|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$640.50 |
| Rate for Payer: Aetna Commercial |
$337.28
|
| Rate for Payer: Aetna Medicare |
$251.70
|
| Rate for Payer: BCBS Complete |
$174.67
|
| Rate for Payer: BCBS MAPPO |
$251.70
|
| Rate for Payer: BCN Commercial |
$415.81
|
| Rate for Payer: BCN Medicare Advantage |
$251.70
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cofinity Commercial |
$362.45
|
| Rate for Payer: Cofinity Commercial |
$337.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.70
|
| Rate for Payer: Healthscope Commercial |
$302.04
|
| Rate for Payer: Healthscope Whirlpool |
$302.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$264.29
|
| Rate for Payer: Meridian Medicaid |
$174.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$276.87
|
| Rate for Payer: Nomi Health Commercial |
$302.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$640.50
|
| Rate for Payer: PACE SWMI |
$251.70
|
| Rate for Payer: PHP Medicare Advantage |
$251.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$444.49
|
| Rate for Payer: Priority Health Medicare |
$251.70
|
| Rate for Payer: Priority Health Narrow Network |
$444.49
|
| Rate for Payer: Railroad Medicare Medicare |
$251.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$251.70
|
| Rate for Payer: UHC Exchange |
$467.49
|
| Rate for Payer: UHC Medicaid |
$166.35
|
| Rate for Payer: UHCCP DNSP |
$251.70
|
| Rate for Payer: UHCCP Medicaid |
$166.35
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$143.99 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$290.66
|
| Rate for Payer: Aetna Medicare |
$216.91
|
| Rate for Payer: BCBS Complete |
$151.19
|
| Rate for Payer: BCBS MAPPO |
$216.91
|
| Rate for Payer: BCN Commercial |
$367.51
|
| Rate for Payer: BCN Medicare Advantage |
$216.91
|
| Rate for Payer: Cash Price |
$488.80
|
| Rate for Payer: Cash Price |
$488.80
|
| Rate for Payer: Cofinity Commercial |
$312.35
|
| Rate for Payer: Cofinity Commercial |
$290.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.91
|
| Rate for Payer: Healthscope Commercial |
$260.29
|
| Rate for Payer: Healthscope Whirlpool |
$260.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.76
|
| Rate for Payer: Meridian Medicaid |
$151.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$238.60
|
| Rate for Payer: Nomi Health Commercial |
$260.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$458.25
|
| Rate for Payer: PACE SWMI |
$216.91
|
| Rate for Payer: PHP Medicare Advantage |
$216.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$447.79
|
| Rate for Payer: Priority Health Medicare |
$216.91
|
| Rate for Payer: Priority Health Narrow Network |
$447.79
|
| Rate for Payer: Railroad Medicare Medicare |
$216.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$420.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$216.91
|
| Rate for Payer: UHC Exchange |
$420.73
|
| Rate for Payer: UHC Medicaid |
$143.99
|
| Rate for Payer: UHCCP DNSP |
$216.91
|
| Rate for Payer: UHCCP Medicaid |
$143.99
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$316.19
|
| Rate for Payer: Aetna Medicare |
$235.96
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCBS MAPPO |
$235.96
|
| Rate for Payer: BCN Commercial |
$398.88
|
| Rate for Payer: BCN Medicare Advantage |
$235.96
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$339.78
|
| Rate for Payer: Cofinity Commercial |
$316.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.96
|
| Rate for Payer: Healthscope Commercial |
$283.15
|
| Rate for Payer: Healthscope Whirlpool |
$283.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.76
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.56
|
| Rate for Payer: Nomi Health Commercial |
$283.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.00
|
| Rate for Payer: PACE SWMI |
$235.96
|
| Rate for Payer: PHP Medicare Advantage |
$235.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$486.02
|
| Rate for Payer: Priority Health Medicare |
$235.96
|
| Rate for Payer: Priority Health Narrow Network |
$486.02
|
| Rate for Payer: Railroad Medicare Medicare |
$235.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$465.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$235.96
|
| Rate for Payer: UHC Exchange |
$465.38
|
| Rate for Payer: UHC Medicaid |
$156.13
|
| Rate for Payer: UHCCP DNSP |
$235.96
|
| Rate for Payer: UHCCP Medicaid |
$156.13
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$349.75 |
| Max. Negotiated Rate |
$1,137.68 |
| Rate for Payer: Aetna Commercial |
$716.65
|
| Rate for Payer: Aetna Medicare |
$534.81
|
| Rate for Payer: BCBS Complete |
$367.24
|
| Rate for Payer: BCBS MAPPO |
$534.81
|
| Rate for Payer: BCN Commercial |
$933.72
|
