|
PR EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 42104
|
| Min. Negotiated Rate |
$87.33 |
| Max. Negotiated Rate |
$1,644.60 |
| Rate for Payer: Aetna Commercial |
$176.41
|
| Rate for Payer: Aetna Medicare |
$192.50
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.60
|
| Rate for Payer: BCN Commercial |
$320.57
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.40
|
| Rate for Payer: Priority Health Narrow Network |
$243.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.41
|
| Rate for Payer: UHC Exchange |
$164.41
|
| Rate for Payer: UHCCP Medicaid |
$87.33
|
|
|
PR EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 42106
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$1,938.86 |
| Rate for Payer: Aetna Commercial |
$217.85
|
| Rate for Payer: Aetna Medicare |
$253.00
|
| Rate for Payer: BCBS Complete |
$109.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.86
|
| Rate for Payer: BCN Commercial |
$374.33
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Meridian Medicaid |
$109.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.16
|
| Rate for Payer: Priority Health Narrow Network |
$288.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.56
|
| Rate for Payer: UHC Exchange |
$211.56
|
| Rate for Payer: UHCCP Medicaid |
$104.16
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
55520
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$825.50 |
| Max. Negotiated Rate |
$1,270.00 |
| Rate for Payer: Aetna Commercial |
$1,143.00
|
| Rate for Payer: ASR ASR |
$1,231.90
|
| Rate for Payer: ASR Commercial |
$1,231.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.92
|
| Rate for Payer: BCN Commercial |
$984.63
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$1,193.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.00
|
| Rate for Payer: Healthscope Commercial |
$1,270.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,231.90
|
| Rate for Payer: Mclaren Commercial |
$1,143.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,079.50
|
| Rate for Payer: Nomi Health Commercial |
$1,041.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,117.60
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
55520
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$825.50 |
| Max. Negotiated Rate |
$5,237.81 |
| Rate for Payer: Aetna Commercial |
$1,143.00
|
| Rate for Payer: Aetna Medicare |
$3,379.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: ASR ASR |
$1,231.90
|
| Rate for Payer: ASR Commercial |
$1,231.90
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,040.00
|
| Rate for Payer: BCN Commercial |
$984.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$1,193.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Healthscope Commercial |
$1,270.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,231.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,379.23
|
| Rate for Payer: Mclaren Commercial |
$1,143.00
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,079.50
|
| Rate for Payer: Nomi Health Commercial |
$1,041.40
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Commercial |
$3,717.15
|
| Rate for Payer: PHP Medicaid |
$1,811.27
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,112.77
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$890.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,117.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$5,237.81
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP DNSP |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
55520
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$2,718.10 |
| Rate for Payer: Aetna Commercial |
$590.37
|
| Rate for Payer: Aetna Medicare |
$635.00
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,718.10
|
| Rate for Payer: BCN Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.25
|
| Rate for Payer: Priority Health Narrow Network |
$739.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$491.91
|
| Rate for Payer: UHC Exchange |
$491.91
|
| Rate for Payer: UHCCP Medicaid |
$298.20
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 55520
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$2,718.10 |
| Rate for Payer: Aetna Commercial |
$590.37
|
| Rate for Payer: Aetna Medicare |
$635.00
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,718.10
|
| Rate for Payer: BCN Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.25
|
| Rate for Payer: Priority Health Narrow Network |
$739.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$491.91
|
| Rate for Payer: UHC Exchange |
$491.91
|
| Rate for Payer: UHCCP Medicaid |
$298.20
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$912.85 |
| Rate for Payer: Aetna Commercial |
$417.83
|
| Rate for Payer: Aetna Medicare |
$528.00
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.63
|
| Rate for Payer: Priority Health Narrow Network |
$495.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.02
|
| Rate for Payer: UHC Exchange |
$361.02
|
| Rate for Payer: UHCCP Medicaid |
$209.59
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$2,430.48 |
| Rate for Payer: Aetna Commercial |
$950.40
|
| Rate for Payer: Aetna Medicare |
$1,568.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: ASR ASR |
$1,024.32
|
| Rate for Payer: ASR Commercial |
$1,024.32
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$864.76
|
| Rate for Payer: BCN Commercial |
$818.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$992.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$1,056.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,024.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.05
|
| Rate for Payer: Mclaren Commercial |
$950.40
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: Nomi Health Commercial |
