|
PR NERVE GRAFT 1 STRAND HAND/FOOT <4 CM
|
Professional
|
Both
|
$3,711.00
|
|
|
Service Code
|
HCPCS 64890
|
| Min. Negotiated Rate |
$359.24 |
| Max. Negotiated Rate |
$2,412.15 |
| Rate for Payer: Aetna Commercial |
$1,390.93
|
| Rate for Payer: Aetna Medicare |
$1,855.50
|
| Rate for Payer: BCBS Complete |
$731.56
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: BCN Commercial |
$1,576.96
|
| Rate for Payer: Cash Price |
$2,968.80
|
| Rate for Payer: Cash Price |
$2,968.80
|
| Rate for Payer: Meridian Medicaid |
$731.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$696.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,412.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,846.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,846.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,259.40
|
| Rate for Payer: UHC Exchange |
$1,259.40
|
| Rate for Payer: UHCCP Medicaid |
$696.72
|
|
|
PR NERVE GRAFT EACH NERVE MULTIPLE STRANDS
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS 64902
|
| Min. Negotiated Rate |
$379.32 |
| Max. Negotiated Rate |
$1,913.60 |
| Rate for Payer: Aetna Commercial |
$890.94
|
| Rate for Payer: Aetna Medicare |
$1,472.00
|
| Rate for Payer: BCBS Complete |
$458.03
|
| Rate for Payer: BCBS Trust/PPO |
$379.32
|
| Rate for Payer: BCN Commercial |
$993.00
|
| Rate for Payer: Cash Price |
$2,355.20
|
| Rate for Payer: Cash Price |
$2,355.20
|
| Rate for Payer: Meridian Medicaid |
$458.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,913.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,156.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,156.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$840.70
|
| Rate for Payer: UHC Exchange |
$840.70
|
| Rate for Payer: UHCCP Medicaid |
$436.22
|
|
|
PR NERVE GRAFT MLT STRANDS ARM/LEG <4 CM
|
Professional
|
Both
|
$2,622.00
|
|
|
Service Code
|
HCPCS 64897
|
| Min. Negotiated Rate |
$407.32 |
| Max. Negotiated Rate |
$2,161.69 |
| Rate for Payer: Aetna Commercial |
$1,632.38
|
| Rate for Payer: Aetna Medicare |
$1,311.00
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: BCN Commercial |
$1,846.72
|
| Rate for Payer: Cash Price |
$2,097.60
|
| Rate for Payer: Cash Price |
$2,097.60
|
| Rate for Payer: Meridian Medicaid |
$856.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,704.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,161.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,161.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,474.44
|
| Rate for Payer: UHC Exchange |
$1,474.44
|
| Rate for Payer: UHCCP Medicaid |
$816.00
|
|
|
PR NERVE GRAFT MLT STRANDS ARM/LEG >4 CM
|
Professional
|
Both
|
$3,191.00
|
|
|
Service Code
|
HCPCS 64898
|
| Min. Negotiated Rate |
$367.70 |
| Max. Negotiated Rate |
$2,340.83 |
| Rate for Payer: Aetna Commercial |
$1,767.51
|
| Rate for Payer: Aetna Medicare |
$1,595.50
|
| Rate for Payer: BCBS Complete |
$927.93
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: BCN Commercial |
$1,999.18
|
| Rate for Payer: Cash Price |
$2,552.80
|
| Rate for Payer: Cash Price |
$2,552.80
|
| Rate for Payer: Meridian Medicaid |
$927.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$883.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,340.83
|
| Rate for Payer: Priority Health Narrow Network |
$2,340.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,604.77
|
| Rate for Payer: UHC Exchange |
$1,604.77
|
| Rate for Payer: UHCCP Medicaid |
$883.74
|
|
|
PR NERVE GRAFT MLT STRANDS HAND/FOOT <4 CM
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 64895
|
| Min. Negotiated Rate |
$219.77 |
| Max. Negotiated Rate |
$2,260.08 |
| Rate for Payer: Aetna Commercial |
$1,709.01
|
| Rate for Payer: Aetna Medicare |
$1,607.50
|
| Rate for Payer: BCBS Complete |
$895.72
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: BCN Commercial |
$1,932.72
|
| Rate for Payer: Cash Price |
$2,572.00
|
| Rate for Payer: Cash Price |
$2,572.00
|
| Rate for Payer: Meridian Medicaid |
$895.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$853.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,089.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,260.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,260.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,531.80
|
| Rate for Payer: UHC Exchange |
$1,531.80
|
| Rate for Payer: UHCCP Medicaid |
$853.07
|
|
|
PR NERVE PEDICLE TRANSFER FIRST STAGE
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
HCPCS 64905
|
| Min. Negotiated Rate |
$641.34 |
| Max. Negotiated Rate |
$1,712.41 |
| Rate for Payer: Aetna Commercial |
$1,305.22
|
| Rate for Payer: Aetna Medicare |
$1,113.50
|
| Rate for Payer: BCBS Complete |
$673.41
|
| Rate for Payer: BCN Commercial |
$1,469.46
|
| Rate for Payer: Cash Price |
$1,781.60
|
| Rate for Payer: Cash Price |
$1,781.60
|
| Rate for Payer: Meridian Medicaid |
