|
PR INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 99219
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Medicare |
$102.50
|
| Rate for Payer: BCBS Complete |
$82.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.25
|
|
|
PR INITIAL OBSERVATION CARE/DAY 70 MINUTES
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 99220
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 99471
|
| Min. Negotiated Rate |
$288.45 |
| Max. Negotiated Rate |
$1,116.63 |
| Rate for Payer: Aetna Commercial |
$781.38
|
| Rate for Payer: Aetna Medicare |
$733.50
|
| Rate for Payer: BCBS Complete |
$764.47
|
| Rate for Payer: BCBS Trust/PPO |
$288.45
|
| Rate for Payer: BCN Commercial |
$1,116.63
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Meridian Medicaid |
$764.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$728.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$861.61
|
| Rate for Payer: UHC Exchange |
$861.61
|
| Rate for Payer: UHCCP Medicaid |
$728.07
|
|
|
PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 99475
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$807.95 |
| Rate for Payer: Aetna Commercial |
$564.10
|
| Rate for Payer: Aetna Medicare |
$621.50
|
| Rate for Payer: BCBS Complete |
$555.42
|
| Rate for Payer: BCBS Trust/PPO |
$94.66
|
| Rate for Payer: BCN Commercial |
$804.85
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Meridian Medicaid |
$555.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$528.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$741.72
|
| Rate for Payer: Priority Health Narrow Network |
$741.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.21
|
| Rate for Payer: UHC Exchange |
$602.21
|
| Rate for Payer: UHCCP Medicaid |
$528.97
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS G0402
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$1,427.47 |
| Rate for Payer: Aetna Commercial |
$133.40
|
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,427.47
|
| Rate for Payer: BCN Commercial |
$240.43
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.05
|
| Rate for Payer: Priority Health Narrow Network |
$171.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.74
|
| Rate for Payer: UHC Exchange |
$148.74
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 99381
|
| Min. Negotiated Rate |
$53.49 |
| Max. Negotiated Rate |
$275.77 |
| Rate for Payer: Aetna Commercial |
$78.23
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$56.16
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: BCN Commercial |
$157.84
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Meridian Medicaid |
$56.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.94
|
| Rate for Payer: Priority Health Narrow Network |
$162.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.29
|
| Rate for Payer: UHC Exchange |
$67.29
|
| Rate for Payer: UHCCP Medicaid |
$53.49
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 99386
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$157.99 |
| Rate for Payer: Aetna Commercial |
$121.06
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: BCBS Complete |
$88.74
|
| Rate for Payer: BCBS Trust/PPO |
$72.38
|
| Rate for Payer: BCN Commercial |
$157.99
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Meridian Medicaid |
$88.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.80
|
| Rate for Payer: Priority Health Narrow Network |
$147.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.35
|
| Rate for Payer: UHC Exchange |
$106.35
|
| Rate for Payer: UHCCP Medicaid |
$84.51
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 99387
|
| Min. Negotiated Rate |
$75.55 |
| Max. Negotiated Rate |
$171.96 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna Medicare |
$120.00
|
| Rate for Payer: BCBS Complete |
$97.04
|
| Rate for Payer: BCBS Trust/PPO |
$75.55
|
| Rate for Payer: BCN Commercial |
$171.96
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Meridian Medicaid |
$97.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.76
|
| Rate for Payer: Priority Health Narrow Network |
$158.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.82
|
| Rate for Payer: UHC Exchange |
$116.82
|
| Rate for Payer: UHCCP Medicaid |
$92.42
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 99384
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$445.89 |
| Rate for Payer: Aetna Commercial |
$103.72
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: BCBS Complete |
$72.45
|
| Rate for Payer: BCBS Trust/PPO |
$445.89
|
| Rate for Payer: BCN Commercial |
$141.16
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Meridian Medicaid |
$72.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.19
|
| Rate for Payer: Priority Health Narrow Network |
$127.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.59
|
| Rate for Payer: UHC Exchange |
$86.59
|
| Rate for Payer: UHCCP Medicaid |
$69.00
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 99382
|
| Min. Negotiated Rate |
$61.08 |
| Max. Negotiated Rate |
$299.02 |
| Rate for Payer: Aetna Commercial |
$83.18
|
| Rate for Payer: Aetna Medicare |
$89.50
|
| Rate for Payer: BCBS Complete |
$64.13
|
| Rate for Payer: BCBS Trust/PPO |
$299.02
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Meridian Medicaid |
$64.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.75
|
| Rate for Payer: Priority Health Narrow Network |
$170.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.53
|
| Rate for Payer: UHC Exchange |
$76.53
|
| Rate for Payer: UHCCP Medicaid |
$61.08
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 99385
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$238.26 |
| Rate for Payer: Aetna Commercial |
$99.47
|
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: BCBS Complete |
$72.45
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$137.21
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Meridian Medicaid |
$72.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.93
|
| Rate for Payer: Priority Health Narrow Network |
$121.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.59
|
| Rate for Payer: UHC Exchange |
$86.59
|
| Rate for Payer: UHCCP Medicaid |
$69.00
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99383
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$125.39 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$64.13
|
| Rate for Payer: BCBS Trust/PPO |
$40.68
|
| Rate for Payer: BCN Commercial |
$125.39
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Meridian Medicaid |
