|
PR SURG OPENING,ESOPHAGUS,ABD APPRCH
|
Professional
|
Both
|
$2,732.00
|
|
|
Service Code
|
HCPCS 43350
|
| Min. Negotiated Rate |
$1,092.80 |
| Max. Negotiated Rate |
$1,912.40 |
| Rate for Payer: BCBS Complete |
$1,092.80
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.40
|
|
|
PR SURG TX ANAL FISTULA 2ND STAGE
|
Professional
|
Both
|
$951.00
|
|
|
Service Code
|
HCPCS 46285
|
| Min. Negotiated Rate |
$273.28 |
| Max. Negotiated Rate |
$2,300.22 |
| Rate for Payer: Aetna Commercial |
$552.84
|
| Rate for Payer: Aetna Medicare |
$412.57
|
| Rate for Payer: BCBS Complete |
$286.94
|
| Rate for Payer: BCBS MAPPO |
$412.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,300.22
|
| Rate for Payer: BCN Commercial |
$826.84
|
| Rate for Payer: BCN Medicare Advantage |
$412.57
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cofinity Commercial |
$594.10
|
| Rate for Payer: Cofinity Commercial |
$552.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$412.57
|
| Rate for Payer: Healthscope Commercial |
$495.08
|
| Rate for Payer: Healthscope Whirlpool |
$495.08
|
| Rate for Payer: Meridian Medicaid |
$286.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$433.20
|
| Rate for Payer: PACE SWMI |
$412.57
|
| Rate for Payer: PHP Medicare Advantage |
$412.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.96
|
| Rate for Payer: Priority Health Medicare |
$412.57
|
| Rate for Payer: Priority Health Narrow Network |
$744.96
|
| Rate for Payer: UHC Medicare Advantage |
$424.95
|
|
|
PR SURG TX ANAL FISTULA INTERSPHINCTERIC
|
Professional
|
Both
|
$1,289.00
|
|
|
Service Code
|
HCPCS 46275
|
| Min. Negotiated Rate |
$272.43 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Aetna Commercial |
$552.92
|
| Rate for Payer: Aetna Medicare |
$412.63
|
| Rate for Payer: BCBS Complete |
$286.05
|
| Rate for Payer: BCBS MAPPO |
$412.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,730.40
|
| Rate for Payer: BCN Commercial |
$830.26
|
| Rate for Payer: BCN Medicare Advantage |
$412.63
|
| Rate for Payer: Cash Price |
$1,031.20
|
| Rate for Payer: Cash Price |
$1,031.20
|
| Rate for Payer: Cofinity Commercial |
$552.92
|
| Rate for Payer: Cofinity Commercial |
$594.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$412.63
|
| Rate for Payer: Healthscope Commercial |
$495.16
|
| Rate for Payer: Healthscope Whirlpool |
$495.16
|
| Rate for Payer: Meridian Medicaid |
$286.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$433.26
|
| Rate for Payer: PACE SWMI |
$412.63
|
| Rate for Payer: PHP Medicare Advantage |
$412.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.96
|
| Rate for Payer: Priority Health Medicare |
$412.63
|
| Rate for Payer: Priority Health Narrow Network |
$744.96
|
| Rate for Payer: UHC Medicare Advantage |
$425.01
|
|
|
PR SURG TX ANAL FISTULA SUBQ
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 46270
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$2,437.58 |
| Rate for Payer: Aetna Commercial |
$525.48
|
| Rate for Payer: Aetna Medicare |
$392.15
|
| Rate for Payer: BCBS Complete |
$271.74
|
| Rate for Payer: BCBS MAPPO |
$392.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,437.58
|
| Rate for Payer: BCN Commercial |
$787.75
|
| Rate for Payer: BCN Medicare Advantage |
$392.15
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$564.70
|
| Rate for Payer: Cofinity Commercial |
$525.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.15
|
| Rate for Payer: Healthscope Commercial |
$470.58
|
| Rate for Payer: Healthscope Whirlpool |
$470.58
|
| Rate for Payer: Meridian Medicaid |
$271.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$411.76
|
| Rate for Payer: PACE SWMI |
$392.15
|
| Rate for Payer: PHP Medicare Advantage |
$392.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$708.51
|
| Rate for Payer: Priority Health Medicare |
$392.15
|
