|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Facility
|
OP
|
$3,146.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$3,146.00 |
| Rate for Payer: Aetna Commercial |
$2,831.40
|
| Rate for Payer: Aetna Medicare |
$1,904.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: ASR ASR |
$3,051.62
|
| Rate for Payer: ASR Commercial |
$3,051.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,576.26
|
| Rate for Payer: BCN Commercial |
$2,439.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| 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 |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$3,146.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,051.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,904.50
|
| Rate for Payer: Mclaren Commercial |
$2,831.40
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| 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 |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,094.95
|
| Rate for Payer: PHP Medicaid |
$1,020.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| 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 |
$1,904.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,205.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,768.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$2,951.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP DNSP |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
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
|
Professional
|
Both
|
$3,146.00
|
|
|
Service Code
|
HCPCS 64718
|
| Min. Negotiated Rate |
$581.37 |
| Max. Negotiated Rate |
$2,044.90 |
| Rate for Payer: Aetna Commercial |
$779.04
|
| Rate for Payer: Aetna Medicare |
$581.37
|
| Rate for Payer: BCBS Complete |
$1,258.40
|
| Rate for Payer: BCBS MAPPO |
$581.37
|
| Rate for Payer: BCN Medicare Advantage |
$581.37
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cofinity Commercial |
$837.17
|
| Rate for Payer: Cofinity Commercial |
$779.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.37
|
| Rate for Payer: Healthscope Commercial |
$697.64
|
| Rate for Payer: Healthscope Whirlpool |
$697.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$610.44
|
| Rate for Payer: Nomi Health Commercial |
$697.64
|
| Rate for Payer: PACE SWMI |
$581.37
|
| Rate for Payer: PHP Medicare Advantage |
$581.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: Priority Health Medicare |
$581.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$581.37
|
| Rate for Payer: UHC Medicare Advantage |
$581.37
|
| Rate for Payer: UHCCP DNSP |
$581.37
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$3,146.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$581.37 |
| Max. Negotiated Rate |
$2,044.90 |
| Rate for Payer: Aetna Commercial |
$779.04
|
| Rate for Payer: Aetna Medicare |
$581.37
|
| Rate for Payer: BCBS Complete |
$1,258.40
|
| Rate for Payer: BCBS MAPPO |
$581.37
|
| Rate for Payer: BCN Medicare Advantage |
$581.37
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cofinity Commercial |
$837.17
|
| Rate for Payer: Cofinity Commercial |
$779.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.37
|
| Rate for Payer: Healthscope Commercial |
$697.64
|
| Rate for Payer: Healthscope Whirlpool |
$697.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$610.44
|
| Rate for Payer: Nomi Health Commercial |
$697.64
|
| Rate for Payer: PACE SWMI |
$581.37
|
| Rate for Payer: PHP Medicare Advantage |
$581.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: Priority Health Medicare |
$581.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$581.37
|
| Rate for Payer: UHC Medicare Advantage |
$581.37
|
| Rate for Payer: UHCCP DNSP |
$581.37
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
64719
|
| Min. Negotiated Rate |
$392.77 |
| Max. Negotiated Rate |
$1,021.80 |
| Rate for Payer: Aetna Commercial |
$526.31
|
| Rate for Payer: Aetna Medicare |
$392.77
|
| Rate for Payer: BCBS Complete |
$628.80
|
| Rate for Payer: BCBS MAPPO |
$392.77
|
| Rate for Payer: BCN Medicare Advantage |
$392.77
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$565.59
|
| Rate for Payer: Cofinity Commercial |
$526.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.77
|
| Rate for Payer: Healthscope Commercial |
$471.32
|
| Rate for Payer: Healthscope Whirlpool |
$471.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.41
|
| Rate for Payer: Nomi Health Commercial |
$471.32
|
| Rate for Payer: PACE SWMI |
$392.77
|
| Rate for Payer: PHP Medicare Advantage |