| Rate for Payer: BCN Medicare Advantage |
$534.81
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cofinity Commercial |
$770.13
|
| Rate for Payer: Cofinity Commercial |
$716.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.81
|
| Rate for Payer: Healthscope Commercial |
$641.77
|
| Rate for Payer: Healthscope Whirlpool |
$641.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.55
|
| Rate for Payer: Meridian Medicaid |
$367.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$588.29
|
| Rate for Payer: Nomi Health Commercial |
$641.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$892.50
|
| Rate for Payer: PACE SWMI |
$534.81
|
| Rate for Payer: PHP Medicare Advantage |
$534.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,137.68
|
| Rate for Payer: Priority Health Medicare |
$534.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,137.68
|
| Rate for Payer: Railroad Medicare Medicare |
$534.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,072.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$534.81
|
| Rate for Payer: UHC Exchange |
$1,072.24
|
| Rate for Payer: UHC Medicaid |
$349.75
|
| Rate for Payer: UHCCP DNSP |
$534.81
|
| Rate for Payer: UHCCP Medicaid |
$349.75
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna Commercial |
$342.30
|
| Rate for Payer: Aetna Medicare |
$255.45
|
| Rate for Payer: BCBS Complete |
$176.90
|
| Rate for Payer: BCBS MAPPO |
$255.45
|
| Rate for Payer: BCN Commercial |
$440.71
|
| Rate for Payer: BCN Medicare Advantage |
$255.45
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$367.85
|
| Rate for Payer: Cofinity Commercial |
$342.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.45
|
| Rate for Payer: Healthscope Commercial |
$306.54
|
| Rate for Payer: Healthscope Whirlpool |
$306.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$268.22
|
| Rate for Payer: Meridian Medicaid |
$176.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$281.00
|
| Rate for Payer: Nomi Health Commercial |
$306.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.00
|
| Rate for Payer: PACE SWMI |
$255.45
|
| Rate for Payer: PHP Medicare Advantage |
$255.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$536.99
|
| Rate for Payer: Priority Health Medicare |
$255.45
|
| Rate for Payer: Priority Health Narrow Network |
$536.99
|
| Rate for Payer: Railroad Medicare Medicare |
$255.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$516.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$255.45
|
| Rate for Payer: UHC Exchange |
$516.17
|
| Rate for Payer: UHC Medicaid |
$168.48
|
| Rate for Payer: UHCCP DNSP |
$255.45
|
| Rate for Payer: UHCCP Medicaid |
$168.48
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Aetna Commercial |
$142.74
|
| Rate for Payer: Aetna Medicare |
$106.52
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$106.52
|
| Rate for Payer: BCN Commercial |
$184.25
|
| Rate for Payer: BCN Medicare Advantage |
$106.52
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cofinity Commercial |
$153.39
|
| Rate for Payer: Cofinity Commercial |
$142.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.52
|
| Rate for Payer: Healthscope Commercial |
$127.82
|
| Rate for Payer: Healthscope Whirlpool |
$127.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.85
|
| Rate for Payer: Meridian Medicaid |
$74.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$117.17
|
| Rate for Payer: Nomi Health Commercial |
$127.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.75
|
| Rate for Payer: PACE SWMI |
$106.52
|
| Rate for Payer: PHP Medicare Advantage |
$106.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$224.50
|
| Rate for Payer: Priority Health Medicare |
$106.52
|
| Rate for Payer: Priority Health Narrow Network |
$224.50
|
| Rate for Payer: Railroad Medicare Medicare |
$106.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$106.52
|
| Rate for Payer: UHC Exchange |
$205.29
|
| Rate for Payer: UHC Medicaid |
$70.72
|
| Rate for Payer: UHCCP DNSP |
$106.52
|
| Rate for Payer: UHCCP Medicaid |
$70.72
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$147.49
|
| Rate for Payer: Aetna Medicare |
$110.07
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: BCBS MAPPO |
$110.07
|
| Rate for Payer: BCN Commercial |
$184.75
|
| Rate for Payer: BCN Medicare Advantage |
$110.07
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$158.50
|
| Rate for Payer: Cofinity Commercial |
$147.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.07
|
| Rate for Payer: Healthscope Commercial |
$132.08
|
| Rate for Payer: Healthscope Whirlpool |
$132.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.57
|
| Rate for Payer: Meridian Medicaid |
