|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$847.81 |
| Rate for Payer: Aetna Commercial |
$788.94
|
| Rate for Payer: Aetna Medicare |
$588.76
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$588.76
|
| Rate for Payer: BCN Medicare Advantage |
$588.76
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$847.81
|
| Rate for Payer: Cofinity Commercial |
$788.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.76
|
| Rate for Payer: Healthscope Commercial |
$706.51
|
| Rate for Payer: Healthscope Whirlpool |
$706.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.20
|
| Rate for Payer: Nomi Health Commercial |
$706.51
|
| Rate for Payer: PACE SWMI |
$588.76
|
| Rate for Payer: PHP Medicare Advantage |
$588.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$588.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.76
|
| Rate for Payer: UHC Medicare Advantage |
$588.76
|
| Rate for Payer: UHCCP DNSP |
$588.76
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$462.15 |
| Rate for Payer: Aetna Commercial |
$369.12
|
| Rate for Payer: Aetna Medicare |
$275.46
|
| Rate for Payer: BCBS Complete |
$284.40
|
| Rate for Payer: BCBS MAPPO |
$275.46
|
| Rate for Payer: BCN Medicare Advantage |
$275.46
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cofinity Commercial |
$396.66
|
| Rate for Payer: Cofinity Commercial |
$369.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.46
|
| Rate for Payer: Healthscope Commercial |
$330.55
|
| Rate for Payer: Healthscope Whirlpool |
$330.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.23
|
| Rate for Payer: Nomi Health Commercial |
$330.55
|
| Rate for Payer: PACE SWMI |
$275.46
|
| Rate for Payer: PHP Medicare Advantage |
$275.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.15
|
| Rate for Payer: Priority Health Medicare |
$275.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.46
|
| Rate for Payer: UHC Medicare Advantage |
$275.46
|
| Rate for Payer: UHCCP DNSP |
$275.46
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$114.45 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna Medicare |
$114.45
|
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: BCBS MAPPO |
$114.45
|
| Rate for Payer: BCN Medicare Advantage |
$114.45
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$164.81
|
| Rate for Payer: Cofinity Commercial |
$153.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.45
|
| Rate for Payer: Healthscope Commercial |
$137.34
|
| Rate for Payer: Healthscope Whirlpool |
$137.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.17
|
| Rate for Payer: Nomi Health Commercial |
$137.34
|
| Rate for Payer: PACE SWMI |
$114.45
|
| Rate for Payer: PHP Medicare Advantage |
$114.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health Medicare |
$114.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.45
|
| Rate for Payer: UHC Medicare Advantage |
$114.45
|
| Rate for Payer: UHCCP DNSP |
$114.45
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$114.60 |
| Max. Negotiated Rate |
$239.85 |
| Rate for Payer: Aetna Commercial |
$153.56
|
| Rate for Payer: Aetna Medicare |
$114.60
|
| Rate for Payer: BCBS Complete |
$147.60
|
| Rate for Payer: BCBS MAPPO |
$114.60
|
| Rate for Payer: BCN Medicare Advantage |
$114.60
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cofinity Commercial |
$165.02
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.60
|
| Rate for Payer: Healthscope Commercial |
$137.52
|
| Rate for Payer: Healthscope Whirlpool |
$137.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.33
|
| Rate for Payer: Nomi Health Commercial |
$137.52
|
| Rate for Payer: PACE SWMI |
$114.60
|
| Rate for Payer: PHP Medicare Advantage |
$114.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.85
|
| Rate for Payer: Priority Health Medicare |
$114.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.60
|
| Rate for Payer: UHC Medicare Advantage |
$114.60
|
| Rate for Payer: UHCCP DNSP |
$114.60
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$524.33 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$702.60
|
| Rate for Payer: Aetna Medicare |
$524.33
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$524.33
|
| Rate for Payer: BCN Medicare Advantage |
$524.33
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$755.04
|
| Rate for Payer: Cofinity Commercial |
$702.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.33
|
| Rate for Payer: Healthscope Commercial |
$629.20
|
| Rate for Payer: Healthscope Whirlpool |
$629.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$550.55
|
| Rate for Payer: Nomi Health Commercial |
$629.20
|
| Rate for Payer: PACE SWMI |
$524.33
|
| Rate for Payer: PHP Medicare Advantage |
$524.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$524.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.33
|