| Rate for Payer: Priority Health Narrow Network |
$708.51
|
| Rate for Payer: UHC Medicare Advantage |
$403.91
|
|
|
PR SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD
|
Professional
|
Both
|
$11,112.00
|
|
|
Service Code
|
HCPCS 33548
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$7,778.40 |
| Rate for Payer: Aetna Commercial |
$3,878.56
|
| Rate for Payer: Aetna Medicare |
$2,894.45
|
| Rate for Payer: BCBS Complete |
$1,931.44
|
| Rate for Payer: BCBS MAPPO |
$2,894.45
|
| Rate for Payer: BCBS Trust/PPO |
$624.98
|
| Rate for Payer: BCN Commercial |
$4,215.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.45
|
| Rate for Payer: Cash Price |
$8,889.60
|
| Rate for Payer: Cash Price |
$8,889.60
|
| Rate for Payer: Cofinity Commercial |
$3,878.56
|
| Rate for Payer: Cofinity Commercial |
$4,168.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.45
|
| Rate for Payer: Healthscope Commercial |
$3,473.34
|
| Rate for Payer: Healthscope Whirlpool |
$3,473.34
|
| Rate for Payer: Meridian Medicaid |
$1,931.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,039.17
|
| Rate for Payer: PACE SWMI |
$2,894.45
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,839.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,778.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,588.67
|
| Rate for Payer: Priority Health Medicare |
$2,894.45
|
| Rate for Payer: Priority Health Narrow Network |
$4,588.67
|
| Rate for Payer: UHC Medicare Advantage |
$2,981.28
|
|
|
PR SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 64832
|
| Min. Negotiated Rate |
$210.23 |
| Max. Negotiated Rate |
$907.90 |
| Rate for Payer: Aetna Commercial |
$437.95
|
| Rate for Payer: Aetna Medicare |
$326.83
|
| Rate for Payer: BCBS Complete |
$220.74
|
| Rate for Payer: BCBS MAPPO |
$326.83
|
| Rate for Payer: BCBS Trust/PPO |
$294.79
|
| Rate for Payer: BCN Commercial |
$481.35
|
| Rate for Payer: BCN Medicare Advantage |
$326.83
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$470.64
|
| Rate for Payer: Cofinity Commercial |
$437.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.83
|
| Rate for Payer: Healthscope Commercial |
$392.20
|
| Rate for Payer: Healthscope Whirlpool |
$392.20
|
| Rate for Payer: Meridian Medicaid |
$220.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$343.17
|
| Rate for Payer: PACE SWMI |
$326.83
|
| Rate for Payer: PHP Medicare Advantage |
$326.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$907.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.73
|
| Rate for Payer: Priority Health Medicare |
$326.83
|
| Rate for Payer: Priority Health Narrow Network |
$557.73
|
| Rate for Payer: UHC Medicare Advantage |
$336.63
|
|
|
PR SUTR ESOPHGL WND/INJ CRV APPR
|
Professional
|
Both
|
$2,799.00
|
|
|
Service Code
|
HCPCS 43410
|
| Min. Negotiated Rate |
$663.50 |
| Max. Negotiated Rate |
$1,959.30 |
| Rate for Payer: Aetna Commercial |
$1,365.00
|
| Rate for Payer: Aetna Medicare |
$1,018.66
|
| Rate for Payer: BCBS Complete |
$696.68
|
| Rate for Payer: BCBS MAPPO |
$1,018.66
|
| Rate for Payer: BCBS Trust/PPO |
$949.92
|
| Rate for Payer: BCN Commercial |
$1,513.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.66
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cofinity Commercial |
$1,466.87
|
| Rate for Payer: Cofinity Commercial |
$1,365.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.66
|
| Rate for Payer: Healthscope Commercial |
$1,222.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,222.39
|
| Rate for Payer: Meridian Medicaid |
$696.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,069.59
|
| Rate for Payer: PACE SWMI |
$1,018.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$663.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,959.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,820.96
|
| Rate for Payer: Priority Health Medicare |