$76.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.08
|
| Rate for Payer: Nomi Health Commercial |
$132.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.00
|
| Rate for Payer: PACE SWMI |
$110.07
|
| Rate for Payer: PHP Medicare Advantage |
$110.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$225.12
|
| Rate for Payer: Priority Health Medicare |
$110.07
|
| Rate for Payer: Priority Health Narrow Network |
$225.12
|
| Rate for Payer: Railroad Medicare Medicare |
$110.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.07
|
| Rate for Payer: UHC Exchange |
$211.50
|
| Rate for Payer: UHC Medicaid |
$73.27
|
| Rate for Payer: UHCCP DNSP |
$110.07
|
| Rate for Payer: UHCCP Medicaid |
$73.27
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$2,042.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$317.58 |
| Max. Negotiated Rate |
$1,531.50 |
| Rate for Payer: Aetna Commercial |
$650.19
|
| Rate for Payer: Aetna Medicare |
$485.22
|
| Rate for Payer: BCBS Complete |
$333.46
|
| Rate for Payer: BCBS MAPPO |
$485.22
|
| Rate for Payer: BCN Commercial |
$831.63
|
| Rate for Payer: BCN Medicare Advantage |
$485.22
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cofinity Commercial |
$698.72
|
| Rate for Payer: Cofinity Commercial |
$650.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.22
|
| Rate for Payer: Healthscope Commercial |
$582.26
|
| Rate for Payer: Healthscope Whirlpool |
$582.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.48
|
| Rate for Payer: Meridian Medicaid |
$333.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$533.74
|
| Rate for Payer: Nomi Health Commercial |
$582.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,531.50
|
| Rate for Payer: PACE SWMI |
$485.22
|
| Rate for Payer: PHP Medicare Advantage |
$485.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,013.29
|
| Rate for Payer: Priority Health Medicare |
$485.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.29
|
| Rate for Payer: Railroad Medicare Medicare |
$485.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$959.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$485.22
|
| Rate for Payer: UHC Exchange |
$959.82
|
| Rate for Payer: UHC Medicaid |
$317.58
|
| Rate for Payer: UHCCP DNSP |
$485.22
|
| Rate for Payer: UHCCP Medicaid |
$317.58
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$644.98 |
| Rate for Payer: Aetna Commercial |
$413.18
|
| Rate for Payer: Aetna Medicare |
$308.34
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS MAPPO |
$308.34
|
| Rate for Payer: BCN Commercial |
$529.35
|
| Rate for Payer: BCN Medicare Advantage |
$308.34
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cofinity Commercial |
$444.01
|
| Rate for Payer: Cofinity Commercial |
$413.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.34
|
| Rate for Payer: Healthscope Commercial |
$370.01
|
| Rate for Payer: Healthscope Whirlpool |
$370.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.76
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$339.17
|
| Rate for Payer: Nomi Health Commercial |
$370.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.00
|
| Rate for Payer: PACE SWMI |
$308.34
|
| Rate for Payer: PHP Medicare Advantage |
$308.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$644.98
|
| Rate for Payer: Priority Health Medicare |
$308.34
|
| Rate for Payer: Priority Health Narrow Network |
$644.98
|
| Rate for Payer: Railroad Medicare Medicare |
$308.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$308.34
|
| Rate for Payer: UHC Exchange |
$606.51
|
| Rate for Payer: UHC Medicaid |
$202.35
|
| Rate for Payer: UHCCP DNSP |
$308.34
|
| Rate for Payer: UHCCP Medicaid |
$202.35
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$208.53 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Medicare |
$317.31
|
| Rate for Payer: BCBS Complete |
$218.96
|
| Rate for Payer: BCBS MAPPO |
$317.31
|
| Rate for Payer: BCN Commercial |
$543.80
|
| Rate for Payer: BCN Medicare Advantage |
$317.31
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cofinity Commercial |
$456.93
|
| Rate for Payer: Cofinity Commercial |
$425.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.31
|
| Rate for Payer: Healthscope Commercial |
$380.77
|
| Rate for Payer: Healthscope Whirlpool |
$380.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.18
|
| Rate for Payer: Meridian Medicaid |
$218.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$349.04
|
| Rate for Payer: Nomi Health Commercial |
$380.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.00
|
| Rate for Payer: PACE SWMI |
$317.31
|
| Rate for Payer: PHP Medicare Advantage |
$317.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$662.57
|