| Rate for Payer: UHC Medicare Advantage |
$524.33
|
| Rate for Payer: UHCCP DNSP |
$524.33
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$290.40 |
| Max. Negotiated Rate |
$479.10 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Aetna Medicare |
$332.71
|
| Rate for Payer: BCBS Complete |
$290.40
|
| Rate for Payer: BCBS MAPPO |
$332.71
|
| Rate for Payer: BCN Medicare Advantage |
$332.71
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$479.10
|
| Rate for Payer: Cofinity Commercial |
$445.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.71
|
| Rate for Payer: Healthscope Commercial |
$399.25
|
| Rate for Payer: Healthscope Whirlpool |
$399.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.35
|
| Rate for Payer: Nomi Health Commercial |
$399.25
|
| Rate for Payer: PACE SWMI |
$332.71
|
| Rate for Payer: PHP Medicare Advantage |
$332.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.90
|
| Rate for Payer: Priority Health Medicare |
$332.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$332.71
|
| Rate for Payer: UHC Medicare Advantage |
$332.71
|
| Rate for Payer: UHCCP DNSP |
$332.71
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$341.59 |
| Max. Negotiated Rate |
$769.60 |
| Rate for Payer: Aetna Commercial |
$457.73
|
| Rate for Payer: Aetna Medicare |
$341.59
|
| Rate for Payer: BCBS Complete |
$473.60
|
| Rate for Payer: BCBS MAPPO |
$341.59
|
| Rate for Payer: BCN Medicare Advantage |
$341.59
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cofinity Commercial |
$491.89
|
| Rate for Payer: Cofinity Commercial |
$457.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.59
|
| Rate for Payer: Healthscope Commercial |
$409.91
|
| Rate for Payer: Healthscope Whirlpool |
$409.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.67
|
| Rate for Payer: Nomi Health Commercial |
$409.91
|
| Rate for Payer: PACE SWMI |
$341.59
|
| Rate for Payer: PHP Medicare Advantage |
$341.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.60
|
| Rate for Payer: Priority Health Medicare |
$341.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.59
|
| Rate for Payer: UHC Medicare Advantage |
$341.59
|
| Rate for Payer: UHCCP DNSP |
$341.59
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,843.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$737.20 |
| Max. Negotiated Rate |
$1,717.60 |
| Rate for Payer: Aetna Commercial |
$1,598.33
|
| Rate for Payer: Aetna Medicare |
$1,192.78
|
| Rate for Payer: BCBS Complete |
$737.20
|
| Rate for Payer: BCBS MAPPO |
$1,192.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.78
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cofinity Commercial |
$1,717.60
|
| Rate for Payer: Cofinity Commercial |
$1,598.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.78
|
| Rate for Payer: Healthscope Commercial |
$1,431.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,431.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,252.42
|
| Rate for Payer: Nomi Health Commercial |
$1,431.34
|
| Rate for Payer: PACE SWMI |
$1,192.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,197.95
|
| Rate for Payer: Priority Health Medicare |
$1,192.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.78
|
| Rate for Payer: UHCCP DNSP |
$1,192.78
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,159.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$948.51 |
| Max. Negotiated Rate |
$2,053.35 |
| Rate for Payer: Aetna Commercial |
$1,271.00
|
| Rate for Payer: Aetna Medicare |
$948.51
|
| Rate for Payer: BCBS Complete |
$1,263.60
|
| Rate for Payer: BCBS MAPPO |
$948.51
|
| Rate for Payer: BCN Medicare Advantage |
$948.51
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cofinity Commercial |
$1,365.85
|
| Rate for Payer: Cofinity Commercial |
$1,271.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$948.51
|
| Rate for Payer: Healthscope Commercial |
$1,138.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,138.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$995.94
|
| Rate for Payer: Nomi Health Commercial |
$1,138.21
|
| Rate for Payer: PACE SWMI |
$948.51
|
| Rate for Payer: PHP Medicare Advantage |
$948.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,053.35
|
| Rate for Payer: Priority Health Medicare |
$948.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$948.51
|
| Rate for Payer: UHC Medicare Advantage |
$948.51
|
| Rate for Payer: UHCCP DNSP |
$948.51
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$166.90
|
| Rate for Payer: Aetna Medicare |
$124.55
|
| Rate for Payer: BCBS Complete |
$116.80
|
| Rate for Payer: BCBS MAPPO |
$124.55
|
| Rate for Payer: BCN Medicare Advantage |
$124.55
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$179.35
|
| Rate for Payer: Cofinity Commercial |
$166.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.55
|
