|
PR SUTURE FACIAL NERVE EXTRACRANIAL
|
Professional
|
Both
|
$2,429.00
|
|
|
Service Code
|
HCPCS 64864
|
| Min. Negotiated Rate |
$305.89 |
| Max. Negotiated Rate |
$1,578.85 |
| Rate for Payer: Aetna Commercial |
$1,100.43
|
| Rate for Payer: Aetna Medicare |
$1,214.50
|
| Rate for Payer: BCBS Complete |
$581.27
|
| Rate for Payer: BCBS Trust/PPO |
$305.89
|
| Rate for Payer: BCN Commercial |
$1,260.78
|
| Rate for Payer: Cash Price |
$1,943.20
|
| Rate for Payer: Cash Price |
$1,943.20
|
| Rate for Payer: Meridian Medicaid |
$581.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,578.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,466.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,466.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,004.86
|
| Rate for Payer: UHC Exchange |
$1,004.86
|
| Rate for Payer: UHCCP Medicaid |
$553.59
|
|
|
PR SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT
|
Professional
|
Both
|
$3,037.00
|
|
|
Service Code
|
HCPCS 64865
|
| Min. Negotiated Rate |
$354.49 |
| Max. Negotiated Rate |
$1,974.05 |
| Rate for Payer: Aetna Commercial |
$1,394.17
|
| Rate for Payer: Aetna Medicare |
$1,518.50
|
| Rate for Payer: BCBS Complete |
$726.86
|
| Rate for Payer: BCBS Trust/PPO |
$354.49
|
| Rate for Payer: BCN Commercial |
$1,592.11
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Meridian Medicaid |
$726.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,853.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,853.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,319.72
|
| Rate for Payer: UHC Exchange |
$1,319.72
|
| Rate for Payer: UHCCP Medicaid |
$692.25
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Professional
|
Both
|
$1,551.00
|
|
|
Service Code
|
HCPCS 27380
|
| Min. Negotiated Rate |
$405.77 |
| Max. Negotiated Rate |
$2,533.73 |
| Rate for Payer: Aetna Commercial |
$824.66
|
| Rate for Payer: Aetna Medicare |
$775.50
|
| Rate for Payer: BCBS Complete |
$426.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,533.73
|
| Rate for Payer: BCN Commercial |
$923.11
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Meridian Medicaid |
$426.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$966.33
|
| Rate for Payer: Priority Health Narrow Network |
$966.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$668.72
|
| Rate for Payer: UHC Exchange |
$668.72
|
| Rate for Payer: UHCCP Medicaid |
$405.77
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$1,008.15 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$1,395.90
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: ASR ASR |
$1,504.47
|
| Rate for Payer: ASR Commercial |
$1,504.47
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,270.11
|
| Rate for Payer: BCN Commercial |
$1,202.49
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Commercial |
$1,457.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$1,551.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,504.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$1,395.90
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,318.35
|
| Rate for Payer: Nomi Health Commercial |
$1,271.82
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,358.99
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,087.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,364.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$1,008.15 |
| Max. Negotiated Rate |
$1,551.00 |
| Rate for Payer: Aetna Commercial |
$1,395.90
|
| Rate for Payer: ASR ASR |
$1,504.47
|
| Rate for Payer: ASR Commercial |
$1,504.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.91
|
| Rate for Payer: BCN Commercial |
$1,202.49
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Commercial |
$1,457.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.80
|
| Rate for Payer: Healthscope Commercial |
$1,551.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,504.47
|
| Rate for Payer: Mclaren Commercial |
$1,395.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,318.35
|
| Rate for Payer: Nomi Health Commercial |
$1,271.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,364.88
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Professional
|
Both
|
$1,551.00
|
|
|
Service Code
|
HCPCS 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$405.77 |
| Max. Negotiated Rate |
$2,533.73 |
| Rate for Payer: Aetna Commercial |
$824.66
|
| Rate for Payer: Aetna Medicare |
$775.50
|
| Rate for Payer: BCBS Complete |
$426.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,533.73
|
| Rate for Payer: BCN Commercial |
$923.11
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Meridian Medicaid |
$426.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$966.33
|
| Rate for Payer: Priority Health Narrow Network |
$966.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$668.72
|
| Rate for Payer: UHC Exchange |
$668.72
|
| Rate for Payer: UHCCP Medicaid |
$405.77
|
|
|