| Rate for Payer: Priority Health Medicare |
$317.31
|
| Rate for Payer: Priority Health Narrow Network |
$662.57
|
| Rate for Payer: Railroad Medicare Medicare |
$317.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$615.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$317.31
|
| Rate for Payer: UHC Exchange |
$615.18
|
| Rate for Payer: UHC Medicaid |
$208.53
|
| Rate for Payer: UHCCP DNSP |
$317.31
|
| Rate for Payer: UHCCP Medicaid |
$208.53
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,898.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$732.72 |
| Max. Negotiated Rate |
$2,248.64 |
| Rate for Payer: Aetna Commercial |
$1,531.02
|
| Rate for Payer: Aetna Medicare |
$1,142.55
|
| Rate for Payer: BCBS Complete |
$769.36
|
| Rate for Payer: BCBS MAPPO |
$1,142.55
|
| Rate for Payer: BCN Commercial |
$1,845.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.55
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Cofinity Commercial |
$1,645.27
|
| Rate for Payer: Cofinity Commercial |
$1,531.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.55
|
| Rate for Payer: Healthscope Commercial |
$1,371.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,371.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.68
|
| Rate for Payer: Meridian Medicaid |
$769.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,256.81
|
| Rate for Payer: Nomi Health Commercial |
$1,371.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,423.50
|
| Rate for Payer: PACE SWMI |
$1,142.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$732.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,248.64
|
| Rate for Payer: Priority Health Medicare |
$1,142.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,248.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,181.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,142.55
|
| Rate for Payer: UHC Exchange |
$2,181.02
|
| Rate for Payer: UHC Medicaid |
$732.72
|
| Rate for Payer: UHCCP DNSP |
$1,142.55
|
| Rate for Payer: UHCCP Medicaid |
$732.72
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$2,440.50 |
| Rate for Payer: Aetna Commercial |
$1,226.76
|
| Rate for Payer: Aetna Medicare |
$915.49
|
| Rate for Payer: BCBS Complete |
$615.93
|
| Rate for Payer: BCBS MAPPO |
$915.49
|
| Rate for Payer: BCN Commercial |
$1,466.56
|
| Rate for Payer: BCN Medicare Advantage |
$915.49
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cofinity Commercial |
$1,318.31
|
| Rate for Payer: Cofinity Commercial |
$1,226.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$915.49
|
| Rate for Payer: Healthscope Commercial |
$1,098.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,098.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$961.26
|
| Rate for Payer: Meridian Medicaid |
$615.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,007.04
|
| Rate for Payer: Nomi Health Commercial |
$1,098.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,440.50
|
| Rate for Payer: PACE SWMI |
$915.49
|
| Rate for Payer: PHP Medicare Advantage |
$915.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,786.89
|
| Rate for Payer: Priority Health Medicare |
$915.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,786.89
|
| Rate for Payer: Railroad Medicare Medicare |
$915.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,749.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$915.49
|
| Rate for Payer: UHC Exchange |
$1,749.41
|
| Rate for Payer: UHC Medicaid |
$586.60
|
| Rate for Payer: UHCCP DNSP |
$915.49
|
| Rate for Payer: UHCCP Medicaid |
$586.60
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$236.99 |
| Rate for Payer: Aetna Commercial |
$158.63
|
| Rate for Payer: Aetna Medicare |
$118.38
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$118.38
|
| Rate for Payer: BCN Commercial |
$189.73
|
| Rate for Payer: BCN Medicare Advantage |
$118.38
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$170.47
|
| Rate for Payer: Cofinity Commercial |
$158.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.38
|
| Rate for Payer: Healthscope Commercial |
$142.06
|
| Rate for Payer: Healthscope Whirlpool |
$142.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.30
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.22
|
| Rate for Payer: Nomi Health Commercial |
$142.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.75
|
| Rate for Payer: PACE SWMI |
$118.38
|
| Rate for Payer: PHP Medicare Advantage |
$118.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$204.03
|
| Rate for Payer: Priority Health Medicare |
$118.38
|
| Rate for Payer: Priority Health Narrow Network |
$204.03
|
| Rate for Payer: Railroad Medicare Medicare |
$118.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$118.38