| Rate for Payer: Healthscope Commercial |
$149.46
|
| Rate for Payer: Healthscope Whirlpool |
$149.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.78
|
| Rate for Payer: Nomi Health Commercial |
$149.46
|
| Rate for Payer: PACE SWMI |
$124.55
|
| Rate for Payer: PHP Medicare Advantage |
$124.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health Medicare |
$124.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.55
|
| Rate for Payer: UHC Medicare Advantage |
$124.55
|
| Rate for Payer: UHCCP DNSP |
$124.55
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$1,444.44 |
| Rate for Payer: Aetna Commercial |
$1,344.13
|
| Rate for Payer: Aetna Medicare |
$1,003.08
|
| Rate for Payer: BCBS Complete |
$849.60
|
| Rate for Payer: BCBS MAPPO |
$1,003.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.08
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cofinity Commercial |
$1,444.44
|
| Rate for Payer: Cofinity Commercial |
$1,344.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.08
|
| Rate for Payer: Healthscope Commercial |
$1,203.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,203.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.23
|
| Rate for Payer: Nomi Health Commercial |
$1,203.70
|
| Rate for Payer: PACE SWMI |
$1,003.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,380.60
|
| Rate for Payer: Priority Health Medicare |
$1,003.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.08
|
| Rate for Payer: UHCCP DNSP |
$1,003.08
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$750.83 |
| Max. Negotiated Rate |
$1,374.10 |
| Rate for Payer: Aetna Commercial |
$1,006.11
|
| Rate for Payer: Aetna Medicare |
$750.83
|
| Rate for Payer: BCBS Complete |
$845.60
|
| Rate for Payer: BCBS MAPPO |
$750.83
|
| Rate for Payer: BCN Medicare Advantage |
$750.83
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,081.20
|
| Rate for Payer: Cofinity Commercial |
$1,006.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.83
|
| Rate for Payer: Healthscope Commercial |
$901.00
|
| Rate for Payer: Healthscope Whirlpool |
$901.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.37
|
| Rate for Payer: Nomi Health Commercial |
$901.00
|
| Rate for Payer: PACE SWMI |
$750.83
|
| Rate for Payer: PHP Medicare Advantage |
$750.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health Medicare |
$750.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$750.83
|
| Rate for Payer: UHC Medicare Advantage |
$750.83
|
| Rate for Payer: UHCCP DNSP |
$750.83
|
|
|
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 MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$750.83 |
| Max. Negotiated Rate |
$1,374.10 |
| Rate for Payer: Aetna Commercial |
$1,006.11
|
| Rate for Payer: Aetna Medicare |
$750.83
|
| Rate for Payer: BCBS Complete |
$845.60
|
| Rate for Payer: BCBS MAPPO |
$750.83
|
| Rate for Payer: BCN Medicare Advantage |
$750.83
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,081.20
|
| Rate for Payer: Cofinity Commercial |
$1,006.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.83
|
| Rate for Payer: Healthscope Commercial |
$901.00
|
| Rate for Payer: Healthscope Whirlpool |
$901.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.37
|
| Rate for Payer: Nomi Health Commercial |
$901.00
|
| Rate for Payer: PACE SWMI |
$750.83
|
| Rate for Payer: PHP Medicare Advantage |
$750.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health Medicare |
$750.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$750.83
|
| Rate for Payer: UHC Medicare Advantage |
$750.83
|
| Rate for Payer: UHCCP DNSP |
$750.83
|
|
|
PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$233.20 |
| Max. Negotiated Rate |
$378.95 |
| Rate for Payer: Aetna Commercial |
$330.67
|
| Rate for Payer: Aetna Medicare |
$246.77
|
| Rate for Payer: BCBS Complete |
$233.20
|
| Rate for Payer: BCBS MAPPO |
$246.77
|
| Rate for Payer: BCN Medicare Advantage |
$246.77
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$355.35
|
| Rate for Payer: Cofinity Commercial |
$330.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.77
|
| Rate for Payer: Healthscope Commercial |
$296.12
|
| Rate for Payer: Healthscope Whirlpool |
$296.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.11
|
| Rate for Payer: Nomi Health Commercial |
$296.12
|
| Rate for Payer: PACE SWMI |
$246.77
|
| Rate for Payer: PHP Medicare Advantage |
$246.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health Medicare |
$246.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.77
|
| Rate for Payer: UHC Medicare Advantage |
$246.77
|
| Rate for Payer: UHCCP DNSP |
$246.77
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$392.33 |
| Max. Negotiated Rate |
$1,238.25 |
| Rate for Payer: Aetna Commercial |
$525.72
|
| Rate for Payer: Aetna Medicare |
$392.33
|
| Rate for Payer: BCBS Complete |