$392.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health Medicare |
$392.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.77
|
| Rate for Payer: UHC Medicare Advantage |
$392.77
|
| Rate for Payer: UHCCP DNSP |
$392.77
|
|
|
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
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 64719
|
| Min. Negotiated Rate |
$392.77 |
| Max. Negotiated Rate |
$1,021.80 |
| Rate for Payer: Aetna Commercial |
$526.31
|
| Rate for Payer: Aetna Medicare |
$392.77
|
| Rate for Payer: BCBS Complete |
$628.80
|
| Rate for Payer: BCBS MAPPO |
$392.77
|
| Rate for Payer: BCN Medicare Advantage |
$392.77
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$565.59
|
| Rate for Payer: Cofinity Commercial |
$526.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.77
|
| Rate for Payer: Healthscope Commercial |
$471.32
|
| Rate for Payer: Healthscope Whirlpool |
$471.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.41
|
| Rate for Payer: Nomi Health Commercial |
$471.32
|
| Rate for Payer: PACE SWMI |
$392.77
|
| Rate for Payer: PHP Medicare Advantage |
$392.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health Medicare |
$392.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.77
|
| Rate for Payer: UHC Medicare Advantage |
$392.77
|
| Rate for Payer: UHCCP DNSP |
$392.77
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
64719
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$2,951.97 |
| Rate for Payer: Aetna Commercial |
$1,414.80
|
| Rate for Payer: Aetna Medicare |
$1,904.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: ASR ASR |
$1,524.84
|
| Rate for Payer: ASR Commercial |
$1,524.84
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.31
|
| Rate for Payer: BCN Commercial |
$1,218.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| 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 |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$1,572.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,524.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,904.50
|
| Rate for Payer: Mclaren Commercial |
$1,414.80
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| 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 |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,094.95
|
| Rate for Payer: PHP Medicaid |
$1,020.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| 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 |
$1,904.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,101.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$2,951.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP DNSP |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
IP
|
$2,254.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,465.10 |
| Max. Negotiated Rate |
$2,254.00 |
| Rate for Payer: Aetna Commercial |
$2,028.60
|
| Rate for Payer: ASR ASR |
$2,186.38
|
| Rate for Payer: ASR Commercial |
$2,186.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.78
|
| Rate for Payer: BCN Commercial |
$1,747.53
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$2,118.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.20
|
| Rate for Payer: Healthscope Commercial |
$2,254.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,186.38
|
| Rate for Payer: Mclaren Commercial |
$2,028.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.90
|
| Rate for Payer: Nomi Health Commercial |
$1,848.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.52
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,254.00
|
|
|
Service Code
|
HCPCS 64721
|
| Hospital Charge Code |
64721
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$1,465.10 |
| Rate for Payer: Aetna Commercial |
$563.09
|
| Rate for Payer: Aetna Medicare |
$420.22
|
| Rate for Payer: BCBS Complete |
$901.60
|
| Rate for Payer: BCBS MAPPO |
$420.22
|
| Rate for Payer: BCN Medicare Advantage |
$420.22
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$605.12
|
| Rate for Payer: Cofinity Commercial |
$563.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.22
|
| Rate for Payer: Healthscope Commercial |
$504.26
|
| Rate for Payer: Healthscope Whirlpool |
$504.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$441.23
|
| Rate for Payer: Nomi Health Commercial |
$504.26
|
| Rate for Payer: PACE SWMI |
$420.22
|
| Rate for Payer: PHP Medicare Advantage |
$420.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health Medicare |
$420.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.22
|
| Rate for Payer: UHC Medicare Advantage |
$420.22
|