$865.92
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,724.86
|
| Rate for Payer: PHP Medicaid |
$840.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$925.27
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$740.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$929.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,430.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP DNSP |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$950.40
|
| Rate for Payer: ASR ASR |
$1,024.32
|
| Rate for Payer: ASR Commercial |
$1,024.32
|
| Rate for Payer: BCBS Trust/PPO |
$860.53
|
| Rate for Payer: BCN Commercial |
$818.72
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$992.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Healthscope Commercial |
$1,056.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,024.32
|
| Rate for Payer: Mclaren Commercial |
$950.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: Nomi Health Commercial |
$865.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$929.28
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$912.85 |
| Rate for Payer: Aetna Commercial |
$417.83
|
| Rate for Payer: Aetna Medicare |
$528.00
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.63
|
| Rate for Payer: Priority Health Narrow Network |
$495.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.02
|
| Rate for Payer: UHC Exchange |
$361.02
|
| Rate for Payer: UHCCP Medicaid |
$209.59
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$575.90 |
| Max. Negotiated Rate |
$886.00 |
| Rate for Payer: Aetna Commercial |
$797.40
|
| Rate for Payer: ASR ASR |
$859.42
|
| Rate for Payer: ASR Commercial |
$859.42
|
| Rate for Payer: BCBS Trust/PPO |
$722.00
|
| Rate for Payer: BCN Commercial |
$686.92
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$832.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Healthscope Commercial |
$886.00
|
| Rate for Payer: Healthscope Whirlpool |
$859.42
|
| Rate for Payer: Mclaren Commercial |
$797.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: Nomi Health Commercial |
$726.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$779.68
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$201.29 |
| Max. Negotiated Rate |
$676.82 |
| Rate for Payer: Aetna Commercial |
$404.59
|
| Rate for Payer: Aetna Medicare |
$443.00
|
| Rate for Payer: BCBS Complete |
$211.35
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$676.82
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Meridian Medicaid |
$211.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.29
|
| Rate for Payer: Priority Health Narrow Network |
$476.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.41
|
| Rate for Payer: UHC Exchange |
$359.41
|
| Rate for Payer: UHCCP Medicaid |
$201.29
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$201.29 |
| Max. Negotiated Rate |
$676.82 |
| Rate for Payer: Aetna Commercial |
$404.59
|
| Rate for Payer: Aetna Medicare |
$443.00
|
| Rate for Payer: BCBS Complete |
$211.35
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$676.82
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Meridian Medicaid |
$211.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.29
|
| Rate for Payer: Priority Health Narrow Network |
$476.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.41
|
| Rate for Payer: UHC Exchange |
$359.41
|
| Rate for Payer: UHCCP Medicaid |
$201.29
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$575.90 |
| Max. Negotiated Rate |
$2,430.48 |
| Rate for Payer: Aetna Commercial |
$797.40
|
| Rate for Payer: Aetna Medicare |
$1,568.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: ASR ASR |
$859.42
|
| Rate for Payer: ASR Commercial |
$859.42
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$725.55
|
| Rate for Payer: BCN Commercial |
$686.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$832.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$886.00
|
| Rate for Payer: Healthscope Whirlpool |
$859.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.05
|
| Rate for Payer: Mclaren Commercial |
$797.40
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: Nomi Health Commercial |
$726.52
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,724.86
|
| Rate for Payer: PHP Medicaid |
$840.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$776.31
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$621.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$779.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,430.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP DNSP |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$177.86 |
| Max. Negotiated Rate |
$612.80 |
| Rate for Payer: Aetna Commercial |
$353.01
|
| Rate for Payer: Aetna Medicare |
$414.50
|
| Rate for Payer: BCBS Complete |
$186.75
|
| Rate for Payer: BCBS Trust/PPO |
$353.43
|
| Rate for Payer: BCN Commercial |
$612.80
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Meridian Medicaid |
$186.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.34
|
| Rate for Payer: Priority Health Narrow Network |
$421.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.24
|
| Rate for Payer: UHC Exchange |
$315.24
|
| Rate for Payer: UHCCP Medicaid |
$177.86
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$534.11 |
| Rate for Payer: Aetna Commercial |
$318.43
|
| Rate for Payer: Aetna Medicare |
$296.50
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCBS Trust/PPO |
$534.11
|
| Rate for Payer: BCN Commercial |
$499.92
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.31
|
| Rate for Payer: Priority Health Narrow Network |
$437.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.00
|
