|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,159.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$627.29 |
| Max. Negotiated Rate |
$2,053.35 |
| Rate for Payer: Aetna Commercial |
$1,326.15
|
| Rate for Payer: Aetna Medicare |
$1,579.50
|
| Rate for Payer: BCBS Complete |
$658.65
|
| Rate for Payer: BCBS Trust/PPO |
$686.26
|
| Rate for Payer: BCN Commercial |
$1,429.87
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Meridian Medicaid |
$658.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,053.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,751.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,751.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,182.31
|
| Rate for Payer: UHC Exchange |
$1,182.31
|
| Rate for Payer: UHCCP Medicaid |
$627.29
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$1,025.43 |
| Rate for Payer: Aetna Commercial |
$175.64
|
| Rate for Payer: Aetna Medicare |
$146.00
|
| Rate for Payer: BCBS Complete |
$85.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.43
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Meridian Medicaid |
$85.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.56
|
| Rate for Payer: Priority Health Narrow Network |
$201.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.83
|
| Rate for Payer: UHC Exchange |
$177.83
|
| Rate for Payer: UHCCP Medicaid |
$81.15
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$659.66 |
| Max. Negotiated Rate |
$5,381.79 |
| Rate for Payer: Aetna Commercial |
$1,400.04
|
| Rate for Payer: Aetna Medicare |
$1,062.00
|
| Rate for Payer: BCBS Complete |
$692.64
|
| Rate for Payer: BCBS Trust/PPO |
$5,381.79
|
| Rate for Payer: BCN Commercial |
$1,497.31
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Meridian Medicaid |
$692.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,380.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,638.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,638.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,420.49
|
| Rate for Payer: UHC Exchange |
$1,420.49
|
| Rate for Payer: UHCCP Medicaid |
$659.66
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$1,397.22 |
| Rate for Payer: Aetna Commercial |
$1,037.13
|
| Rate for Payer: Aetna Medicare |
$1,057.00
|
| Rate for Payer: BCBS Complete |
$525.13
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$1,133.25
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Meridian Medicaid |
$525.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,397.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,397.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$911.68
|
| Rate for Payer: UHC Exchange |
$911.68
|
| Rate for Payer: UHCCP Medicaid |
$500.12
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$1,397.22 |
| Rate for Payer: Aetna Commercial |
$1,037.13
|
| Rate for Payer: Aetna Medicare |
$1,057.00
|
| Rate for Payer: BCBS Complete |
$525.13
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$1,133.25
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Meridian Medicaid |
$525.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,397.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,397.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$911.68
|
| Rate for Payer: UHC Exchange |
$911.68
|
| Rate for Payer: UHCCP Medicaid |
$500.12
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
OP
|
$2,114.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$845.60 |
| Max. Negotiated Rate |
$2,114.00 |
| Rate for Payer: Aetna Commercial |
$1,902.60
|
| Rate for Payer: Aetna Medicare |
$1,057.00
|
| Rate for Payer: ASR ASR |
$2,050.58
|
| Rate for Payer: ASR Commercial |
$2,050.58
|
| Rate for Payer: BCBS Complete |
$845.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,731.15
|
| Rate for Payer: BCN Commercial |
$1,638.98
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,987.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.20
|
| Rate for Payer: Healthscope Commercial |
$2,114.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,050.58
|
| Rate for Payer: Mclaren Commercial |
$1,902.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.90
|
| Rate for Payer: Nomi Health Commercial |
$1,733.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,852.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,481.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,860.32
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
IP
|
$2,114.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$1,374.10 |
| Max. Negotiated Rate |
$2,114.00 |
| Rate for Payer: Aetna Commercial |
$1,902.60
|
| Rate for Payer: ASR ASR |
$2,050.58
|
| Rate for Payer: ASR Commercial |
$2,050.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,722.70
|
| Rate for Payer: BCN Commercial |
$1,638.98