| Rate for Payer: UHCCP DNSP |
$420.22
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
OP
|
$2,254.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$2,951.97 |
| Rate for Payer: Aetna Commercial |
$2,028.60
|
| Rate for Payer: Aetna Medicare |
$1,904.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: ASR ASR |
$2,186.38
|
| Rate for Payer: ASR Commercial |
$2,186.38
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.80
|
| Rate for Payer: BCN Commercial |
$1,747.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$2,118.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$2,254.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,186.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,904.50
|
| Rate for Payer: Mclaren Commercial |
$2,028.60
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.90
|
| Rate for Payer: Nomi Health Commercial |
$1,848.28
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,094.95
|
| Rate for Payer: PHP Medicaid |
$1,020.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,974.95
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,580.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$2,951.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP DNSP |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,254.00
|
|
|
Service Code
|
HCPCS 64721
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$1,465.10 |
| Rate for Payer: Aetna Commercial |
$563.09
|
| Rate for Payer: Aetna Medicare |
$420.22
|
| Rate for Payer: BCBS Complete |
$901.60
|
| Rate for Payer: BCBS MAPPO |
$420.22
|
| Rate for Payer: BCN Medicare Advantage |
$420.22
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$605.12
|
| Rate for Payer: Cofinity Commercial |
$563.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.22
|
| Rate for Payer: Healthscope Commercial |
$504.26
|
| Rate for Payer: Healthscope Whirlpool |
$504.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$441.23
|
| Rate for Payer: Nomi Health Commercial |
$504.26
|
| Rate for Payer: PACE SWMI |
$420.22
|
| Rate for Payer: PHP Medicare Advantage |
$420.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health Medicare |
$420.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.22
|
| Rate for Payer: UHC Medicare Advantage |
$420.22
|
| Rate for Payer: UHCCP DNSP |
$420.22
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 96132
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$136.57
|
| Rate for Payer: Aetna Medicare |
$101.92
|
| Rate for Payer: BCBS Complete |
$106.40
|
| Rate for Payer: BCBS MAPPO |
$101.92
|
| Rate for Payer: BCN Medicare Advantage |
$101.92
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$146.76
|
| Rate for Payer: Cofinity Commercial |
$136.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.92
|
| Rate for Payer: Healthscope Commercial |
$122.30
|
| Rate for Payer: Healthscope Whirlpool |
$122.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.02
|
| Rate for Payer: Nomi Health Commercial |
$122.30
|
| Rate for Payer: PACE SWMI |
$101.92
|
| Rate for Payer: PHP Medicare Advantage |
$101.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health Medicare |
$101.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.92
|
| Rate for Payer: UHC Medicare Advantage |
$101.92
|
| Rate for Payer: UHCCP DNSP |
$101.92
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 96133
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$96.86
|
| Rate for Payer: Aetna Medicare |
$72.28
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$72.28
|
| Rate for Payer: BCN Medicare Advantage |
$72.28
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$96.86
|
| Rate for Payer: Cofinity Commercial |
$104.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.28
|
| Rate for Payer: Healthscope Commercial |
$86.74
|
| Rate for Payer: Healthscope Whirlpool |
$86.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.89
|
| Rate for Payer: Nomi Health Commercial |
$86.74
|
| Rate for Payer: PACE SWMI |
$72.28
|
| Rate for Payer: PHP Medicare Advantage |
$72.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health Medicare |
$72.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.28
|
| Rate for Payer: UHC Medicare Advantage |
$72.28
|
| Rate for Payer: UHCCP DNSP |
$72.28
|
|
|
PR NEUROPSYCH TESTING BY COMPUTER
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 96120
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Medicare |
$86.00
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
|
|
PR NEUROPSYCH TESTING BY PSYCH/PHYS