$1,018.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,820.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,049.22
|
|
|
PR SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR
|
Professional
|
Both
|
$3,996.00
|
|
|
Service Code
|
HCPCS 43415
|
| Min. Negotiated Rate |
$1,207.03 |
| Max. Negotiated Rate |
$4,470.35 |
| Rate for Payer: Aetna Commercial |
$3,407.08
|
| Rate for Payer: Aetna Medicare |
$2,542.60
|
| Rate for Payer: BCBS Complete |
$1,711.82
|
| Rate for Payer: BCBS MAPPO |
$2,542.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.03
|
| Rate for Payer: BCN Commercial |
$3,715.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,542.60
|
| Rate for Payer: Cash Price |
$3,196.80
|
| Rate for Payer: Cash Price |
$3,196.80
|
| Rate for Payer: Cofinity Commercial |
$3,407.08
|
| Rate for Payer: Cofinity Commercial |
$3,661.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,542.60
|
| Rate for Payer: Healthscope Commercial |
$3,051.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,051.12
|
| Rate for Payer: Meridian Medicaid |
$1,711.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,669.73
|
| Rate for Payer: PACE SWMI |
$2,542.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,542.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,630.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,470.35
|
| Rate for Payer: Priority Health Medicare |
$2,542.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,470.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,618.88
|
|
|
PR SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF
|
Professional
|
Both
|
$1,555.00
|
|
|
Service Code
|
HCPCS 27381
|
| Min. Negotiated Rate |
$530.58 |
| Max. Negotiated Rate |
$3,176.14 |
| Rate for Payer: Aetna Commercial |
$1,083.48
|
| Rate for Payer: Aetna Medicare |
$808.57
|
| Rate for Payer: BCBS Complete |
$557.11
|
| Rate for Payer: BCBS MAPPO |
$808.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.14
|
| Rate for Payer: BCN Commercial |
$1,209.96
|
| Rate for Payer: BCN Medicare Advantage |
$808.57
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Cofinity Commercial |
$1,164.34
|
| Rate for Payer: Cofinity Commercial |
$1,083.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$808.57
|
| Rate for Payer: Healthscope Commercial |
$970.28
|
| Rate for Payer: Healthscope Whirlpool |
$970.28
|
| Rate for Payer: Meridian Medicaid |
$557.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$849.00
|
| Rate for Payer: PACE SWMI |
$808.57
|
| Rate for Payer: PHP Medicare Advantage |
$808.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$530.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,088.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.37
|
| Rate for Payer: Priority Health Medicare |
$808.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,264.37
|
| Rate for Payer: UHC Medicare Advantage |
$832.83
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY
|
Professional
|
Both
|
$2,880.00
|
|
|
Service Code
|
HCPCS 44605
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$2,268.40 |
| Rate for Payer: Aetna Commercial |
$1,722.28
|
| Rate for Payer: Aetna Medicare |
$1,285.28
|
| Rate for Payer: BCBS Complete |
$860.38
|
| Rate for Payer: BCBS MAPPO |
$1,285.28
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$1,885.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,285.28
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Cofinity Commercial |
$1,850.80
|
| Rate for Payer: Cofinity Commercial |
$1,722.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,285.28
|
| Rate for Payer: Healthscope Commercial |
$1,542.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,542.34
|
| Rate for Payer: Meridian Medicaid |
$860.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,349.54
|
| Rate for Payer: PACE SWMI |