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,987.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.20
|
| Rate for Payer: Healthscope Commercial |
$2,114.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,050.58
|
| Rate for Payer: Mclaren Commercial |
$1,902.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.90
|
| Rate for Payer: Nomi Health Commercial |
$1,733.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,860.32
|
|
|
PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$762.87 |
| Rate for Payer: Aetna Commercial |
$357.02
|
| Rate for Payer: Aetna Medicare |
$291.50
|
| Rate for Payer: BCBS Complete |
$178.92
|
| Rate for Payer: BCBS Trust/PPO |
$762.87
|
| Rate for Payer: BCN Commercial |
$539.99
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Meridian Medicaid |
$178.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.68
|
| Rate for Payer: Priority Health Narrow Network |
$476.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.83
|
| Rate for Payer: UHC Exchange |
$320.83
|
| Rate for Payer: UHCCP Medicaid |
$170.40
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$161.13 |
| Max. Negotiated Rate |
$1,238.25 |
| Rate for Payer: Aetna Commercial |
$515.29
|
| Rate for Payer: Aetna Medicare |
$952.50
|
| Rate for Payer: BCBS Complete |
$279.56
|
| Rate for Payer: BCBS Trust/PPO |
$161.13
|
| Rate for Payer: BCN Commercial |
$595.21
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Meridian Medicaid |
$279.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,238.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$707.49
|
| Rate for Payer: Priority Health Narrow Network |
$707.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$447.22
|
| Rate for Payer: UHC Exchange |
$447.22
|
| Rate for Payer: UHCCP Medicaid |
$266.25
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$2,003.00
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$209.74 |
| Max. Negotiated Rate |
$1,850.03 |
| Rate for Payer: Aetna Commercial |
$1,376.32
|
| Rate for Payer: Aetna Medicare |
$1,001.50
|
| Rate for Payer: BCBS Complete |
$732.68
|
| Rate for Payer: BCBS Trust/PPO |
$209.74
|
| Rate for Payer: BCN Commercial |
$1,559.37
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Meridian Medicaid |
$732.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$697.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,850.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,850.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,326.46
|
| Rate for Payer: UHC Exchange |
$1,326.46
|
| Rate for Payer: UHCCP Medicaid |
$697.79
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$2,381.00
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$160.07 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Aetna Commercial |
$1,074.60
|
| Rate for Payer: Aetna Medicare |
$1,190.50
|
| Rate for Payer: BCBS Complete |
$583.73
|
| Rate for Payer: BCBS Trust/PPO |
$160.07
|
| Rate for Payer: BCN Commercial |
$1,243.68
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Meridian Medicaid |
$583.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$555.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,465.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,465.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$953.99
|
| Rate for Payer: UHC Exchange |
$953.99
|
| Rate for Payer: UHCCP Medicaid |
$555.93
|
|
|
PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$266.26 |
| Max. Negotiated Rate |
$791.70 |
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: Aetna Medicare |
$609.00
|
| Rate for Payer: BCBS Complete |
$293.87
|
| Rate for Payer: BCBS Trust/PPO |
$266.26
|
| Rate for Payer: BCN Commercial |
$627.46
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Meridian Medicaid |
$293.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.90
|
| Rate for Payer: Priority Health Narrow Network |
$739.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.16
|
| Rate for Payer: UHC Exchange |
$473.16
|
| Rate for Payer: UHCCP Medicaid |
$279.88
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$1,259.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$262.42 |
| Max. Negotiated Rate |
$818.35 |
| Rate for Payer: Aetna Commercial |
$501.13
|
| Rate for Payer: Aetna Medicare |
$629.50
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$302.19
|
| Rate for Payer: BCN Commercial |
$584.95
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Meridian Medicaid |
$275.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$700.09
|
| Rate for Payer: Priority Health Narrow Network |
$700.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.05
|
| Rate for Payer: UHC Exchange |
$446.05
|
| Rate for Payer: UHCCP Medicaid |
$262.42
|
|
|
PR EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 64783
