|
PR SURG TX ANAL FISTULA INTERSPHINCTERIC
|
Professional
|
Both
|
$1,315.00
|
|
|
Service Code
|
HCPCS 46275
|
| Min. Negotiated Rate |
$274.98 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Aetna Commercial |
$558.68
|
| Rate for Payer: Aetna Medicare |
$657.50
|
| Rate for Payer: BCBS Complete |
$288.73
|
| Rate for Payer: BCBS Trust/PPO |
$4,730.40
|
| Rate for Payer: BCN Commercial |
$830.26
|
| Rate for Payer: Cash Price |
$1,052.00
|
| Rate for Payer: Cash Price |
$1,052.00
|
| Rate for Payer: Meridian Medicaid |
$288.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$763.05
|
| Rate for Payer: Priority Health Narrow Network |
$763.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.55
|
| Rate for Payer: UHC Exchange |
$467.55
|
| Rate for Payer: UHCCP Medicaid |
$274.98
|
|
|
PR SURG TX ANAL FISTULA SUBQ
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 46270
|
| Min. Negotiated Rate |
$261.99 |
| Max. Negotiated Rate |
$2,437.58 |
| Rate for Payer: Aetna Commercial |
$530.44
|
| Rate for Payer: Aetna Medicare |
$431.00
|
| Rate for Payer: BCBS Complete |
$275.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,437.58
|
| Rate for Payer: BCN Commercial |
$787.75
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Meridian Medicaid |
$275.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$724.86
|
| Rate for Payer: Priority Health Narrow Network |
$724.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.06
|
| Rate for Payer: UHC Exchange |
$440.06
|
| Rate for Payer: UHCCP Medicaid |
$261.99
|
|
|
PR SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD
|
Professional
|
Both
|
$11,334.00
|
|
|
Service Code
|
HCPCS 33548
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$7,367.10 |
| Rate for Payer: Aetna Commercial |
$3,982.60
|
| Rate for Payer: Aetna Medicare |
$5,667.00
|
| Rate for Payer: BCBS Complete |
$1,939.72
|
| Rate for Payer: BCBS Trust/PPO |
$624.98
|
| Rate for Payer: BCN Commercial |
$4,215.34
|
| Rate for Payer: Cash Price |
$9,067.20
|
| Rate for Payer: Cash Price |
$9,067.20
|
| Rate for Payer: Meridian Medicaid |
$1,939.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,847.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,367.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,592.84
|
| Rate for Payer: Priority Health Narrow Network |
$4,592.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,921.84
|
| Rate for Payer: UHC Exchange |
$3,921.84
|
| Rate for Payer: UHCCP Medicaid |
$1,847.35
|
|
|
PR SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
HCPCS 64832
|
| Min. Negotiated Rate |
$210.87 |
| Max. Negotiated Rate |
$859.95 |
| Rate for Payer: Aetna Commercial |
$430.52
|
| Rate for Payer: Aetna Medicare |
$661.50
|
| Rate for Payer: BCBS Complete |
$221.41
|
| Rate for Payer: BCBS Trust/PPO |
$294.79
|
| Rate for Payer: BCN Commercial |
$481.35
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Meridian Medicaid |
$221.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.33
|
| Rate for Payer: Priority Health Narrow Network |
$561.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.24
|
| Rate for Payer: UHC Exchange |
$401.24
|
| Rate for Payer: UHCCP Medicaid |
$210.87
|
|
|
PR SUTR ESOPHGL WND/INJ CRV APPR
|
Professional
|
Both
|
$2,855.00
|
|
|
Service Code
|
HCPCS 43410
|
| Min. Negotiated Rate |
$666.69 |
| Max. Negotiated Rate |
$1,858.40 |
| Rate for Payer: Aetna Commercial |
$1,357.86
|
| Rate for Payer: Aetna Medicare |
$1,427.50
|
| Rate for Payer: BCBS Complete |
$700.02
|
| Rate for Payer: BCBS Trust/PPO |
$949.92
|
| Rate for Payer: BCN Commercial |
$1,513.44
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Meridian Medicaid |
$700.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$666.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,858.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,858.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,261.59
|
| Rate for Payer: UHC Exchange |
$1,261.59
|
| Rate for Payer: UHCCP Medicaid |
$666.69
|
|
|
PR SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 43415
|
| Min. Negotiated Rate |
$1,207.03 |
| Max. Negotiated Rate |
$4,566.34 |
| Rate for Payer: Aetna Commercial |
$3,436.27
|
| Rate for Payer: Aetna Medicare |
$2,038.00
|
| Rate for Payer: BCBS Complete |
$1,710.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.03
|
| Rate for Payer: BCN Commercial |
$3,715.41
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Meridian Medicaid |
$1,710.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,628.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,649.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,566.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,566.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,147.01
|
| Rate for Payer: UHC Exchange |
$2,147.01
|
| Rate for Payer: UHCCP Medicaid |
$1,628.81
|
|
|
PR SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 27381
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$3,176.14 |