$762.00
|
| Rate for Payer: BCBS MAPPO |
$392.33
|
| Rate for Payer: BCN Medicare Advantage |
$392.33
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cofinity Commercial |
$564.96
|
| Rate for Payer: Cofinity Commercial |
$525.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.33
|
| Rate for Payer: Healthscope Commercial |
$470.80
|
| Rate for Payer: Healthscope Whirlpool |
$470.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.95
|
| Rate for Payer: Nomi Health Commercial |
$470.80
|
| Rate for Payer: PACE SWMI |
$392.33
|
| Rate for Payer: PHP Medicare Advantage |
$392.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,238.25
|
| Rate for Payer: Priority Health Medicare |
$392.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.33
|
| Rate for Payer: UHC Medicare Advantage |
$392.33
|
| Rate for Payer: UHCCP DNSP |
$392.33
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$2,003.00
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$801.20 |
| Max. Negotiated Rate |
$1,504.44 |
| Rate for Payer: Aetna Commercial |
$1,399.96
|
| Rate for Payer: Aetna Medicare |
$1,044.75
|
| Rate for Payer: BCBS Complete |
$801.20
|
| Rate for Payer: BCBS MAPPO |
$1,044.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,044.75
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cofinity Commercial |
$1,504.44
|
| Rate for Payer: Cofinity Commercial |
$1,399.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,044.75
|
| Rate for Payer: Healthscope Commercial |
$1,253.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,253.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,096.99
|
| Rate for Payer: Nomi Health Commercial |
$1,253.70
|
| Rate for Payer: PACE SWMI |
$1,044.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,044.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.95
|
| Rate for Payer: Priority Health Medicare |
$1,044.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,044.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,044.75
|
| Rate for Payer: UHCCP DNSP |
$1,044.75
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$2,381.00
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$830.55 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Aetna Commercial |
$1,112.94
|
| Rate for Payer: Aetna Medicare |
$830.55
|
| Rate for Payer: BCBS Complete |
$952.40
|
| Rate for Payer: BCBS MAPPO |
$830.55
|
| Rate for Payer: BCN Medicare Advantage |
$830.55
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cofinity Commercial |
$1,195.99
|
| Rate for Payer: Cofinity Commercial |
$1,112.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.55
|
| Rate for Payer: Healthscope Commercial |
$996.66
|
| Rate for Payer: Healthscope Whirlpool |
$996.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.08
|
| Rate for Payer: Nomi Health Commercial |
$996.66
|
| Rate for Payer: PACE SWMI |
$830.55
|
| Rate for Payer: PHP Medicare Advantage |
$830.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.65
|
| Rate for Payer: Priority Health Medicare |
$830.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.55
|
| Rate for Payer: UHC Medicare Advantage |
$830.55
|
| Rate for Payer: UHCCP DNSP |
$830.55
|
|
|
PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$413.65 |
| Max. Negotiated Rate |
$791.70 |
| Rate for Payer: Aetna Commercial |
$554.29
|
| Rate for Payer: Aetna Medicare |
$413.65
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$413.65
|
| Rate for Payer: BCN Medicare Advantage |
$413.65
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$595.66
|
| Rate for Payer: Cofinity Commercial |
$554.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.65
|
| Rate for Payer: Healthscope Commercial |
$496.38
|
| Rate for Payer: Healthscope Whirlpool |
$496.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.33
|
| Rate for Payer: Nomi Health Commercial |
$496.38
|
| Rate for Payer: PACE SWMI |
$413.65
|
| Rate for Payer: PHP Medicare Advantage |
$413.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$413.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.65
|
| Rate for Payer: UHC Medicare Advantage |
$413.65
|
| Rate for Payer: UHCCP DNSP |
$413.65
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$1,259.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$386.88 |
| Max. Negotiated Rate |
$818.35 |
| Rate for Payer: Aetna Commercial |
$518.42
|
| Rate for Payer: Aetna Medicare |
$386.88
|
| Rate for Payer: BCBS Complete |
$503.60
|
| Rate for Payer: BCBS MAPPO |
$386.88
|
| Rate for Payer: BCN Medicare Advantage |
$386.88
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cofinity Commercial |
$557.11
|
| Rate for Payer: Cofinity Commercial |
$518.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.88
|
| Rate for Payer: Healthscope Commercial |
$464.26
|
| Rate for Payer: Healthscope Whirlpool |