PR SUTURE MESENTERY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
HCPCS 44850
|
| Min. Negotiated Rate |
$330.19 |
| Max. Negotiated Rate |
$1,342.93 |
| Rate for Payer: Aetna Commercial |
$1,006.64
|
| Rate for Payer: Aetna Medicare |
$989.50
|
| Rate for Payer: BCBS Complete |
$506.57
|
| Rate for Payer: BCBS Trust/PPO |
$330.19
|
| Rate for Payer: BCN Commercial |
$1,090.73
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Meridian Medicaid |
$506.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,286.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,342.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,342.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$893.49
|
| Rate for Payer: UHC Exchange |
$893.49
|
| Rate for Payer: UHCCP Medicaid |
$482.45
|
|
|
PR SUTURE NERVE REQ SECONDARY/DELAYED SUTURE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 64872
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$213.43 |
| Rate for Payer: Aetna Commercial |
$150.63
|
| Rate for Payer: Aetna Medicare |
$101.00
|
| Rate for Payer: BCBS Complete |
$77.16
|
| Rate for Payer: BCBS Trust/PPO |
$213.43
|
| Rate for Payer: BCN Commercial |
$167.13
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Meridian Medicaid |
$77.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.50
|
| Rate for Payer: Priority Health Narrow Network |
$194.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.30
|
| Rate for Payer: UHC Exchange |
$139.30
|
| Rate for Payer: UHCCP Medicaid |
$73.49
|
|
|
PR SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 64874
|
| Min. Negotiated Rate |
$109.91 |
| Max. Negotiated Rate |
$303.24 |
| Rate for Payer: Aetna Commercial |
$225.49
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: BCBS Complete |
$115.41
|
| Rate for Payer: BCBS Trust/PPO |
$303.24
|
| Rate for Payer: BCN Commercial |
$249.71
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Meridian Medicaid |
$115.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.74
|
| Rate for Payer: Priority Health Narrow Network |
$291.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.84
|
| Rate for Payer: UHC Exchange |
$201.84
|
| Rate for Payer: UHCCP Medicaid |
$109.91
|
|
|
PR SUTURE PHARYNX WOUND/INJURY
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 42900
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$1,110.49 |
| Rate for Payer: Aetna Commercial |
$440.38
|
| Rate for Payer: Aetna Medicare |
$311.50
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,110.49
|
| Rate for Payer: BCN Commercial |
$485.75
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.60
|
| Rate for Payer: Priority Health Narrow Network |
$596.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.54
|
| Rate for Payer: UHC Exchange |
$419.54
|
| Rate for Payer: UHCCP Medicaid |
$213.64
|
|
|
PR SUTURE POSTERIOR TIBIAL NERVE
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64840
|
| Min. Negotiated Rate |
$247.24 |
| Max. Negotiated Rate |
$1,651.55 |
| Rate for Payer: Aetna Commercial |
$1,237.15
|
| Rate for Payer: Aetna Medicare |
$989.50
|
| Rate for Payer: BCBS Complete |
$655.29
|
| Rate for Payer: BCBS Trust/PPO |
$247.24
|
| Rate for Payer: BCN Commercial |
$1,409.35
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Meridian Medicaid |
$655.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,286.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,651.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,651.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$980.86
|
| Rate for Payer: UHC Exchange |
$980.86
|
| Rate for Payer: UHCCP Medicaid |
$624.09
|
|
|
PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Facility
|
IP
|
$1,903.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
27385
|
| Min. Negotiated Rate |
$1,236.95 |
| Max. Negotiated Rate |
$1,903.00 |
| Rate for Payer: Aetna Commercial |
$1,712.70
|
| Rate for Payer: ASR ASR |
$1,845.91
|
| Rate for Payer: ASR Commercial |
$1,845.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,550.75
|
| Rate for Payer: BCN Commercial |
$1,475.40
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cofinity Commercial |
$1,788.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,522.40
|
| Rate for Payer: Healthscope Commercial |
$1,903.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,845.91
|
| Rate for Payer: Mclaren Commercial |
$1,712.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,617.55
|
| Rate for Payer: Nomi Health Commercial |
$1,560.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,674.64
|
|
|
PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$1,903.00
|
|
|
Service Code
|
HCPCS 27385
|
| Min. Negotiated Rate |
$395.97 |
| Max. Negotiated Rate |
$1,236.95 |
| Rate for Payer: Aetna Commercial |
$800.67
|
| Rate for Payer: Aetna Medicare |
$951.50
|
| Rate for Payer: BCBS Complete |
$415.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.92
|
| Rate for Payer: BCN Commercial |