| Rate for Payer: Aetna Commercial |
$1,093.37
|
| Rate for Payer: Aetna Medicare |
$793.00
|
| Rate for Payer: BCBS Complete |
$560.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.14
|
| Rate for Payer: BCN Commercial |
$1,209.96
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Meridian Medicaid |
$560.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$533.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,267.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,267.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.24
|
| Rate for Payer: UHC Exchange |
$912.24
|
| Rate for Payer: UHCCP Medicaid |
$533.78
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY
|
Professional
|
Both
|
$2,938.00
|
|
|
Service Code
|
HCPCS 44605
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$2,295.10 |
| Rate for Payer: Aetna Commercial |
$1,748.55
|
| Rate for Payer: Aetna Medicare |
$1,469.00
|
| Rate for Payer: BCBS Complete |
$865.75
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$1,885.32
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Meridian Medicaid |
$865.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$824.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,909.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,295.10
|
| Rate for Payer: Priority Health Narrow Network |
$2,295.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,582.64
|
| Rate for Payer: UHC Exchange |
$1,582.64
|
| Rate for Payer: UHCCP Medicaid |
$824.52
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$3,081.00
|
|
|
Service Code
|
HCPCS 44604
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$2,002.65 |
| Rate for Payer: Aetna Commercial |
$1,425.76
|
| Rate for Payer: Aetna Medicare |
$1,540.50
|
| Rate for Payer: BCBS Complete |
$708.30
|
| Rate for Payer: BCBS Trust/PPO |
$54.94
|
| Rate for Payer: BCN Commercial |
$1,534.94
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Meridian Medicaid |
$708.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,881.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,881.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,282.34
|
| Rate for Payer: UHC Exchange |
$1,282.34
|
| Rate for Payer: UHCCP Medicaid |
$674.57
|
|
|
PR SUTR&/LIG THORACIC DUCT THORACIC APPROACH
|
Professional
|
Both
|
$5,927.00
|
|
|
Service Code
|
HCPCS 38381
|
| Min. Negotiated Rate |
$516.53 |
| Max. Negotiated Rate |
$3,852.55 |
| Rate for Payer: Aetna Commercial |
$994.35
|
| Rate for Payer: Aetna Medicare |
$2,963.50
|
| Rate for Payer: BCBS Complete |
$542.36
|
| Rate for Payer: BCBS Trust/PPO |
$540.98
|
| Rate for Payer: BCN Commercial |
$1,163.05
|
| Rate for Payer: Cash Price |
$4,741.60
|
| Rate for Payer: Cash Price |
$4,741.60
|
| Rate for Payer: Meridian Medicaid |
$542.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,596.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,596.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$943.08
|
| Rate for Payer: UHC Exchange |
$943.08
|
| Rate for Payer: UHCCP Medicaid |
$516.53
|
|
|
PR SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE
|
Professional
|
Both
|
$2,055.00
|
|
|
Service Code
|
HCPCS 69740
|
| Min. Negotiated Rate |
$740.81 |
| Max. Negotiated Rate |
$1,902.94 |
| Rate for Payer: Aetna Commercial |
$1,318.76
|
| Rate for Payer: Aetna Medicare |
$1,027.50
|
| Rate for Payer: BCBS Complete |
$777.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,902.94
|
| Rate for Payer: BCN Commercial |
$1,709.39
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Meridian Medicaid |
$777.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$740.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,335.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,699.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,699.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,304.34
|
| Rate for Payer: UHC Exchange |
$1,304.34
|
| Rate for Payer: UHCCP Medicaid |
$740.81
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS
|
Professional
|
Both
|
$3,175.00
|
|
|
Service Code
|
HCPCS 64857
|
| Min. Negotiated Rate |
$202.87 |
| Max. Negotiated Rate |
$2,063.75 |
| Rate for Payer: Aetna Commercial |
$1,356.55
|
| Rate for Payer: Aetna Medicare |
$1,587.50
|
| Rate for Payer: BCBS Complete |
$710.54
|
| Rate for Payer: BCBS Trust/PPO |
$202.87
|
| Rate for Payer: BCN Commercial |
$1,539.82
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Meridian Medicaid |
$710.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$676.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,063.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,801.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,801.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,223.10
|
| Rate for Payer: UHC Exchange |
$1,223.10
|
| Rate for Payer: UHCCP Medicaid |
$676.70
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS
|
Professional
|
Both
|
$3,953.00
|
|
|
Service Code
|
HCPCS 64856
|
| Min. Negotiated Rate |
$183.32 |