$464.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.22
|
| Rate for Payer: Nomi Health Commercial |
$464.26
|
| Rate for Payer: PACE SWMI |
$386.88
|
| Rate for Payer: PHP Medicare Advantage |
$386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.35
|
| Rate for Payer: Priority Health Medicare |
$386.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.88
|
| Rate for Payer: UHC Medicare Advantage |
$386.88
|
| Rate for Payer: UHCCP DNSP |
$386.88
|
|
|
PR EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 64783
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Aetna Commercial |
$276.84
|
| Rate for Payer: Aetna Medicare |
$206.60
|
| Rate for Payer: BCBS Complete |
$178.00
|
| Rate for Payer: BCBS MAPPO |
$206.60
|
| Rate for Payer: BCN Medicare Advantage |
$206.60
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$297.50
|
| Rate for Payer: Cofinity Commercial |
$276.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.60
|
| Rate for Payer: Healthscope Commercial |
$247.92
|
| Rate for Payer: Healthscope Whirlpool |
$247.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.93
|
| Rate for Payer: Nomi Health Commercial |
$247.92
|
| Rate for Payer: PACE SWMI |
$206.60
|
| Rate for Payer: PHP Medicare Advantage |
$206.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health Medicare |
$206.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.60
|
| Rate for Payer: UHC Medicare Advantage |
$206.60
|
| Rate for Payer: UHCCP DNSP |
$206.60
|
|
|
PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$441.57 |
| Max. Negotiated Rate |
$1,101.10 |
| Rate for Payer: Aetna Commercial |
$591.70
|
| Rate for Payer: Aetna Medicare |
$441.57
|
| Rate for Payer: BCBS Complete |
$677.60
|
| Rate for Payer: BCBS MAPPO |
$441.57
|
| Rate for Payer: BCN Medicare Advantage |
$441.57
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cofinity Commercial |
$635.86
|
| Rate for Payer: Cofinity Commercial |
$591.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.57
|
| Rate for Payer: Healthscope Commercial |
$529.88
|
| Rate for Payer: Healthscope Whirlpool |
$529.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$529.88
|
| Rate for Payer: PACE SWMI |
$441.57
|
| Rate for Payer: PHP Medicare Advantage |
$441.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,101.10
|
| Rate for Payer: Priority Health Medicare |
$441.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.57
|
| Rate for Payer: UHC Medicare Advantage |
$441.57
|
| Rate for Payer: UHCCP DNSP |
$441.57
|
|
|
PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$2,489.00
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$701.96 |
| Max. Negotiated Rate |
$1,617.85 |
| Rate for Payer: Aetna Commercial |
$940.63
|
| Rate for Payer: Aetna Medicare |
$701.96
|
| Rate for Payer: BCBS Complete |
$995.60
|
| Rate for Payer: BCBS MAPPO |
$701.96
|
| Rate for Payer: BCN Medicare Advantage |
$701.96
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cofinity Commercial |
$940.63
|
| Rate for Payer: Cofinity Commercial |
$1,010.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$701.96
|
| Rate for Payer: Healthscope Commercial |
$842.35
|
| Rate for Payer: Healthscope Whirlpool |
$842.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.06
|
| Rate for Payer: Nomi Health Commercial |
$842.35
|
| Rate for Payer: PACE SWMI |
$701.96
|
| Rate for Payer: PHP Medicare Advantage |
$701.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.85
|
| Rate for Payer: Priority Health Medicare |
$701.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$701.96
|
| Rate for Payer: UHC Medicare Advantage |
$701.96
|
| Rate for Payer: UHCCP DNSP |
$701.96
|
|
|
PR EXC PRESAC/SACROCOCCYGEAL TUMOR
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 49215
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$3,070.67 |
| Rate for Payer: Aetna Commercial |
$2,857.43
|
| Rate for Payer: Aetna Medicare |
$2,132.41
|
| Rate for Payer: BCBS Complete |
$1,600.00
|
| Rate for Payer: BCBS MAPPO |
$2,132.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,132.41
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$3,070.67
|
| Rate for Payer: Cofinity Commercial |
$2,857.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,132.41
|
| Rate for Payer: Healthscope Commercial |
$2,558.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,558.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,239.03
|
| Rate for Payer: Nomi Health Commercial |
$2,558.89
|
| Rate for Payer: PACE SWMI |
$2,132.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,132.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,600.00
|
| Rate for Payer: Priority Health Medicare |
$2,132.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,132.41
|
| Rate for Payer: UHC Medicare Advantage |
$2,132.41
|
| Rate for Payer: UHCCP DNSP |
$2,132.41
|
|
