payer: Aetna Medicare |
$1,985.00
|
| Rate for Payer: BCBS Complete |
$1,588.00
|
| Rate for Payer: BCBS Trust/PPO |
$624.45
|
| Rate for Payer: BCN Commercial |
$2,216.64
|
| Rate for Payer: Cash Price |
$3,176.00
|
| Rate for Payer: Cash Price |
$3,176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,580.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,855.68
|
| Rate for Payer: UHC Exchange |
$1,855.68
|
|
|
PR EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM
|
Professional
|
Both
|
$3,208.00
|
|
|
Service Code
|
HCPCS 49205
|
| Min. Negotiated Rate |
$366.64 |
| Max. Negotiated Rate |
$2,544.55 |
| Rate for Payer: Aetna Commercial |
$2,348.49
|
| Rate for Payer: Aetna Medicare |
$1,604.00
|
| Rate for Payer: BCBS Complete |
$1,283.20
|
| Rate for Payer: BCBS Trust/PPO |
$366.64
|
| Rate for Payer: BCN Commercial |
$2,544.55
|
| Rate for Payer: Cash Price |
$2,566.40
|
| Rate for Payer: Cash Price |
$2,566.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,085.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,131.29
|
| Rate for Payer: UHC Exchange |
$2,131.29
|
|
|
PR EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 42870
|
| Min. Negotiated Rate |
$377.01 |
| Max. Negotiated Rate |
$1,057.77 |
| Rate for Payer: Aetna Commercial |
$780.39
|
| Rate for Payer: Aetna Medicare |
$525.50
|
| Rate for Payer: BCBS Complete |
$395.86
|
| Rate for Payer: BCBS Trust/PPO |
$829.43
|
| Rate for Payer: BCN Commercial |
$869.36
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Meridian Medicaid |
$395.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,057.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,057.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$680.33
|
| Rate for Payer: UHC Exchange |
$680.33
|
| Rate for Payer: UHCCP Medicaid |
$377.01
|
|
|
PR EXC EXCSV SKN ABD INFRAUMBILICAL PANNICULECTOMY
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 15830
|
| Min. Negotiated Rate |
$226.01 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Commercial |
$1,270.12
|
| Rate for Payer: Aetna Medicare |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$795.97
|
| Rate for Payer: BCBS Trust/PPO |
$226.01
|
| Rate for Payer: BCN Commercial |
$1,711.83
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Meridian Medicaid |
$795.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$758.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,588.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,588.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,228.28
|
| Rate for Payer: UHC Exchange |
$1,228.28
|
| Rate for Payer: UHCCP Medicaid |
$758.07
|
|
|
PR EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$2,651.00
|
|
|
Service Code
|
HCPCS 26390
|
| Min. Negotiated Rate |
$153.74 |
| Max. Negotiated Rate |
$1,723.15 |
| Rate for Payer: Aetna Commercial |
$1,166.48
|
| Rate for Payer: Aetna Medicare |
$1,325.50
|
| Rate for Payer: BCBS Complete |
$594.02
|
| Rate for Payer: BCBS Trust/PPO |
$153.74
|
| Rate for Payer: BCN Commercial |
$1,303.31
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Meridian Medicaid |
$594.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$565.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,355.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,355.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$929.42
|
| Rate for Payer: UHC Exchange |
$929.42
|
| Rate for Payer: UHCCP Medicaid |
$565.73
|
|
|
PR EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 40819
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$760.22 |
| Rate for Payer: Aetna Commercial |
$264.81
|
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$137.10
|
| Rate for Payer: BCBS Trust/PPO |
$760.22
|
| Rate for Payer: BCN Commercial |
$394.36
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Meridian Medicaid |
$137.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.56
|
| Rate for Payer: Priority Health Narrow Network |
$358.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.55
|
| Rate for Payer: UHC Exchange |
$273.55
|
| Rate for Payer: UHCCP Medicaid |
$130.57
|
|
|
PR EXC/FULGURATION URETHRAL CARUNCLE
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 53265
|
| Min. Negotiated Rate |
$122.05 |
| Max. Negotiated Rate |
$1,099.39 |
| Rate for Payer: Aetna Commercial |
$241.82
|
| Rate for Payer: Aetna Medicare |
$206.00
|
| Rate for Payer: BCBS Complete |
$128.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.39
|
| Rate for Payer: BCN Commercial |
$334.26
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Meridian Medicaid |
$128.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.98
|
| Rate for Payer: Priority Health Narrow Network |
$301.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.78
|
| Rate for Payer: UHC Exchange |
$221.78
|
| Rate for Payer: UHCCP Medicaid |
$122.05
|
|
|
PR EXC/FULGURATION URETHRAL POLYP DSTL URETHRA
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 53260
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$546.26 |
| Rate for Payer: Aetna Commercial |
$232.51
|
| Rate for Payer: Aetna Medicare |
$137.50
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS Trust/PPO |
$546.26
|
| Rate for Payer: BCN Commercial |
$302.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.27
|
| Rate for Payer: Priority Health Narrow Network |
$290.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.22
|
| Rate for Payer: UHC Exchange |
$212.22
|
| Rate for Payer: UHCCP Medicaid |
$116.94
|
|
|
PR EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 50435
|
| Min. Negotiated Rate |
$62.62 |
| Max. Negotiated Rate |
$888.91 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Medicare |
$637.00
|
| Rate for Payer: BCBS Complete |
$65.75
|
| Rate for Payer: BCN Commercial |
$888.91
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Meridian Medicaid |
$65.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.52
|
| Rate for Payer: Priority Health Narrow Network |
$155.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.68
|
| Rate for Payer: UHC Exchange |
$123.68
|
| Rate for Payer: UHCCP Medicaid |
$62.62
|
|