| Max. Negotiated Rate |
$2,569.45 |
| Rate for Payer: Aetna Commercial |
$1,297.52
|
| Rate for Payer: Aetna Medicare |
$1,976.50
|
| Rate for Payer: BCBS Complete |
$685.49
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$1,480.20
|
| Rate for Payer: Cash Price |
$3,162.40
|
| Rate for Payer: Cash Price |
$3,162.40
|
| Rate for Payer: Meridian Medicaid |
$685.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,569.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,723.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,723.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,171.76
|
| Rate for Payer: UHC Exchange |
$1,171.76
|
| Rate for Payer: UHCCP Medicaid |
$652.85
|
|
|
PR SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ
|
Professional
|
Both
|
$2,342.00
|
|
|
Service Code
|
HCPCS 27386
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$1,522.30 |
| Rate for Payer: Aetna Commercial |
$1,142.85
|
| Rate for Payer: Aetna Medicare |
$1,171.00
|
| Rate for Payer: BCBS Complete |
$584.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.54
|
| Rate for Payer: BCN Commercial |
$1,261.27
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Meridian Medicaid |
$584.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$557.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,323.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,323.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$947.18
|
| Rate for Payer: UHC Exchange |
$947.18
|
| Rate for Payer: UHCCP Medicaid |
$557.00
|
|
|
PR SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP
|
Professional
|
Both
|
$2,203.00
|
|
|
Service Code
|
HCPCS 33320
|
| Min. Negotiated Rate |
$375.26 |
| Max. Negotiated Rate |
$1,682.16 |
| Rate for Payer: Aetna Commercial |
$1,417.73
|
| Rate for Payer: Aetna Medicare |
$1,101.50
|
| Rate for Payer: BCBS Complete |
$710.09
|
| Rate for Payer: BCBS Trust/PPO |
$375.26
|
| Rate for Payer: BCN Commercial |
$1,538.85
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Meridian Medicaid |
$710.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$676.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,431.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,682.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,682.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.18
|
| Rate for Payer: UHC Exchange |
$1,381.18
|
| Rate for Payer: UHCCP Medicaid |
$676.28
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK
|
Professional
|
Both
|
$1,151.00
|
|
|
Service Code
|
HCPCS 67935
|
| Min. Negotiated Rate |
$277.33 |
| Max. Negotiated Rate |
$2,017.58 |
| Rate for Payer: Aetna Commercial |
$573.82
|
| Rate for Payer: Aetna Medicare |
$575.50
|
| Rate for Payer: BCBS Complete |
$291.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,017.58
|
| Rate for Payer: BCN Commercial |
$870.33
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Meridian Medicaid |
$291.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.38
|
| Rate for Payer: Priority Health Narrow Network |
$760.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$487.35
|
| Rate for Payer: UHC Exchange |
$487.35
|
| Rate for Payer: UHCCP Medicaid |
$277.33
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 67930
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$668.30 |
| Rate for Payer: Aetna Commercial |
$309.73
|
| Rate for Payer: Aetna Medicare |
$382.50
|
| Rate for Payer: BCBS Complete |
$156.56
|
| Rate for Payer: BCBS Trust/PPO |
$668.30
|
| Rate for Payer: BCN Commercial |
$539.50
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Meridian Medicaid |
$156.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.85
|
| Rate for Payer: Priority Health Narrow Network |
$408.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.58
|
| Rate for Payer: UHC Exchange |
$267.58
|
| Rate for Payer: UHCCP Medicaid |
$149.10
|
|
|
PR SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 64834
|
| Min. Negotiated Rate |
$404.68 |
| Max. Negotiated Rate |
$1,397.50 |
| Rate for Payer: Aetna Commercial |
$952.43
|
| Rate for Payer: Aetna Medicare |
$1,075.00
|
| Rate for Payer: BCBS Complete |
$509.25
|
| Rate for Payer: BCBS Trust/PPO |
$404.68
|
| Rate for Payer: BCN Commercial |
$1,077.53
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Meridian Medicaid |
$509.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,280.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,280.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.81
|
| Rate for Payer: UHC Exchange |
$850.81
|
| Rate for Payer: UHCCP Medicaid |
$485.00
|
|
|
PR SUTURE 1 NERVE MEDIAN MOTOR THENAR
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 64835
|
| Min. Negotiated Rate |
$302.72 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$1,049.59
|
| Rate for Payer: Aetna Medicare |
$1,143.50
|
| Rate for Payer: BCBS Complete |
$556.67
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: BCN Commercial |
$1,197.26