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 96118
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$144.95 |
| Rate for Payer: Aetna Medicare |
$111.50
|
| Rate for Payer: BCBS Complete |
$89.20
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.95
|
|
|
PR NEUROPSYCH TESTING BY TECHNICIAN
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 96119
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
|
|
PR NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC
|
Professional
|
Both
|
$2,646.00
|
|
|
Service Code
|
HCPCS 64708
|
| Min. Negotiated Rate |
$483.15 |
| Max. Negotiated Rate |
$1,719.90 |
| Rate for Payer: Aetna Commercial |
$647.42
|
| Rate for Payer: Aetna Medicare |
$483.15
|
| Rate for Payer: BCBS Complete |
$1,058.40
|
| Rate for Payer: BCBS MAPPO |
$483.15
|
| Rate for Payer: BCN Medicare Advantage |
$483.15
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cofinity Commercial |
$695.74
|
| Rate for Payer: Cofinity Commercial |
$647.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.15
|
| Rate for Payer: Healthscope Commercial |
$579.78
|
| Rate for Payer: Healthscope Whirlpool |
$579.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.31
|
| Rate for Payer: Nomi Health Commercial |
$579.78
|
| Rate for Payer: PACE SWMI |
$483.15
|
| Rate for Payer: PHP Medicare Advantage |
$483.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,719.90
|
| Rate for Payer: Priority Health Medicare |
$483.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$483.15
|
| Rate for Payer: UHC Medicare Advantage |
$483.15
|
| Rate for Payer: UHCCP DNSP |
$483.15
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 64713
|
| Min. Negotiated Rate |
$774.67 |
| Max. Negotiated Rate |
$1,803.10 |
| Rate for Payer: Aetna Commercial |
$1,038.06
|
| Rate for Payer: Aetna Medicare |
$774.67
|
| Rate for Payer: BCBS Complete |
$1,109.60
|
| Rate for Payer: BCBS MAPPO |
$774.67
|
| Rate for Payer: BCN Medicare Advantage |
$774.67
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,115.52
|
| Rate for Payer: Cofinity Commercial |
$1,038.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.67
|
| Rate for Payer: Healthscope Commercial |
$929.60
|
| Rate for Payer: Healthscope Whirlpool |
$929.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$813.40
|
| Rate for Payer: Nomi Health Commercial |
$929.60
|
| Rate for Payer: PACE SWMI |
$774.67
|
| Rate for Payer: PHP Medicare Advantage |
$774.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health Medicare |
$774.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.67
|
| Rate for Payer: UHC Medicare Advantage |
$774.67
|
| Rate for Payer: UHCCP DNSP |
$774.67
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS
|
Professional
|
Both
|
$3,408.00
|
|
|
Service Code
|
HCPCS 64714
|
| Min. Negotiated Rate |
$741.82 |
| Max. Negotiated Rate |
$2,215.20 |
| Rate for Payer: Aetna Commercial |
$994.04
|
| Rate for Payer: Aetna Medicare |
$741.82
|
| Rate for Payer: BCBS Complete |
$1,363.20
|
| Rate for Payer: BCBS MAPPO |
$741.82
|
| Rate for Payer: BCN Medicare Advantage |
$741.82
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cofinity Commercial |
$994.04
|
| Rate for Payer: Cofinity Commercial |
$1,068.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$741.82
|
| Rate for Payer: Healthscope Commercial |
$890.18
|
| Rate for Payer: Healthscope Whirlpool |
$890.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$778.91
|
| Rate for Payer: Nomi Health Commercial |
$890.18
|
| Rate for Payer: PACE SWMI |
$741.82
|
| Rate for Payer: PHP Medicare Advantage |
$741.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,215.20
|
| Rate for Payer: Priority Health Medicare |
$741.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$741.82
|
| Rate for Payer: UHC Medicare Advantage |
$741.82
|
| Rate for Payer: UHCCP DNSP |
$741.82
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV
|
Professional
|
Both
|
$997.00
|
|
|
Service Code
|
HCPCS 64712
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$825.09 |
| Rate for Payer: Aetna Commercial |
$767.79
|
| Rate for Payer: Aetna Medicare |
$572.98
|
| Rate for Payer: BCBS Complete |
$398.80
|
| Rate for Payer: BCBS MAPPO |
$572.98
|
| Rate for Payer: BCN Medicare Advantage |
$572.98
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cofinity Commercial |
$825.09
|
| Rate for Payer: Cofinity Commercial |
$767.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.98
|
| Rate for Payer: Healthscope Commercial |
$687.58
|
| Rate for Payer: Healthscope Whirlpool |