|
| Min. Negotiated Rate |
$136.96 |
| Max. Negotiated Rate |
$362.83 |
| Rate for Payer: Aetna Commercial |
$279.67
|
| Rate for Payer: Aetna Medicare |
$222.50
|
| Rate for Payer: BCBS Complete |
$143.81
|
| Rate for Payer: BCN Commercial |
$311.78
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Meridian Medicaid |
$143.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$362.83
|
| Rate for Payer: Priority Health Narrow Network |
$362.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.46
|
| Rate for Payer: UHC Exchange |
$254.46
|
| Rate for Payer: UHCCP Medicaid |
$136.96
|
|
|
PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$1,101.10 |
| Rate for Payer: Aetna Commercial |
$586.40
|
| Rate for Payer: Aetna Medicare |
$847.00
|
| Rate for Payer: BCBS Complete |
$313.78
|
| Rate for Payer: BCBS Trust/PPO |
$306.94
|
| Rate for Payer: BCN Commercial |
$666.56
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Meridian Medicaid |
$313.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,101.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$784.25
|
| Rate for Payer: Priority Health Narrow Network |
$784.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$524.21
|
| Rate for Payer: UHC Exchange |
$524.21
|
| Rate for Payer: UHCCP Medicaid |
$298.84
|
|
|
PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$2,489.00
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$1,617.85 |
| Rate for Payer: Aetna Commercial |
$937.29
|
| Rate for Payer: Aetna Medicare |
$1,244.50
|
| Rate for Payer: BCBS Complete |
$496.05
|
| Rate for Payer: BCBS Trust/PPO |
$128.38
|
| Rate for Payer: BCN Commercial |
$1,063.36
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Meridian Medicaid |
$496.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,244.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,244.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.18
|
| Rate for Payer: UHC Exchange |
$836.18
|
| Rate for Payer: UHCCP Medicaid |
$472.43
|
|
|
PR EXC PRESAC/SACROCOCCYGEAL TUMOR
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 49215
|
| Min. Negotiated Rate |
$757.05 |
| Max. Negotiated Rate |
$3,963.18 |
| Rate for Payer: Aetna Commercial |
$2,988.87
|
| Rate for Payer: Aetna Medicare |
$2,000.00
|
| Rate for Payer: BCBS Complete |
$1,484.82
|
| Rate for Payer: BCBS Trust/PPO |
$757.05
|
| Rate for Payer: BCN Commercial |
$3,195.95
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Meridian Medicaid |
$1,484.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,414.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,600.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,963.18
|
| Rate for Payer: Priority Health Narrow Network |
$3,963.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,668.83
|
| Rate for Payer: UHC Exchange |
$2,668.83
|
| Rate for Payer: UHCCP Medicaid |
$1,414.11
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,787.00
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,903.13 |
| Rate for Payer: Aetna Commercial |
$1,398.85
|
| Rate for Payer: Aetna Medicare |
$893.50
|
| Rate for Payer: BCBS Complete |
$715.46
|
| Rate for Payer: BCBS Trust/PPO |
$284.75
|
| Rate for Payer: BCN Commercial |
$1,551.06
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Meridian Medicaid |
$715.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$681.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,903.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,903.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,373.63
|
| Rate for Payer: UHC Exchange |
$1,373.63
|
| Rate for Payer: UHCCP Medicaid |
$681.39
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$1,136.52 |
| Rate for Payer: Aetna Commercial |
$830.54
|
| Rate for Payer: Aetna Medicare |
$592.00
|
| Rate for Payer: BCBS Complete |
$426.50
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: BCN Commercial |
$926.05
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Meridian Medicaid |
$426.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$762.70
|
| Rate for Payer: UHC Exchange |
$762.70
|
| Rate for Payer: UHCCP Medicaid |
$406.19
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$2,032.00
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$279.47 |
| Max. Negotiated Rate |
$2,128.06 |
| Rate for Payer: Aetna Commercial |
$1,570.77
|
| Rate for Payer: Aetna Medicare |
$1,016.00
|
| Rate for Payer: BCBS Complete |
$800.67
|
| Rate for Payer: BCBS Trust/PPO |
$279.47
|
| Rate for Payer: BCN Commercial |
$1,737.25
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Meridian Medicaid |
$800.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,128.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,128.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,575.00