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Meridian Medicaid |
$556.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$530.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,404.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,404.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$931.60
|
| Rate for Payer: UHC Exchange |
$931.60
|
| Rate for Payer: UHCCP Medicaid |
$530.16
|
|
|
PR SUTURE 1 NERVE ULNAR MOTOR
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
HCPCS 64836
|
| Min. Negotiated Rate |
$219.24 |
| Max. Negotiated Rate |
$1,404.16 |
| Rate for Payer: Aetna Commercial |
$1,049.59
|
| Rate for Payer: Aetna Medicare |
$902.50
|
| Rate for Payer: BCBS Complete |
$556.67
|
| Rate for Payer: BCBS Trust/PPO |
$219.24
|
| Rate for Payer: BCN Commercial |
$1,197.26
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Meridian Medicaid |
$556.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$530.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,404.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,404.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$932.45
|
| Rate for Payer: UHC Exchange |
$932.45
|
| Rate for Payer: UHCCP Medicaid |
$530.16
|
|
|
PR SUTURE BRACHIAL PLEXUS
|
Professional
|
Both
|
$3,705.00
|
|
|
Service Code
|
HCPCS 64861
|
| Min. Negotiated Rate |
$244.60 |
| Max. Negotiated Rate |
$2,643.96 |
| Rate for Payer: Aetna Commercial |
$1,962.06
|
| Rate for Payer: Aetna Medicare |
$1,852.50
|
| Rate for Payer: BCBS Complete |
$1,045.34
|
| Rate for Payer: BCBS Trust/PPO |
$244.60
|
| Rate for Payer: BCN Commercial |
$2,250.85
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Meridian Medicaid |
$1,045.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$995.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,408.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,643.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,643.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,569.25
|
| Rate for Payer: UHC Exchange |
$1,569.25
|
| Rate for Payer: UHCCP Medicaid |
$995.56
|
|
|
PR SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 64831
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,290.25 |
| Rate for Payer: Aetna Commercial |
$883.33
|
| Rate for Payer: Aetna Medicare |
$992.50
|
| Rate for Payer: BCBS Complete |
$476.15
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$1,019.87
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Meridian Medicaid |
$476.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,197.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,197.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$771.84
|
| Rate for Payer: UHC Exchange |
$771.84
|
| Rate for Payer: UHCCP Medicaid |
$453.48
|
|
|
PR SUTURE EACH ADDITIONAL NERVE HAND/FOOT
|
Professional
|
Both
|
$1,311.00
|
|
|
Service Code
|
HCPCS 64837
|
| Min. Negotiated Rate |
$206.57 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Aetna Commercial |
$471.67
|
| Rate for Payer: Aetna Medicare |
$655.50
|
| Rate for Payer: BCBS Complete |
$242.43
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: BCN Commercial |
$525.33
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Meridian Medicaid |
$242.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$612.51
|
| Rate for Payer: Priority Health Narrow Network |
$612.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.48
|
| Rate for Payer: UHC Exchange |
$434.48
|
| Rate for Payer: UHCCP Medicaid |
$230.89
|
|
|
PR SUTURE EACH ADDITIONAL PERIPHERAL NERVE
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 64859
|
| Min. Negotiated Rate |
$156.77 |
| Max. Negotiated Rate |
$1,061.45 |
| Rate for Payer: Aetna Commercial |
$320.62
|
| Rate for Payer: Aetna Medicare |
$816.50
|
| Rate for Payer: BCBS Complete |
$164.61
|
| Rate for Payer: BCBS Trust/PPO |
$304.83
|
| Rate for Payer: BCN Commercial |
$357.23
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Meridian Medicaid |
$164.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.29
|
| Rate for Payer: Priority Health Narrow Network |
$416.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.99
|
| Rate for Payer: UHC Exchange |
$301.99
|
| Rate for Payer: UHCCP Medicaid |
$156.77
|
|
|
PR SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY
|
Professional
|
Both
|
$3,048.00
|
|
|
Service Code
|
HCPCS 47900
|
| Min. Negotiated Rate |
$886.08 |
| Max. Negotiated Rate |
$3,830.18 |
| Rate for Payer: Aetna Commercial |
$1,836.31
|
| Rate for Payer: Aetna Medicare |
$1,524.00
|
| Rate for Payer: BCBS Complete |
$930.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,830.18
|
| Rate for Payer: BCN Commercial |
$2,015.80
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Meridian Medicaid |
$930.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,469.89
|
| Rate for Payer: Priority Health Narrow Network |
$2,469.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,642.03
|
| Rate for Payer: UHC Exchange |
$1,642.03
|
| Rate for Payer: UHCCP Medicaid |
$886.08
|
|