$1,285.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,285.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,268.40
|
| Rate for Payer: Priority Health Medicare |
$1,285.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,268.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,323.84
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$3,021.00
|
|
|
Service Code
|
HCPCS 44604
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$2,114.70 |
| Rate for Payer: Aetna Commercial |
$1,403.69
|
| Rate for Payer: Aetna Medicare |
$1,047.53
|
| Rate for Payer: BCBS Complete |
$705.17
|
| Rate for Payer: BCBS MAPPO |
$1,047.53
|
| Rate for Payer: BCBS Trust/PPO |
$54.94
|
| Rate for Payer: BCN Commercial |
$1,534.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.53
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Cofinity Commercial |
$1,508.44
|
| Rate for Payer: Cofinity Commercial |
$1,403.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.53
|
| Rate for Payer: Healthscope Commercial |
$1,257.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.04
|
| Rate for Payer: Meridian Medicaid |
$705.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,099.91
|
| Rate for Payer: PACE SWMI |
$1,047.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$671.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,114.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,846.83
|
| Rate for Payer: Priority Health Medicare |
$1,047.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,846.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,078.96
|
|
|
PR SUTR&/LIG THORACIC DUCT THORACIC APPROACH
|
Professional
|
Both
|
$5,811.00
|
|
|
Service Code
|
HCPCS 38381
|
| Min. Negotiated Rate |
$510.77 |
| Max. Negotiated Rate |
$4,067.70 |
| Rate for Payer: Aetna Commercial |
$1,062.37
|
| Rate for Payer: Aetna Medicare |
$792.81
|
| Rate for Payer: BCBS Complete |
$536.31
|
| Rate for Payer: BCBS MAPPO |
$792.81
|
| Rate for Payer: BCBS Trust/PPO |
$540.98
|
| Rate for Payer: BCN Commercial |
$1,163.05
|
| Rate for Payer: BCN Medicare Advantage |
$792.81
|
| Rate for Payer: Cash Price |
$4,648.80
|
| Rate for Payer: Cash Price |
$4,648.80
|
| Rate for Payer: Cofinity Commercial |
$1,141.65
|
| Rate for Payer: Cofinity Commercial |
$1,062.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$792.81
|
| Rate for Payer: Healthscope Commercial |
$951.37
|
| Rate for Payer: Healthscope Whirlpool |
$951.37
|
| Rate for Payer: Meridian Medicaid |
$536.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$832.45
|
| Rate for Payer: PACE SWMI |
$792.81
|
| Rate for Payer: PHP Medicare Advantage |
$792.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,067.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,723.94
|
| Rate for Payer: Priority Health Medicare |
$792.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,723.94
|
| Rate for Payer: UHC Medicare Advantage |
$816.59
|
|
|
PR SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 69740
|
| Min. Negotiated Rate |
$744.22 |
| Max. Negotiated Rate |
$1,902.94 |
| Rate for Payer: Aetna Commercial |
$1,530.17
|
| Rate for Payer: Aetna Medicare |
$1,141.92
|
| Rate for Payer: BCBS Complete |
$781.43
|
| Rate for Payer: BCBS MAPPO |
$1,141.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,902.94
|
| Rate for Payer: BCN Commercial |
$1,709.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,141.92
|
| Rate for Payer: Cash Price |
$1,612.00
|
| Rate for Payer: Cash Price |
$1,612.00
|
| Rate for Payer: Cofinity Commercial |
$1,644.36
|
| Rate for Payer: Cofinity Commercial |
$1,530.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,141.92
|
| Rate for Payer: Healthscope Commercial |
$1,370.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.30
|
| Rate for Payer: Meridian Medicaid |
$781.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,199.02
|
| Rate for Payer: PACE SWMI |