$687.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.63
|
| Rate for Payer: Nomi Health Commercial |
$687.58
|
| Rate for Payer: PACE SWMI |
$572.98
|
| Rate for Payer: PHP Medicare Advantage |
$572.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.05
|
| Rate for Payer: Priority Health Medicare |
$572.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.98
|
| Rate for Payer: UHC Medicare Advantage |
$572.98
|
| Rate for Payer: UHCCP DNSP |
$572.98
|
|
|
PR N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 93924
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$207.35 |
| Rate for Payer: Aetna Commercial |
$191.19
|
| Rate for Payer: Aetna Medicare |
$142.68
|
| Rate for Payer: BCBS Complete |
$127.60
|
| Rate for Payer: BCBS MAPPO |
$142.68
|
| Rate for Payer: BCN Medicare Advantage |
$142.68
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$205.46
|
| Rate for Payer: Cofinity Commercial |
$191.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.68
|
| Rate for Payer: Healthscope Commercial |
$171.22
|
| Rate for Payer: Healthscope Whirlpool |
$171.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.81
|
| Rate for Payer: Nomi Health Commercial |
$171.22
|
| Rate for Payer: PACE SWMI |
$142.68
|
| Rate for Payer: PHP Medicare Advantage |
$142.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.35
|
| Rate for Payer: Priority Health Medicare |
$142.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.68
|
| Rate for Payer: UHC Medicare Advantage |
$142.68
|
| Rate for Payer: UHCCP DNSP |
$142.68
|
|
|
PR NIPPLE/AREOLA RECONSTRUCTION
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 19350
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Commercial |
$863.92
|
| Rate for Payer: Aetna Medicare |
$644.72
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$644.72
|
| Rate for Payer: BCN Medicare Advantage |
$644.72
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$928.40
|
| Rate for Payer: Cofinity Commercial |
$863.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.72
|
| Rate for Payer: Healthscope Commercial |
$773.66
|
| Rate for Payer: Healthscope Whirlpool |
$773.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$676.96
|
| Rate for Payer: Nomi Health Commercial |
$773.66
|
| Rate for Payer: PACE SWMI |
$644.72
|
| Rate for Payer: PHP Medicare Advantage |
$644.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$644.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.72
|
| Rate for Payer: UHC Medicare Advantage |
$644.72
|
| Rate for Payer: UHCCP DNSP |
$644.72
|
|
|
PR NIPPLE EXPLORATION
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 19110
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$455.91
|
| Rate for Payer: Aetna Medicare |
$340.23
|
| Rate for Payer: BCBS Complete |
$307.20
|
| Rate for Payer: BCBS MAPPO |
$340.23
|
| Rate for Payer: BCN Medicare Advantage |
$340.23
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$489.93
|
| Rate for Payer: Cofinity Commercial |
$455.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.23
|
| Rate for Payer: Healthscope Commercial |
$408.28
|
| Rate for Payer: Healthscope Whirlpool |
$408.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.24
|
| Rate for Payer: Nomi Health Commercial |
$408.28
|
| Rate for Payer: PACE SWMI |
$340.23
|
| Rate for Payer: PHP Medicare Advantage |
$340.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health Medicare |
$340.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.23
|
| Rate for Payer: UHC Medicare Advantage |
$340.23
|
| Rate for Payer: UHCCP DNSP |
$340.23
|
|
|
PR NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 95012
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Aetna Commercial |
$22.23
|
| Rate for Payer: Aetna Medicare |
$16.59
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$16.59
|
| Rate for Payer: BCN Medicare Advantage |
$16.59
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Cofinity Commercial |
$22.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.59
|
| Rate for Payer: Healthscope Commercial |
$19.91
|
| Rate for Payer: Healthscope Whirlpool |
$19.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.42
|
| Rate for Payer: Nomi Health Commercial |
$19.91
|
| Rate for Payer: PACE SWMI |
$16.59
|
| Rate for Payer: PHP Medicare Advantage |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$16.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.59
|
| Rate for Payer: UHC Medicare Advantage |
$16.59
|
| Rate for Payer: UHCCP DNSP |
$16.59
|
|