$673.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$641.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,447.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,712.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,712.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,188.97
|
| Rate for Payer: UHC Exchange |
$1,188.97
|
| Rate for Payer: UHCCP Medicaid |
$641.34
|
|
|
PR NERVE REPAIR W/CONDUIT EACH NERVE
|
Professional
|
Both
|
$2,621.00
|
|
|
Service Code
|
HCPCS 64910
|
| Min. Negotiated Rate |
$272.60 |
| Max. Negotiated Rate |
$1,703.65 |
| Rate for Payer: Aetna Commercial |
$998.70
|
| Rate for Payer: Aetna Medicare |
$1,310.50
|
| Rate for Payer: BCBS Complete |
$517.52
|
| Rate for Payer: BCBS Trust/PPO |
$272.60
|
| Rate for Payer: BCN Commercial |
$1,113.21
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Meridian Medicaid |
$517.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,306.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,306.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$937.82
|
| Rate for Payer: UHC Exchange |
$937.82
|
| Rate for Payer: UHCCP Medicaid |
$492.88
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 64913
|
| Min. Negotiated Rate |
$108.84 |
| Max. Negotiated Rate |
$291.18 |
| Rate for Payer: Aetna Commercial |
$228.03
|
| Rate for Payer: Aetna Medicare |
$162.50
|
| Rate for Payer: BCBS Complete |
$114.28
|
| Rate for Payer: BCBS Trust/PPO |
$274.19
|
| Rate for Payer: BCN Commercial |
$250.69
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Meridian Medicaid |
$114.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.18
|
| Rate for Payer: Priority Health Narrow Network |
$291.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.76
|
| Rate for Payer: UHC Exchange |
$200.76
|
| Rate for Payer: UHCCP Medicaid |
$108.84
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND
|
Professional
|
Both
|
$1,592.00
|
|
|
Service Code
|
HCPCS 64912
|
| Min. Negotiated Rate |
$311.17 |
| Max. Negotiated Rate |
$1,533.25 |
| Rate for Payer: Aetna Commercial |
$1,126.41
|
| Rate for Payer: Aetna Medicare |
$796.00
|
| Rate for Payer: BCBS Complete |
$605.64
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$1,309.17
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Meridian Medicaid |
$605.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$576.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,533.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,533.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$982.66
|
| Rate for Payer: UHC Exchange |
$982.66
|
| Rate for Payer: UHCCP Medicaid |
$576.80
|
|
|
PR NEURAXIAL LABOR ANALG/ANES PLND VAGINAL DELIVERY
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01967
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$650.00
|
| Rate for Payer: Priority Health Narrow Network |
$650.00
|
|
|
PR NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 96116
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$1,244.67 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$52.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,244.67
|
| Rate for Payer: BCN Commercial |
$134.38
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Meridian Medicaid |
$52.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.20
|
| Rate for Payer: Priority Health Narrow Network |
$107.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.45
|
| Rate for Payer: UHC Exchange |
$92.45
|
| Rate for Payer: UHCCP Medicaid |
$50.27
|
|
|
PR NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 96121
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$1,458.64 |
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.64
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.11
|
| Rate for Payer: Priority Health Narrow Network |
$89.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.21
|
| Rate for Payer: UHC Exchange |
$85.21
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
|
|
PR NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY
|
Professional
|
Both
|
$4,388.00
|
|
|
Service Code
|
HCPCS 62164
|
| Min. Negotiated Rate |
$1,230.41 |
| Max. Negotiated Rate |
$4,290.63 |
| Rate for Payer: Aetna Commercial |
$2,702.98
|
| Rate for Payer: Aetna Medicare |
$2,194.00
|
| Rate for Payer: BCBS Complete |
$1,435.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.41
|
| Rate for Payer: BCN Commercial |
$4,290.63
|
| Rate for Payer: Cash Price |
$3,510.40
|
| Rate for Payer: Cash Price |
$3,510.40
|
| Rate for Payer: Meridian Medicaid |
$1,435.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,367.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,852.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,632.96
|
| Rate for Payer: Priority Health Narrow Network |
$3,632.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,389.66
|
| Rate for Payer: UHC Exchange |
$2,389.66
|
| Rate for Payer: UHCCP Medicaid |
$1,367.03
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 95937
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$111.69
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: BCBS Complete |