$1,141.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,141.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$744.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,649.16
|
| Rate for Payer: Priority Health Medicare |
$1,141.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,649.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,176.18
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS
|
Professional
|
Both
|
$3,113.00
|
|
|
Service Code
|
HCPCS 64857
|
| Min. Negotiated Rate |
$202.87 |
| Max. Negotiated Rate |
$2,179.10 |
| Rate for Payer: Aetna Commercial |
$1,389.98
|
| Rate for Payer: Aetna Medicare |
$1,037.30
|
| Rate for Payer: BCBS Complete |
$708.30
|
| Rate for Payer: BCBS MAPPO |
$1,037.30
|
| Rate for Payer: BCBS Trust/PPO |
$202.87
|
| Rate for Payer: BCN Commercial |
$1,539.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,037.30
|
| Rate for Payer: Cash Price |
$2,490.40
|
| Rate for Payer: Cash Price |
$2,490.40
|
| Rate for Payer: Cofinity Commercial |
$1,493.71
|
| Rate for Payer: Cofinity Commercial |
$1,389.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,037.30
|
| Rate for Payer: Healthscope Commercial |
$1,244.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,244.76
|
| Rate for Payer: Meridian Medicaid |
$708.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,089.16
|
| Rate for Payer: PACE SWMI |
$1,037.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,037.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,179.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,784.18
|
| Rate for Payer: Priority Health Medicare |
$1,037.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,784.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,068.42
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS
|
Professional
|
Both
|
$3,875.00
|
|
|
Service Code
|
HCPCS 64856
|
| Min. Negotiated Rate |
$183.32 |
| Max. Negotiated Rate |
$2,712.50 |
| Rate for Payer: Aetna Commercial |
$1,337.68
|
| Rate for Payer: Aetna Medicare |
$998.27
|
| Rate for Payer: BCBS Complete |
$677.66
|
| Rate for Payer: BCBS MAPPO |
$998.27
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$1,480.20
|
| Rate for Payer: BCN Medicare Advantage |
$998.27
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cofinity Commercial |
$1,437.51
|
| Rate for Payer: Cofinity Commercial |
$1,337.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$998.27
|
| Rate for Payer: Healthscope Commercial |
$1,197.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,197.92
|
| Rate for Payer: Meridian Medicaid |
$677.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,048.18
|
| Rate for Payer: PACE SWMI |
$998.27
|
| Rate for Payer: PHP Medicare Advantage |
$998.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,712.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,715.09
|
| Rate for Payer: Priority Health Medicare |
$998.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,715.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,028.22
|
|
|
PR SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ
|
Professional
|
Both
|
$2,296.00
|
|
|
Service Code
|
HCPCS 27386
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$1,607.20 |
| Rate for Payer: Aetna Commercial |
$1,128.86
|
| Rate for Payer: Aetna Medicare |
$842.43
|
| Rate for Payer: BCBS Complete |
$581.49
|
| Rate for Payer: BCBS MAPPO |
$842.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.54
|
| Rate for Payer: BCN Commercial |
$1,261.27
|
| Rate for Payer: BCN Medicare Advantage |
$842.43
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Cofinity Commercial |
$1,213.10
|
| Rate for Payer: Cofinity Commercial |
$1,128.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$842.43
|
| Rate for Payer: Healthscope Commercial |
$1,010.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,010.92
|
| Rate for Payer: Meridian Medicaid |