|
| Rate for Payer: UHC Exchange |
$236.99
|
| Rate for Payer: UHC Medicaid |
$74.76
|
| Rate for Payer: UHCCP DNSP |
$118.38
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$630.48 |
| Max. Negotiated Rate |
$1,889.21 |
| Rate for Payer: Aetna Commercial |
$1,322.63
|
| Rate for Payer: Aetna Medicare |
$987.04
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$987.04
|
| Rate for Payer: BCN Commercial |
$1,542.25
|
| Rate for Payer: BCN Medicare Advantage |
$987.04
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cofinity Commercial |
$1,421.34
|
| Rate for Payer: Cofinity Commercial |
$1,322.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$987.04
|
| Rate for Payer: Healthscope Commercial |
$1,184.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,184.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,036.39
|
| Rate for Payer: Meridian Medicaid |
$662.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,085.74
|
| Rate for Payer: Nomi Health Commercial |
$1,184.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.00
|
| Rate for Payer: PACE SWMI |
$987.04
|
| Rate for Payer: PHP Medicare Advantage |
$987.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,658.49
|
| Rate for Payer: Priority Health Medicare |
$987.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,658.49
|
| Rate for Payer: Railroad Medicare Medicare |
$987.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,889.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$987.04
|
| Rate for Payer: UHC Exchange |
$1,889.21
|
| Rate for Payer: UHC Medicaid |
$630.48
|
| Rate for Payer: UHCCP DNSP |
$987.04
|
| Rate for Payer: UHCCP Medicaid |
$630.48
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,177.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$1,632.75 |
| Rate for Payer: Aetna Commercial |
$979.00
|
| Rate for Payer: Aetna Medicare |
$730.60
|
| Rate for Payer: BCBS Complete |
$495.39
|
| Rate for Payer: BCBS MAPPO |
$730.60
|
| Rate for Payer: BCN Commercial |
$1,169.25
|
| Rate for Payer: BCN Medicare Advantage |
$730.60
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Cofinity Commercial |
$979.00
|
| Rate for Payer: Cofinity Commercial |
$1,052.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$730.60
|
| Rate for Payer: Healthscope Commercial |
$876.72
|
| Rate for Payer: Healthscope Whirlpool |
$876.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$767.13
|
| Rate for Payer: Meridian Medicaid |
$495.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$803.66
|
| Rate for Payer: Nomi Health Commercial |
$876.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,632.75
|
| Rate for Payer: PACE SWMI |
$730.60
|
| Rate for Payer: PHP Medicare Advantage |
$730.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,424.67
|
| Rate for Payer: Priority Health Medicare |
$730.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.67
|
| Rate for Payer: Railroad Medicare Medicare |
$730.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,364.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$730.60
|
| Rate for Payer: UHC Exchange |
$1,364.06
|
| Rate for Payer: UHC Medicaid |
$471.80
|
| Rate for Payer: UHCCP DNSP |
$730.60
|
| Rate for Payer: UHCCP Medicaid |
$471.80
|
|
|
PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$485.40 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Aetna Medicare |
$235.60
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCBS MAPPO |
$235.60
|
| Rate for Payer: BCN Commercial |
$398.38
|
| Rate for Payer: BCN Medicare Advantage |
$235.60
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$339.26
|
| Rate for Payer: Cofinity Commercial |
$315.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$282.72
|
| Rate for Payer: Healthscope Whirlpool |
$282.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.38
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.16
|
| Rate for Payer: Nomi Health Commercial |
$282.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.00
|
| Rate for Payer: PACE SWMI |
$235.60
|
| Rate for Payer: PHP Medicare Advantage |
$235.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$485.40
|
| Rate for Payer: Priority Health Medicare |
$235.60
|
| Rate for Payer: Priority Health Narrow Network |
$485.40
|
| Rate for Payer: Railroad Medicare Medicare |
$235.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$235.60
|
| Rate for Payer: UHC Exchange |
$463.71
|
| Rate for Payer: UHC Medicaid |
$157.19
|
| Rate for Payer: UHCCP DNSP |
$235.60
|
| Rate for Payer: UHCCP Medicaid |
$157.19
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,962.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$249.42 |
| Max. Negotiated Rate |
$1,471.50 |