|
| Rate for Payer: UHC Exchange |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$762.54
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH
|
Professional
|
Both
|
$2,703.00
|
|
|
Service Code
|
HCPCS 45135
|
| Min. Negotiated Rate |
$826.87 |
| Max. Negotiated Rate |
$2,305.83 |
| Rate for Payer: Aetna Commercial |
$1,721.13
|
| Rate for Payer: Aetna Medicare |
$1,351.50
|
| Rate for Payer: BCBS Complete |
$868.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,920.90
|
| Rate for Payer: BCN Commercial |
$1,878.48
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Meridian Medicaid |
$868.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,756.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,305.83
|
| Rate for Payer: Priority Health Narrow Network |
$2,305.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,632.74
|
| Rate for Payer: UHC Exchange |
$1,632.74
|
| Rate for Payer: UHCCP Medicaid |
$826.87
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH
|
Professional
|
Both
|
$2,827.00
|
|
|
Service Code
|
HCPCS 45130
|
| Min. Negotiated Rate |
$692.46 |
| Max. Negotiated Rate |
$2,249.50 |
| Rate for Payer: Aetna Commercial |
$1,446.17
|
| Rate for Payer: Aetna Medicare |
$1,413.50
|
| Rate for Payer: BCBS Complete |
$727.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,249.50
|
| Rate for Payer: BCN Commercial |
$1,574.03
|
| Rate for Payer: Cash Price |
$2,261.60
|
| Rate for Payer: Cash Price |
$2,261.60
|
| Rate for Payer: Meridian Medicaid |
$727.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,837.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,930.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,930.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,306.69
|
| Rate for Payer: UHC Exchange |
$1,306.69
|
| Rate for Payer: UHCCP Medicaid |
$692.46
|
|
|
PR EXC RCT TUM INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,883.00
|
|
|
Service Code
|
HCPCS 45172
|
| Min. Negotiated Rate |
$478.64 |
| Max. Negotiated Rate |
$1,476.58 |
| Rate for Payer: Aetna Commercial |
$1,102.79
|
| Rate for Payer: Aetna Medicare |
$941.50
|
| Rate for Payer: BCBS Complete |
$556.22
|
| Rate for Payer: BCBS Trust/PPO |
$478.64
|
| Rate for Payer: BCN Commercial |
$1,203.12
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Meridian Medicaid |
$556.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$529.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,223.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,476.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,476.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,011.63
|
| Rate for Payer: UHC Exchange |
$1,011.63
|
| Rate for Payer: UHCCP Medicaid |
$529.73
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 45171
|
| Min. Negotiated Rate |
$398.52 |
| Max. Negotiated Rate |
$2,751.91 |
| Rate for Payer: Aetna Commercial |
$825.89
|
| Rate for Payer: Aetna Medicare |
$685.00
|
| Rate for Payer: BCBS Complete |
$418.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,751.91
|
| Rate for Payer: BCN Commercial |
$905.03
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Meridian Medicaid |
$418.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,109.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,109.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$735.63
|
| Rate for Payer: UHC Exchange |
$735.63
|
| Rate for Payer: UHCCP Medicaid |
$398.52
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$890.50 |
| Max. Negotiated Rate |
$4,164.76 |
| Rate for Payer: Aetna Commercial |
$1,233.00
|
| Rate for Payer: Aetna Medicare |
$2,686.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: ASR ASR |
$1,328.90
|
| Rate for Payer: ASR Commercial |
$1,328.90
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.89
|
| Rate for Payer: BCN Commercial |
$1,062.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$1,287.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Healthscope Commercial |
$1,370.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,328.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,686.94
|
| Rate for Payer: Mclaren Commercial |
$1,233.00
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,164.50
|
| Rate for Payer: Nomi Health Commercial |
$1,123.40
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Commercial |
$2,955.63
|
| Rate for Payer: PHP Medicaid |
$1,440.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,200.39
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$960.37
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,205.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$4,164.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP DNSP |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,440.20
|
| Rate for Payer: VA VA |
$2,686.94
|
|