$581.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$884.55
|
| Rate for Payer: PACE SWMI |
$842.43
|
| Rate for Payer: PHP Medicare Advantage |
$842.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,607.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,317.99
|
| Rate for Payer: Priority Health Medicare |
$842.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,317.99
|
| Rate for Payer: UHC Medicare Advantage |
$867.70
|
|
|
PR SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP
|
Professional
|
Both
|
$2,160.00
|
|
|
Service Code
|
HCPCS 33320
|
| Min. Negotiated Rate |
$375.26 |
| Max. Negotiated Rate |
$1,675.14 |
| Rate for Payer: Aetna Commercial |
$1,411.07
|
| Rate for Payer: Aetna Medicare |
$1,053.04
|
| Rate for Payer: BCBS Complete |
$707.41
|
| Rate for Payer: BCBS MAPPO |
$1,053.04
|
| Rate for Payer: BCBS Trust/PPO |
$375.26
|
| Rate for Payer: BCN Commercial |
$1,538.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,053.04
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cofinity Commercial |
$1,411.07
|
| Rate for Payer: Cofinity Commercial |
$1,516.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,053.04
|
| Rate for Payer: Healthscope Commercial |
$1,263.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,263.65
|
| Rate for Payer: Meridian Medicaid |
$707.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,105.69
|
| Rate for Payer: PACE SWMI |
$1,053.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,053.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,675.14
|
| Rate for Payer: Priority Health Medicare |
$1,053.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,675.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,084.63
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK
|
Professional
|
Both
|
$1,128.00
|
|
|
Service Code
|
HCPCS 67935
|
| Min. Negotiated Rate |
$276.90 |
| Max. Negotiated Rate |
$2,017.58 |
| Rate for Payer: Aetna Commercial |
$563.95
|
| Rate for Payer: Aetna Medicare |
$420.86
|
| Rate for Payer: BCBS Complete |
$290.74
|
| Rate for Payer: BCBS MAPPO |
$420.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,017.58
|
| Rate for Payer: BCN Commercial |
$870.33
|
| Rate for Payer: BCN Medicare Advantage |
$420.86
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cofinity Commercial |
$606.04
|
| Rate for Payer: Cofinity Commercial |
$563.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.86
|
| Rate for Payer: Healthscope Commercial |
$505.03
|
| Rate for Payer: Healthscope Whirlpool |
$505.03
|
| Rate for Payer: Meridian Medicaid |
$290.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.90
|
| Rate for Payer: PACE SWMI |
$420.86
|
| Rate for Payer: PHP Medicare Advantage |
$420.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.77
|
| Rate for Payer: Priority Health Medicare |
$420.86
|
| Rate for Payer: Priority Health Narrow Network |
$755.77
|
| Rate for Payer: UHC Medicare Advantage |
$433.49
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 67930
|
| Min. Negotiated Rate |
$148.89 |
| Max. Negotiated Rate |
$668.30 |
| Rate for Payer: Aetna Commercial |
$303.67
|
| Rate for Payer: Aetna Medicare |
$226.62
|
| Rate for Payer: BCBS Complete |
$156.33
|
| Rate for Payer: BCBS MAPPO |
$226.62
|
| Rate for Payer: BCBS Trust/PPO |
$668.30
|
| Rate for Payer: BCN Commercial |
$539.50
|
| Rate for Payer: BCN Medicare Advantage |
$226.62
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$326.33
|
| Rate for Payer: Cofinity Commercial |
$303.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.62
|
| Rate for Payer: Healthscope Commercial |
$271.94
|
| Rate for Payer: Healthscope Whirlpool |
$271.94
|
| Rate for Payer: Meridian Medicaid |
$156.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.95
|
| Rate for Payer: PACE SWMI |
$226.62
|
| Rate for Payer: PHP Medicare Advantage |