| Rate for Payer: Aetna Commercial |
$508.76
|
| Rate for Payer: Aetna Medicare |
$379.67
|
| Rate for Payer: BCBS Complete |
$261.89
|
| Rate for Payer: BCBS MAPPO |
$379.67
|
| Rate for Payer: BCN Commercial |
$622.48
|
| Rate for Payer: BCN Medicare Advantage |
$379.67
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cofinity Commercial |
$546.72
|
| Rate for Payer: Cofinity Commercial |
$508.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.67
|
| Rate for Payer: Healthscope Commercial |
$455.60
|
| Rate for Payer: Healthscope Whirlpool |
$455.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.65
|
| Rate for Payer: Meridian Medicaid |
$261.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$417.64
|
| Rate for Payer: Nomi Health Commercial |
$455.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,471.50
|
| Rate for Payer: PACE SWMI |
$379.67
|
| Rate for Payer: PHP Medicare Advantage |
$379.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$722.99
|
| Rate for Payer: Priority Health Medicare |
$379.67
|
| Rate for Payer: Priority Health Narrow Network |
$722.99
|
| Rate for Payer: Railroad Medicare Medicare |
$379.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$700.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$379.67
|
| Rate for Payer: UHC Exchange |
$700.02
|
| Rate for Payer: UHC Medicaid |
$249.42
|
| Rate for Payer: UHCCP DNSP |
$379.67
|
| Rate for Payer: UHCCP Medicaid |
$249.42
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$773.62 |
| Max. Negotiated Rate |
$1,894.82 |
| Rate for Payer: Aetna Commercial |
$1,607.38
|
| Rate for Payer: Aetna Medicare |
$1,199.54
|
| Rate for Payer: BCBS Complete |
$812.30
|
| Rate for Payer: BCBS MAPPO |
$1,199.54
|
| Rate for Payer: BCN Commercial |
$1,631.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,199.54
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cofinity Commercial |
$1,727.34
|
| Rate for Payer: Cofinity Commercial |
$1,607.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,199.54
|
| Rate for Payer: Healthscope Commercial |
$1,439.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,439.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,259.52
|
| Rate for Payer: Meridian Medicaid |
$812.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,319.49
|
| Rate for Payer: Nomi Health Commercial |
$1,439.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,547.25
|
| Rate for Payer: PACE SWMI |
$1,199.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,199.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$773.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,894.82
|
| Rate for Payer: Priority Health Medicare |
$1,199.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,894.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,199.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,859.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,199.54
|
| Rate for Payer: UHC Exchange |
$1,859.26
|
| Rate for Payer: UHC Medicaid |
$773.62
|
| Rate for Payer: UHCCP DNSP |
$1,199.54
|
| Rate for Payer: UHCCP Medicaid |
$773.62
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$2,452.00
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$512.69 |
| Max. Negotiated Rate |
$1,839.00 |
| Rate for Payer: Aetna Commercial |
$1,059.59
|
| Rate for Payer: Aetna Medicare |
$790.74
|
| Rate for Payer: BCBS Complete |
$538.32
|
| Rate for Payer: BCBS MAPPO |
$790.74
|
| Rate for Payer: BCN Commercial |
$1,299.73
|
| Rate for Payer: BCN Medicare Advantage |
$790.74
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cofinity Commercial |
$1,138.67
|
| Rate for Payer: Cofinity Commercial |
$1,059.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.74
|
| Rate for Payer: Healthscope Commercial |
$948.89
|
| Rate for Payer: Healthscope Whirlpool |
$948.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$830.28
|
| Rate for Payer: Meridian Medicaid |
$538.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$869.81
|
| Rate for Payer: Nomi Health Commercial |
$948.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,839.00
|
| Rate for Payer: PACE SWMI |
$790.74
|
| Rate for Payer: PHP Medicare Advantage |
$790.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,509.61
|
| Rate for Payer: Priority Health Medicare |
$790.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,509.61
|
| Rate for Payer: Railroad Medicare Medicare |
$790.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,465.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$790.74
|
| Rate for Payer: UHC Exchange |
$1,465.83
|
| Rate for Payer: UHC Medicaid |
$512.69
|
| Rate for Payer: UHCCP DNSP |
$790.74
|
| Rate for Payer: UHCCP Medicaid |
$512.69
|
|
|
PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$262.63 |
| Max. Negotiated Rate |
$941.25 |
| Rate for Payer: Aetna Commercial |
$537.39
|
| Rate for Payer: Aetna Medicare |
$401.04
|
| Rate for Payer: BCBS Complete |
$275.76
|
| Rate for Payer: BCBS MAPPO |
$401.04
|
| Rate for Payer: BCN Commercial |
$654.35
|
| Rate for Payer: BCN Medicare Advantage |
$401.04
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$537.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$401.04
|
| Rate for Payer: Healthscope Commercial |
$481.25
|
| Rate for Payer: Healthscope Whirlpool |
$481.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$421.09
|
| Rate for Payer: Meridian Medicaid |
$275.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$441.14
|
| Rate for Payer: Nomi Health Commercial |
$481.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$941.25
|
| Rate for Payer: PACE SWMI |
$401.04
|
| Rate for Payer: PHP Medicare Advantage |
$401.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$760.01
|
| Rate for Payer: Priority Health Medicare |
$401.04
|
| Rate for Payer: Priority Health Narrow Network |
$760.01
|
| Rate for Payer: Railroad Medicare Medicare |
$401.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$714.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$401.04
|
| Rate for Payer: UHC Exchange |
$714.60
|
| Rate for Payer: UHC Medicaid |
$262.63
|
| Rate for Payer: UHCCP DNSP |
$401.04
|
| Rate for Payer: UHCCP Medicaid |
$262.63
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$238.77 |
| Max. Negotiated Rate |
$972.75 |
| Rate for Payer: Aetna Commercial |
$488.14
|
| Rate for Payer: Aetna Medicare |
$364.28
|
| Rate for Payer: BCBS Complete |
$250.71
|
| Rate for Payer: BCBS MAPPO |
$364.28
|
| Rate for Payer: BCN Commercial |
$613.51
|
| Rate for Payer: BCN Medicare Advantage |
$364.28
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$524.56
|
| Rate for Payer: Cofinity Commercial |
$488.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$364.28
|
| Rate for Payer: Healthscope Commercial |
$437.14
|
| Rate for Payer: Healthscope Whirlpool |
$437.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$382.49
|
| Rate for Payer: Meridian Medicaid |
$250.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$400.71
|
| Rate for Payer: Nomi Health Commercial |
$437.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$972.75
|
| Rate for Payer: PACE SWMI |
$364.28
|
| Rate for Payer: PHP Medicare Advantage |
$364.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$712.59
|
| Rate for Payer: Priority Health Medicare |
$364.28
|
| Rate for Payer: Priority Health Narrow Network |
$712.59
|
| Rate for Payer: Railroad Medicare Medicare |
$364.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$679.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$364.28
|
| Rate for Payer: UHC Exchange |
$679.47
|
| Rate for Payer: UHC Medicaid |
$238.77
|
| Rate for Payer: UHCCP DNSP |
$364.28
|
| Rate for Payer: UHCCP Medicaid |
$238.77
|
|
|
PR EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 64783
|
| Min. Negotiated Rate |
$118.22 |
| Max. Negotiated Rate |
$386.26 |
| Rate for Payer: Aetna Commercial |
$248.42
|
| Rate for Payer: Aetna Medicare |
$185.39
|
| Rate for Payer: BCBS Complete |
$124.13
|
| Rate for Payer: BCBS MAPPO |
$185.39
|
| Rate for Payer: BCN Commercial |
$320.20
|
| Rate for Payer: BCN Medicare Advantage |
$185.39
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$248.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.39
|
| Rate for Payer: Healthscope Commercial |
$222.47
|
| Rate for Payer: Healthscope Whirlpool |
$222.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.66
|
| Rate for Payer: Meridian Medicaid |
$124.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.93
|
| Rate for Payer: Nomi Health Commercial |
$222.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PACE SWMI |
$185.39
|
| Rate for Payer: PHP Medicare Advantage |
$185.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$371.91
|
| Rate for Payer: Priority Health Medicare |
$185.39
|
| Rate for Payer: Priority Health Narrow Network |
$371.91
|
| Rate for Payer: Railroad Medicare Medicare |
$185.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.39
|
| Rate for Payer: UHC Exchange |
$386.26
|
| Rate for Payer: UHC Medicaid |
$118.22
|
| Rate for Payer: UHCCP DNSP |
$185.39
|
| Rate for Payer: UHCCP Medicaid |
$118.22
|
|
|
PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,745.00
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$278.18 |
| Max. Negotiated Rate |
$1,308.75 |
| Rate for Payer: Aetna Commercial |
$569.97
|
| Rate for Payer: Aetna Medicare |
$425.35
|
| Rate for Payer: BCBS Complete |
$292.09
|