$898.67
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Meridian Medicaid |
$415.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$942.92
|
| Rate for Payer: Priority Health Narrow Network |
$942.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.86
|
| Rate for Payer: UHC Exchange |
$715.86
|
| Rate for Payer: UHCCP Medicaid |
$395.97
|
|
|
PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Facility
|
OP
|
$1,903.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
27385
|
| Min. Negotiated Rate |
$1,236.95 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$1,712.70
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: ASR ASR |
$1,845.91
|
| Rate for Payer: ASR Commercial |
$1,845.91
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,558.37
|
| Rate for Payer: BCN Commercial |
$1,475.40
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cofinity Commercial |
$1,788.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,522.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$1,903.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,845.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$1,712.70
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,617.55
|
| Rate for Payer: Nomi Health Commercial |
$1,560.46
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,667.41
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,334.00
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,674.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$1,903.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
27385
|
| Min. Negotiated Rate |
$395.97 |
| Max. Negotiated Rate |
$1,236.95 |
| Rate for Payer: Aetna Commercial |
$800.67
|
| Rate for Payer: Aetna Medicare |
$951.50
|
| Rate for Payer: BCBS Complete |
$415.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.92
|
| Rate for Payer: BCN Commercial |
$898.67
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Meridian Medicaid |
$415.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$942.92
|
| Rate for Payer: Priority Health Narrow Network |
$942.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.86
|
| Rate for Payer: UHC Exchange |
$715.86
|
| Rate for Payer: UHCCP Medicaid |
$395.97
|
|
|
PR SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS
|
Professional
|
Both
|
$5,688.00
|
|
|
Service Code
|
HCPCS 33322
|
| Min. Negotiated Rate |
$484.45 |
| Max. Negotiated Rate |
$3,697.20 |
| Rate for Payer: Aetna Commercial |
$1,863.91
|
| Rate for Payer: Aetna Medicare |
$2,844.00
|
| Rate for Payer: BCBS Complete |
$919.20
|
| Rate for Payer: BCBS Trust/PPO |
$484.45
|
| Rate for Payer: BCN Commercial |
$1,990.39
|
| Rate for Payer: Cash Price |
$4,550.40
|
| Rate for Payer: Cash Price |
$4,550.40
|
| Rate for Payer: Meridian Medicaid |
$919.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$875.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,697.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,194.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,194.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,818.23
|
| Rate for Payer: UHC Exchange |
$1,818.23
|
| Rate for Payer: UHCCP Medicaid |
$875.43
|
|
|
PR SUTURE/REPAIR TESTICULAR INJURY
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
HCPCS 54670
|
| Min. Negotiated Rate |
$264.12 |
| Max. Negotiated Rate |
$2,909.88 |
| Rate for Payer: Aetna Commercial |
$521.74
|
| Rate for Payer: Aetna Medicare |
$628.00
|
| Rate for Payer: BCBS Complete |
$277.33
|
| Rate for Payer: BCBS Trust/PPO |
$2,909.88
|
| Rate for Payer: BCN Commercial |
$593.26
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Meridian Medicaid |
$277.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$816.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$656.16
|
| Rate for Payer: Priority Health Narrow Network |
$656.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$483.46
|
| Rate for Payer: UHC Exchange |
$483.46
|
| Rate for Payer: UHCCP Medicaid |
$264.12
|
|
|
PR SUTURE SCIATIC NERVE
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 64858
|
| Min. Negotiated Rate |
$255.70 |
| Max. Negotiated Rate |
$2,009.84 |
| Rate for Payer: Aetna Commercial |
$1,514.83
|
| Rate for Payer: Aetna Medicare |
$1,250.00
|
| Rate for Payer: BCBS Complete |
$796.19
|
| Rate for Payer: BCBS Trust/PPO |
$255.70
|
| Rate for Payer: BCN Commercial |
$1,715.75
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Meridian Medicaid |
$796.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$758.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,625.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,009.84
|
| Rate for Payer: Priority Health Narrow Network |
$2,009.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.63
|
| Rate for Payer: UHC Exchange |
$1,381.63
|
| Rate for Payer: UHCCP Medicaid |
$758.28
|
|
|
PR SUTURE TRACHEAL WOUND/INJURY CERVICAL
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 31800
|