$226.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.70
|
| Rate for Payer: Priority Health Medicare |
$226.62
|
| Rate for Payer: Priority Health Narrow Network |
$405.70
|
| Rate for Payer: UHC Medicare Advantage |
$233.42
|
|
|
PR SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE
|
Professional
|
Both
|
$2,108.00
|
|
|
Service Code
|
HCPCS 64834
|
| Min. Negotiated Rate |
$404.68 |
| Max. Negotiated Rate |
$1,475.60 |
| Rate for Payer: Aetna Commercial |
$970.37
|
| Rate for Payer: Aetna Medicare |
$724.16
|
| Rate for Payer: BCBS Complete |
$503.43
|
| Rate for Payer: BCBS MAPPO |
$724.16
|
| Rate for Payer: BCBS Trust/PPO |
$404.68
|
| Rate for Payer: BCN Commercial |
$1,077.53
|
| Rate for Payer: BCN Medicare Advantage |
$724.16
|
| Rate for Payer: Cash Price |
$1,686.40
|
| Rate for Payer: Cash Price |
$1,686.40
|
| Rate for Payer: Cofinity Commercial |
$970.37
|
| Rate for Payer: Cofinity Commercial |
$1,042.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.16
|
| Rate for Payer: Healthscope Commercial |
$868.99
|
| Rate for Payer: Healthscope Whirlpool |
$868.99
|
| Rate for Payer: Meridian Medicaid |
$503.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$760.37
|
| Rate for Payer: PACE SWMI |
$724.16
|
| Rate for Payer: PHP Medicare Advantage |
$724.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,248.52
|
| Rate for Payer: Priority Health Medicare |
$724.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,248.52
|
| Rate for Payer: UHC Medicare Advantage |
$745.88
|
|
|
PR SUTURE 1 NERVE MEDIAN MOTOR THENAR
|
Professional
|
Both
|
$2,242.00
|
|
|
Service Code
|
HCPCS 64835
|
| Min. Negotiated Rate |
$302.72 |
| Max. Negotiated Rate |
$1,569.40 |
| Rate for Payer: Aetna Commercial |
$1,078.59
|
| Rate for Payer: Aetna Medicare |
$804.92
|
| Rate for Payer: BCBS Complete |
$552.20
|
| Rate for Payer: BCBS MAPPO |
$804.92
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: BCN Commercial |
$1,197.26
|
| Rate for Payer: BCN Medicare Advantage |
$804.92
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cofinity Commercial |
$1,159.08
|
| Rate for Payer: Cofinity Commercial |
$1,078.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.92
|
| Rate for Payer: Healthscope Commercial |
$965.90
|
| Rate for Payer: Healthscope Whirlpool |
$965.90
|
| Rate for Payer: Meridian Medicaid |
$552.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$845.17
|
| Rate for Payer: PACE SWMI |
$804.92
|
| Rate for Payer: PHP Medicare Advantage |
$804.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,569.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,387.25
|
| Rate for Payer: Priority Health Medicare |
$804.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,387.25
|
| Rate for Payer: UHC Medicare Advantage |
$829.07
|
|
|
PR SUTURE 1 NERVE ULNAR MOTOR
|
Professional
|
Both
|
$1,770.00
|
|
|
Service Code
|
HCPCS 64836
|
| Min. Negotiated Rate |
$219.24 |
| Max. Negotiated Rate |
$1,387.25 |
| Rate for Payer: Aetna Commercial |
$1,078.59
|
| Rate for Payer: Aetna Medicare |
$804.92
|
| Rate for Payer: BCBS Complete |
$552.20
|
| Rate for Payer: BCBS MAPPO |
$804.92
|
| Rate for Payer: BCBS Trust/PPO |
$219.24
|
| Rate for Payer: BCN Commercial |
$1,197.26
|
| Rate for Payer: BCN Medicare Advantage |
$804.92
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cofinity Commercial |
$1,159.08
|
| Rate for Payer: Cofinity Commercial |
$1,078.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.92
|
| Rate for Payer: Healthscope Commercial |
$965.90
|
| Rate for Payer: Healthscope Whirlpool |
$965.90
|
| Rate for Payer: Meridian Medicaid |
$552.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$845.17
|
| Rate for Payer: PACE SWMI |
$804.92
|
| Rate for Payer: PHP Medicare Advantage |
$804.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,387.25
|
| Rate for Payer: Priority Health Medicare |