| Rate for Payer: BCBS MAPPO |
$425.35
|
| Rate for Payer: BCN Commercial |
$698.67
|
| Rate for Payer: BCN Medicare Advantage |
$425.35
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Cofinity Commercial |
$612.50
|
| Rate for Payer: Cofinity Commercial |
$569.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.35
|
| Rate for Payer: Healthscope Commercial |
$510.42
|
| Rate for Payer: Healthscope Whirlpool |
$510.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.62
|
| Rate for Payer: Meridian Medicaid |
$292.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$467.88
|
| Rate for Payer: Nomi Health Commercial |
$510.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,308.75
|
| Rate for Payer: PACE SWMI |
$425.35
|
| Rate for Payer: PHP Medicare Advantage |
$425.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$811.49
|
| Rate for Payer: Priority Health Medicare |
$425.35
|
| Rate for Payer: Priority Health Narrow Network |
$811.49
|
| Rate for Payer: Railroad Medicare Medicare |
$425.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$425.35
|
| Rate for Payer: UHC Exchange |
$795.89
|
| Rate for Payer: UHC Medicaid |
$278.18
|
| Rate for Payer: UHCCP DNSP |
$425.35
|
| Rate for Payer: UHCCP Medicaid |
$278.18
|
|
|
PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$2,564.00
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$429.20 |
| Max. Negotiated Rate |
$1,923.00 |
| Rate for Payer: Aetna Commercial |
$883.81
|
| Rate for Payer: Aetna Medicare |
$659.56
|
| Rate for Payer: BCBS Complete |
$450.66
|
| Rate for Payer: BCBS MAPPO |
$659.56
|
| Rate for Payer: BCN Commercial |
$1,104.52
|
| Rate for Payer: BCN Medicare Advantage |
$659.56
|
| Rate for Payer: Cash Price |
$2,051.20
|
| Rate for Payer: Cash Price |
$2,051.20
|
| Rate for Payer: Cofinity Commercial |
$949.77
|
| Rate for Payer: Cofinity Commercial |
$883.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$659.56
|
| Rate for Payer: Healthscope Commercial |
$791.47
|
| Rate for Payer: Healthscope Whirlpool |
$791.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$692.54
|
| Rate for Payer: Meridian Medicaid |
$450.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$725.52
|
| Rate for Payer: Nomi Health Commercial |
$791.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,923.00
|
| Rate for Payer: PACE SWMI |
$659.56
|
| Rate for Payer: PHP Medicare Advantage |
$659.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,282.89
|
| Rate for Payer: Priority Health Medicare |
$659.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,282.89
|
| Rate for Payer: Railroad Medicare Medicare |
$659.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,277.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$659.56
|
| Rate for Payer: UHC Exchange |
$1,277.51
|
| Rate for Payer: UHC Medicaid |
$429.20
|
| Rate for Payer: UHCCP DNSP |
$659.56
|
| Rate for Payer: UHCCP Medicaid |
$429.20
|
|
|
PR EXC PRESAC/SACROCOCCYGEAL TUMOR
|
Professional
|
Both
|
$4,120.00
|
|
|
Service Code
|
HCPCS 49215
|
| Min. Negotiated Rate |
$1,277.57 |
| Max. Negotiated Rate |
$4,028.25 |
| Rate for Payer: Aetna Commercial |
$2,672.63
|
| Rate for Payer: Aetna Medicare |
$1,994.50
|
| Rate for Payer: BCBS Complete |
$1,341.45
|
| Rate for Payer: BCBS MAPPO |
$1,994.50
|
| Rate for Payer: BCN Commercial |
$3,306.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,994.50
|
| Rate for Payer: Cash Price |
$3,296.00
|
| Rate for Payer: Cash Price |
$3,296.00
|
| Rate for Payer: Cofinity Commercial |
$2,872.08
|
| Rate for Payer: Cofinity Commercial |
$2,672.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,994.50
|
| Rate for Payer: Healthscope Commercial |
$2,393.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,393.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,094.22
|
| Rate for Payer: Meridian Medicaid |
$1,341.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,193.95
|
| Rate for Payer: Nomi Health Commercial |
$2,393.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,090.00
|
| Rate for Payer: PACE SWMI |
$1,994.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,994.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,277.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,028.25
|
| Rate for Payer: Priority Health Medicare |
$1,994.50
|
| Rate for Payer: Priority Health Narrow Network |
$4,028.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,994.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,948.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,994.50
|
| Rate for Payer: UHC Exchange |
$3,948.88
|
| Rate for Payer: UHC Medicaid |
$1,277.57
|
| Rate for Payer: UHCCP DNSP |
$1,994.50
|
| Rate for Payer: UHCCP Medicaid |
$1,277.57
|
|