$64.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.90
|
| Rate for Payer: Priority Health Narrow Network |
$107.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.53
|
| Rate for Payer: UHC Exchange |
$76.53
|
| Rate for Payer: UHCCP Medicaid |
$61.08
|
|
|
PR INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 16000
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$569.29 |
| Rate for Payer: Aetna Commercial |
$49.54
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS Trust/PPO |
$569.29
|
| Rate for Payer: BCN Commercial |
$92.28
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.40
|
| Rate for Payer: Priority Health Narrow Network |
$61.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.59
|
| Rate for Payer: UHC Exchange |
$50.59
|
| Rate for Payer: UHCCP Medicaid |
$29.18
|
|
|
PR INIT/SUB PSYCH CARE M 1ST 30
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS G2214
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$38.17
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCBS Complete |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCN Commercial |
$81.69
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Meridian Medicaid |
$25.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.86
|
| Rate for Payer: Priority Health Narrow Network |
$76.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.13
|
| Rate for Payer: UHC Exchange |
$45.13
|
| Rate for Payer: UHCCP Medicaid |
$24.28
|
|
|
PR INJ DEXAMETHASONE ACETATE
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J1094
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.83
|
| Rate for Payer: UHC Exchange |
$0.83
|
|
|
PR INJ, DUROLANE 1 MG
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J7318
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$6.33
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$16.25
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.66
|
| Rate for Payer: UHC Exchange |
$6.66
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
20550
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Commercial |
$52.35
|
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.02
|
| Rate for Payer: Priority Health Narrow Network |
$59.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.41
|
| Rate for Payer: UHC Exchange |
$48.41
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: ASR ASR |
$140.65
|
| Rate for Payer: ASR Commercial |
$140.65
|
| Rate for Payer: BCBS Trust/PPO |
$118.16
|
| Rate for Payer: BCN Commercial |
$112.42
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$136.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.00
|
| Rate for Payer: Healthscope Commercial |
$145.00
|
| Rate for Payer: Healthscope Whirlpool |
$140.65
|
| Rate for Payer: Mclaren Commercial |
$130.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.25
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.60
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$140.65
|
| Rate for Payer: ASR Commercial |
$140.65
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$118.74
|
| Rate for Payer: BCN Commercial |
$112.42
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$136.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$145.00
|
| Rate for Payer: Healthscope Whirlpool |
$140.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$130.50
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.25
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.07
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$323.26
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 20550
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Commercial |
$52.35
|
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.02
|
| Rate for Payer: Priority Health Narrow Network |
$59.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.41
|
| Rate for Payer: UHC Exchange |
$48.41
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
PR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 64417
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$234.08 |
| Rate for Payer: Aetna Commercial |
$78.61
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS Trust/PPO |
$82.94
|
| Rate for Payer: BCN Commercial |
$234.08
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.06
|
| Rate for Payer: Priority Health Narrow Network |
$108.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.72
|
| Rate for Payer: UHC Exchange |
$83.72
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
|
|
PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Professional
|
Both
|
$524.00
|
|
|
Service Code
|
HCPCS 64415
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$547.85 |
| Rate for Payer: Aetna Commercial |
$81.83
|
| Rate for Payer: Aetna Medicare |
$262.00
|
| Rate for Payer: BCBS Complete |
$46.52
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$196.93
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Meridian Medicaid |
$46.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.15
|
| Rate for Payer: Priority Health Narrow Network |
$117.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.07
|
| Rate for Payer: UHC Exchange |
$85.07
|
| Rate for Payer: UHCCP Medicaid |
$44.30
|
|
|
PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 64447
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$2,134.86 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,134.86
|
| Rate for Payer: BCN Commercial |
$170.06
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.35
|
| Rate for Payer: Priority Health Narrow Network |
$106.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.84
|
| Rate for Payer: UHC Exchange |
$80.84
|
| Rate for Payer: UHCCP Medicaid |
$40.47
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 64454
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$550.49 |
| Rate for Payer: Aetna Commercial |
$104.95
|
| Rate for Payer: Aetna Medicare |
$208.00
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.33
|
| Rate for Payer: Priority Health Narrow Network |
$139.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.81
|
| Rate for Payer: UHC Exchange |
$103.81
|
| Rate for Payer: UHCCP Medicaid |
$52.61
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$550.49 |
| Rate for Payer: Aetna Commercial |
$104.95
|
| Rate for Payer: Aetna Medicare |
$208.00
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.33
|
| Rate for Payer: Priority Health Narrow Network |
$139.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.81
|
| Rate for Payer: UHC Exchange |
$103.81
|
| Rate for Payer: UHCCP Medicaid |
$52.61
|
|