$804.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,387.25
|
| Rate for Payer: UHC Medicare Advantage |
$829.07
|
|
|
PR SUTURE BRACHIAL PLEXUS
|
Professional
|
Both
|
$3,632.00
|
|
|
Service Code
|
HCPCS 64861
|
| Min. Negotiated Rate |
$244.60 |
| Max. Negotiated Rate |
$2,608.02 |
| Rate for Payer: Aetna Commercial |
$2,053.27
|
| Rate for Payer: Aetna Medicare |
$1,532.29
|
| Rate for Payer: BCBS Complete |
$1,039.75
|
| Rate for Payer: BCBS MAPPO |
$1,532.29
|
| Rate for Payer: BCBS Trust/PPO |
$244.60
|
| Rate for Payer: BCN Commercial |
$2,250.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,532.29
|
| Rate for Payer: Cash Price |
$2,905.60
|
| Rate for Payer: Cash Price |
$2,905.60
|
| Rate for Payer: Cofinity Commercial |
$2,053.27
|
| Rate for Payer: Cofinity Commercial |
$2,206.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,532.29
|
| Rate for Payer: Healthscope Commercial |
$1,838.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,838.75
|
| Rate for Payer: Meridian Medicaid |
$1,039.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,608.90
|
| Rate for Payer: PACE SWMI |
$1,532.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,532.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,542.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,608.02
|
| Rate for Payer: Priority Health Medicare |
$1,532.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,608.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,578.26
|
|
|
PR SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
HCPCS 64831
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,362.20 |
| Rate for Payer: Aetna Commercial |
$912.88
|
| Rate for Payer: Aetna Medicare |
$681.25
|
| Rate for Payer: BCBS Complete |
$470.79
|
| Rate for Payer: BCBS MAPPO |
$681.25
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$1,019.87
|
| Rate for Payer: BCN Medicare Advantage |
$681.25
|
| Rate for Payer: Cash Price |
$1,556.80
|
| Rate for Payer: Cash Price |
$1,556.80
|
| Rate for Payer: Cofinity Commercial |
$981.00
|
| Rate for Payer: Cofinity Commercial |
$912.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.25
|
| Rate for Payer: Healthscope Commercial |
$817.50
|
| Rate for Payer: Healthscope Whirlpool |
$817.50
|
| Rate for Payer: Meridian Medicaid |
$470.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$715.31
|
| Rate for Payer: PACE SWMI |
$681.25
|
| Rate for Payer: PHP Medicare Advantage |
$681.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,181.72
|
| Rate for Payer: Priority Health Medicare |
$681.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,181.72
|
| Rate for Payer: UHC Medicare Advantage |
$701.69
|
|
|
PR SUTURE EACH ADDITIONAL NERVE HAND/FOOT
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 64837
|
| Min. Negotiated Rate |
$206.57 |
| Max. Negotiated Rate |
$899.50 |
| Rate for Payer: Aetna Commercial |
$479.40
|
| Rate for Payer: Aetna Medicare |
$357.76
|
| Rate for Payer: BCBS Complete |
$240.87
|
| Rate for Payer: BCBS MAPPO |
$357.76
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: BCN Commercial |
$525.33
|
| Rate for Payer: BCN Medicare Advantage |
$357.76
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cofinity Commercial |
$479.40
|
| Rate for Payer: Cofinity Commercial |
$515.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.76
|
| Rate for Payer: Healthscope Commercial |
$429.31
|
| Rate for Payer: Healthscope Whirlpool |
$429.31
|
| Rate for Payer: Meridian Medicaid |
$240.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$375.65
|
| Rate for Payer: PACE SWMI |
$357.76
|
| Rate for Payer: PHP Medicare Advantage |
$357.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$608.69
|
| Rate for Payer: Priority Health Medicare |
$357.76
|
| Rate for Payer: Priority Health Narrow Network |
$608.69
|
| Rate for Payer: UHC Medicare Advantage |
$368.49
|
|