$22.59
|
| Rate for Payer: BCBS Trust/PPO |
$59.17
|
| Rate for Payer: BCN Commercial |
$153.93
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Meridian Medicaid |
$22.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.68
|
| Rate for Payer: Priority Health Narrow Network |
$45.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.73
|
| Rate for Payer: UHC Exchange |
$60.73
|
| Rate for Payer: UHCCP Medicaid |
$21.51
|
|
|
PR NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT
|
Professional
|
Both
|
$2,488.00
|
|
|
Service Code
|
HCPCS 64702
|
| Min. Negotiated Rate |
$336.75 |
| Max. Negotiated Rate |
$4,639.00 |
| Rate for Payer: Aetna Commercial |
$649.73
|
| Rate for Payer: Aetna Medicare |
$1,244.00
|
| Rate for Payer: BCBS Complete |
$353.59
|
| Rate for Payer: BCBS Trust/PPO |
$4,639.00
|
| Rate for Payer: BCN Commercial |
$756.96
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Meridian Medicaid |
$353.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$891.19
|
| Rate for Payer: Priority Health Narrow Network |
$891.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.25
|
| Rate for Payer: UHC Exchange |
$541.25
|
| Rate for Payer: UHCCP Medicaid |
$336.75
|
|
|
PR NEUROPLASTY NERVE HAND/FOOT
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 64704
|
| Min. Negotiated Rate |
$211.72 |
| Max. Negotiated Rate |
$6,889.56 |
| Rate for Payer: Aetna Commercial |
$413.18
|
| Rate for Payer: Aetna Medicare |
$944.00
|
| Rate for Payer: BCBS Complete |
$222.31
|
| Rate for Payer: BCBS Trust/PPO |
$6,889.56
|
| Rate for Payer: BCN Commercial |
$474.51
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Meridian Medicaid |
$222.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.62
|
| Rate for Payer: Priority Health Narrow Network |
$559.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.67
|
| Rate for Payer: UHC Exchange |
$375.67
|
| Rate for Payer: UHCCP Medicaid |
$211.72
|
|
|
PR NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE
|
Professional
|
Both
|
$960.00
|
|
|
Service Code
|
HCPCS 64716
|
| Min. Negotiated Rate |
$330.79 |
| Max. Negotiated Rate |
$5,621.64 |
| Rate for Payer: Aetna Commercial |
$656.90
|
| Rate for Payer: Aetna Medicare |
$480.00
|
| Rate for Payer: BCBS Complete |
$347.33
|
| Rate for Payer: BCBS Trust/PPO |
$5,621.64
|
| Rate for Payer: BCN Commercial |
$751.59
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Meridian Medicaid |
$347.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$880.93
|
| Rate for Payer: Priority Health Narrow Network |
$880.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.32
|
| Rate for Payer: UHC Exchange |
$605.32
|
| Rate for Payer: UHCCP Medicaid |
$330.79
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$3,146.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$396.18 |
| Max. Negotiated Rate |
$4,438.25 |
| Rate for Payer: Aetna Commercial |
$765.15
|
| Rate for Payer: Aetna Medicare |
$1,573.00
|
| Rate for Payer: BCBS Complete |
$415.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,438.25
|
| Rate for Payer: BCN Commercial |
$889.40
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Meridian Medicaid |
$415.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,047.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,047.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$655.26
|
| Rate for Payer: UHC Exchange |
$655.26
|
| Rate for Payer: UHCCP Medicaid |
$396.18
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Facility
|
IP
|
$3,146.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$2,044.90 |
| Max. Negotiated Rate |
$3,146.00 |
| Rate for Payer: Aetna Commercial |
$2,831.40
|
| Rate for Payer: ASR ASR |
$3,051.62
|
| Rate for Payer: ASR Commercial |
$3,051.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.68
|
| Rate for Payer: BCN Commercial |
$2,439.09
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cofinity Commercial |
$2,957.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,516.80
|
| Rate for Payer: Healthscope Commercial |
$3,146.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,051.62
|
| Rate for Payer: Mclaren Commercial |
$2,831.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,674.10
|
| Rate for Payer: Nomi Health Commercial |
$2,579.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,768.48
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Facility
|
OP
|
$3,146.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$1,025.52 |
| Max. Negotiated Rate |
$3,146.00 |
| Rate for Payer: Aetna Commercial |
$2,831.40
|
| Rate for Payer: Aetna Medicare |
$1,913.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: ASR ASR |
$3,051.62
|
| Rate for Payer: ASR Commercial |
$3,051.62
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,576.26
|
| Rate for Payer: BCN Commercial |
$2,439.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cofinity Commercial |