| Min. Negotiated Rate |
$451.56 |
| Max. Negotiated Rate |
$1,267.39 |
| Rate for Payer: Aetna Commercial |
$913.40
|
| Rate for Payer: Aetna Medicare |
$794.50
|
| Rate for Payer: BCBS Complete |
$474.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,267.39
|
| Rate for Payer: BCN Commercial |
$1,045.28
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Meridian Medicaid |
$474.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$451.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$986.72
|
| Rate for Payer: Priority Health Narrow Network |
$986.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$765.67
|
| Rate for Payer: UHC Exchange |
$765.67
|
| Rate for Payer: UHCCP Medicaid |
$451.56
|
|
|
PR SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC
|
Professional
|
Both
|
$1,671.00
|
|
|
Service Code
|
HCPCS 31805
|
| Min. Negotiated Rate |
$520.79 |
| Max. Negotiated Rate |
$1,619.77 |
| Rate for Payer: Aetna Commercial |
$1,053.39
|
| Rate for Payer: Aetna Medicare |
$835.50
|
| Rate for Payer: BCBS Complete |
$546.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,619.77
|
| Rate for Payer: BCN Commercial |
$1,181.62
|
| Rate for Payer: Cash Price |
$1,336.80
|
| Rate for Payer: Cash Price |
$1,336.80
|
| Rate for Payer: Meridian Medicaid |
$546.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$520.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,128.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,128.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.35
|
| Rate for Payer: UHC Exchange |
$971.35
|
| Rate for Payer: UHCCP Medicaid |
$520.79
|
|
|
PR SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 99058
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$773.43 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$773.43
|
| Rate for Payer: BCN Commercial |
$42.19
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.94
|
| Rate for Payer: Priority Health Narrow Network |
$28.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.78
|
| Rate for Payer: UHC Exchange |
$25.78
|
|
|
PR SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 99051
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$556.30 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$556.30
|
| Rate for Payer: BCN Commercial |
$20.16
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.43
|
| Rate for Payer: Priority Health Narrow Network |
$24.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.71
|
| Rate for Payer: UHC Exchange |
$19.71
|
|
|
PR SYMPATHECTOMY CERVICAL
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 64802
|
| Min. Negotiated Rate |
$206.04 |
| Max. Negotiated Rate |
$1,478.09 |
| Rate for Payer: Aetna Commercial |
$1,082.29
|
| Rate for Payer: Aetna Medicare |
$864.50
|
| Rate for Payer: BCBS Complete |
$585.07
|
| Rate for Payer: BCBS Trust/PPO |
$206.04
|
| Rate for Payer: BCN Commercial |
$1,254.44
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Meridian Medicaid |
$585.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$557.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,478.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,478.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$694.90
|
| Rate for Payer: UHC Exchange |
$694.90
|
| Rate for Payer: UHCCP Medicaid |
$557.21
|
|
|
PR SYMPATHECTOMY LUMBAR
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 64818
|
| Min. Negotiated Rate |
$159.50 |
| Max. Negotiated Rate |
$1,337.62 |
| Rate for Payer: Aetna Commercial |
$1,002.38
|
| Rate for Payer: Aetna Medicare |
$159.50
|
| Rate for Payer: BCBS Complete |
$530.50
|
| Rate for Payer: BCBS Trust/PPO |
$668.83
|
| Rate for Payer: BCN Commercial |
$1,141.55
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Meridian Medicaid |
$530.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,337.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,337.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$782.33
|
| Rate for Payer: UHC Exchange |
$782.33
|
| Rate for Payer: UHCCP Medicaid |
$505.24
|
|
|
PR SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI
|
Professional
|
Both
|
$2,168.00
|
|
|
Service Code
|
HCPCS 50540
|
| Min. Negotiated Rate |
$730.80 |
| Max. Negotiated Rate |
$2,068.29 |
| Rate for Payer: Aetna Commercial |
$1,471.63
|
| Rate for Payer: Aetna Medicare |
$1,084.00
|
| Rate for Payer: BCBS Complete |
$767.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,068.29
|
| Rate for Payer: BCN Commercial |
$1,647.33
|
| Rate for Payer: Cash Price |
$1,734.40
|
| Rate for Payer: Cash Price |
$1,734.40
|
| Rate for Payer: Meridian Medicaid |
$767.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$730.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,816.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,816.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.03
|
| Rate for Payer: UHC Exchange |
$1,369.03
|
| Rate for Payer: UHCCP Medicaid |
$730.80
|
|