| Rate for Payer: UHC Exchange |
$296.00
|
| Rate for Payer: UHCCP Medicaid |
$157.19
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$569.51 |
| Rate for Payer: Aetna Commercial |
$350.99
|
| Rate for Payer: Aetna Medicare |
$378.50
|
| Rate for Payer: BCBS Complete |
$179.14
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Meridian Medicaid |
$179.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.30
|
| Rate for Payer: Priority Health Narrow Network |
$474.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.51
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHCCP Medicaid |
$170.61
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$1,117.41 |
| Rate for Payer: Aetna Commercial |
$810.36
|
| Rate for Payer: Aetna Medicare |
$577.50
|
| Rate for Payer: BCBS Complete |
$419.35
|
| Rate for Payer: BCBS Trust/PPO |
$515.09
|
| Rate for Payer: BCN Commercial |
$911.87
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Meridian Medicaid |
$419.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,117.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$765.15
|
| Rate for Payer: UHC Exchange |
$765.15
|
| Rate for Payer: UHCCP Medicaid |
$399.38
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$188.51 |
| Max. Negotiated Rate |
$633.33 |
| Rate for Payer: Aetna Commercial |
$383.32
|
| Rate for Payer: Aetna Medicare |
$355.50
|
| Rate for Payer: BCBS Complete |
$197.94
|
| Rate for Payer: BCBS Trust/PPO |
$529.88
|
| Rate for Payer: BCN Commercial |
$633.33
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Meridian Medicaid |
$197.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$517.85
|
| Rate for Payer: Priority Health Narrow Network |
$517.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.21
|
| Rate for Payer: UHC Exchange |
$361.21
|
| Rate for Payer: UHCCP Medicaid |
$188.51
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$339.70 |
| Rate for Payer: Aetna Commercial |
$156.16
|
| Rate for Payer: Aetna Medicare |
$210.00
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS Trust/PPO |
$339.70
|
| Rate for Payer: BCN Commercial |
$324.97
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.96
|
| Rate for Payer: Priority Health Narrow Network |
$218.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.19
|
| Rate for Payer: UHC Exchange |
$149.19
|
| Rate for Payer: UHCCP Medicaid |
$78.81
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$79.02 |
| Max. Negotiated Rate |
$667.79 |
| Rate for Payer: Aetna Commercial |
$159.38
|
| Rate for Payer: Aetna Medicare |
$184.50
|
| Rate for Payer: BCBS Complete |
$82.97
|
| Rate for Payer: BCBS Trust/PPO |
$667.79
|
| Rate for Payer: BCN Commercial |
$320.09
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Meridian Medicaid |
$82.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.73
|
| Rate for Payer: Priority Health Narrow Network |
$220.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.99
|
| Rate for Payer: UHC Exchange |
$148.99
|
| Rate for Payer: UHCCP Medicaid |
$79.02
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$355.71 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$731.34
|
| Rate for Payer: Aetna Medicare |
$991.50
|
| Rate for Payer: BCBS Complete |
$373.50
|
| Rate for Payer: BCBS Trust/PPO |
$774.49
|
| Rate for Payer: BCN Commercial |
$808.76
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Meridian Medicaid |
$373.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$995.13
|
| Rate for Payer: Priority Health Narrow Network |
$995.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$670.95
|
| Rate for Payer: UHC Exchange |
$670.95
|
| Rate for Payer: UHCCP Medicaid |
$355.71
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$226.42 |
| Max. Negotiated Rate |
$719.83 |
| Rate for Payer: Aetna Commercial |
$459.97
|
| Rate for Payer: Aetna Medicare |
$363.00
|
| Rate for Payer: BCBS Complete |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: BCN Commercial |
$719.83
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Meridian Medicaid |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$630.60
|
| Rate for Payer: Priority Health Narrow Network |
$630.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.36
|
| Rate for Payer: UHC Exchange |
$426.36
|
| Rate for Payer: UHCCP Medicaid |
$226.42
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$769.60 |
| Rate for Payer: Aetna Commercial |
$468.59
|
| Rate for Payer: Aetna Medicare |
$592.00
|
| Rate for Payer: BCBS Complete |
$244.23
|
| Rate for Payer: BCBS Trust/PPO |
$423.17
|
| Rate for Payer: BCN Commercial |
$744.75
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Meridian Medicaid |
$244.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.33
|
| Rate for Payer: Priority Health Narrow Network |
$644.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.35
|
| Rate for Payer: UHC Exchange |
$431.35
|
| Rate for Payer: UHCCP Medicaid |
$232.60
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,843.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$787.17 |
| Max. Negotiated Rate |
$2,200.84 |
| Rate for Payer: Aetna Commercial |
$1,652.07
|
| Rate for Payer: Aetna Medicare |
$921.50
|
| Rate for Payer: BCBS Complete |
$828.85
|
| Rate for Payer: BCBS Trust/PPO |
$787.17
|
| Rate for Payer: BCN Commercial |
$1,790.02
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Meridian Medicaid |
$828.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,197.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,200.84
|
| Rate for Payer: Priority Health Narrow Network |
$2,200.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,474.40
|
| Rate for Payer: UHC Exchange |
$1,474.40
|
| Rate for Payer: UHCCP Medicaid |
$789.38
|
|