$2,957.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,516.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$3,146.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,051.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,913.28
|
| Rate for Payer: Mclaren Commercial |
$2,831.40
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,674.10
|
| Rate for Payer: Nomi Health Commercial |
$2,579.72
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$2,104.61
|
| Rate for Payer: PHP Medicaid |
$1,025.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,756.53
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,205.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,768.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$2,965.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP DNSP |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$3,146.00
|
|
|
Service Code
|
HCPCS 64718
|
| Min. Negotiated Rate |
$396.18 |
| Max. Negotiated Rate |
$4,438.25 |
| Rate for Payer: Aetna Commercial |
$765.15
|
| Rate for Payer: Aetna Medicare |
$1,573.00
|
| Rate for Payer: BCBS Complete |
$415.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,438.25
|
| Rate for Payer: BCN Commercial |
$889.40
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Meridian Medicaid |
$415.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,047.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,047.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$655.26
|
| Rate for Payer: UHC Exchange |
$655.26
|
| Rate for Payer: UHCCP Medicaid |
$396.18
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
64719
|
| Min. Negotiated Rate |
$1,021.80 |
| Max. Negotiated Rate |
$1,572.00 |
| Rate for Payer: Aetna Commercial |
$1,414.80
|
| Rate for Payer: ASR ASR |
$1,524.84
|
| Rate for Payer: ASR Commercial |
$1,524.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,281.02
|
| Rate for Payer: BCN Commercial |
$1,218.77
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$1,477.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,257.60
|
| Rate for Payer: Healthscope Commercial |
$1,572.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,524.84
|
| Rate for Payer: Mclaren Commercial |
$1,414.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.20
|
| Rate for Payer: Nomi Health Commercial |
$1,289.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.36
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
64719
|
| Min. Negotiated Rate |
$1,021.80 |
| Max. Negotiated Rate |
$2,965.58 |
| Rate for Payer: Aetna Commercial |
$1,414.80
|
| Rate for Payer: Aetna Medicare |
$1,913.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: ASR ASR |
$1,524.84
|
| Rate for Payer: ASR Commercial |
$1,524.84
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.31
|
| Rate for Payer: BCN Commercial |
$1,218.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$1,477.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,257.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$1,572.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,524.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,913.28
|
| Rate for Payer: Mclaren Commercial |
$1,414.80
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.20
|
| Rate for Payer: Nomi Health Commercial |
$1,289.04
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$2,104.61
|
| Rate for Payer: PHP Medicaid |
$1,025.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,377.39
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,101.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$2,965.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP DNSP |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 64719
|
| Min. Negotiated Rate |
$267.74 |
| Max. Negotiated Rate |
$3,989.19 |
| Rate for Payer: Aetna Commercial |
$517.96
|
| Rate for Payer: Aetna Medicare |
$786.00
|
| Rate for Payer: BCBS Complete |
$281.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,989.19
|
| Rate for Payer: BCN Commercial |
$602.05
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Meridian Medicaid |
$281.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$708.62
|
| Rate for Payer: Priority Health Narrow Network |
$708.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$445.32
|
| Rate for Payer: UHC Exchange |
$445.32
|
| Rate for Payer: UHCCP Medicaid |
$267.74
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
64719
|
| Min. Negotiated Rate |
$267.74 |
| Max. Negotiated Rate |
$3,989.19 |
| Rate for Payer: Aetna Commercial |
$517.96
|
| Rate for Payer: Aetna Medicare |
$786.00
|
| Rate for Payer: BCBS Complete |
$281.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,989.19
|
| Rate for Payer: BCN Commercial |
$602.05
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Meridian Medicaid |
$281.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$708.62
|
| Rate for Payer: Priority Health Narrow Network |
$708.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$445.32
|
| Rate for Payer: UHC Exchange |
$445.32
|
| Rate for Payer: UHCCP Medicaid |
$267.74
|
|
