|
PR REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY
|
Professional
|
Both
|
$2,257.00
|
|
|
Service Code
|
HCPCS 49402
|
| Min. Negotiated Rate |
$832.38 |
| Max. Negotiated Rate |
$1,467.05 |
| Rate for Payer: Aetna Commercial |
$1,115.39
|
| Rate for Payer: Aetna Medicare |
$865.68
|
| Rate for Payer: BCBS Complete |
$902.80
|
| Rate for Payer: BCBS MAPPO |
$832.38
|
| Rate for Payer: BCN Medicare Advantage |
$832.38
|
| Rate for Payer: Cash Price |
$1,805.60
|
| Rate for Payer: Cash Price |
$1,805.60
|
| Rate for Payer: Cofinity Commercial |
$1,198.63
|
| Rate for Payer: Cofinity Commercial |
$1,115.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$832.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$874.00
|
| Rate for Payer: Nomi Health Commercial |
$998.86
|
| Rate for Payer: PACE SWMI |
$832.38
|
| Rate for Payer: PHP Medicare Advantage |
$832.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,467.05
|
| Rate for Payer: Priority Health Medicare |
$840.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$832.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$832.38
|
| Rate for Payer: UHC Exchange |
$832.38
|
| Rate for Payer: UHC Medicare Advantage |
$832.38
|
|
|
PR REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 33233
|
| Min. Negotiated Rate |
$219.56 |
| Max. Negotiated Rate |
$412.75 |
| Rate for Payer: Aetna Commercial |
$294.21
|
| Rate for Payer: Aetna Medicare |
$228.34
|
| Rate for Payer: BCBS Complete |
$254.00
|
| Rate for Payer: BCBS MAPPO |
$219.56
|
| Rate for Payer: BCN Medicare Advantage |
$219.56
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cofinity Commercial |
$294.21
|
| Rate for Payer: Cofinity Commercial |
$316.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.54
|
| Rate for Payer: Nomi Health Commercial |
$263.47
|
| Rate for Payer: PACE SWMI |
$219.56
|
| Rate for Payer: PHP Medicare Advantage |
$219.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.75
|
| Rate for Payer: Priority Health Medicare |
$221.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.56
|
| Rate for Payer: UHC Exchange |
$219.56
|
| Rate for Payer: UHC Medicare Advantage |
$219.56
|
|
|
PR REMOVAL PERQ LEFT HRT VAD ARTL/ARTL&VEN SEP INSJ
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 33992
|
| Min. Negotiated Rate |
$179.45 |
| Max. Negotiated Rate |
$365.95 |
| Rate for Payer: Aetna Commercial |
$240.46
|
| Rate for Payer: Aetna Medicare |
$186.63
|
| Rate for Payer: BCBS Complete |
$225.20
|
| Rate for Payer: BCBS MAPPO |
$179.45
|
| Rate for Payer: BCN Medicare Advantage |
$179.45
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$258.41
|
| Rate for Payer: Cofinity Commercial |
$240.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.42
|
| Rate for Payer: Nomi Health Commercial |
$215.34
|
| Rate for Payer: PACE SWMI |
$179.45
|
| Rate for Payer: PHP Medicare Advantage |
$179.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.95
|
| Rate for Payer: Priority Health Medicare |
$181.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.45
|
| Rate for Payer: UHC Exchange |
$179.45
|
| Rate for Payer: UHC Medicare Advantage |
$179.45
|
|
|
PR REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$2,102.00
|
|
|
Service Code
|
HCPCS 22850
|
| Min. Negotiated Rate |
$719.58 |
| Max. Negotiated Rate |
$1,366.30 |
| Rate for Payer: Aetna Commercial |
$964.24
|
| Rate for Payer: Aetna Medicare |
$748.36
|
| Rate for Payer: BCBS Complete |
$840.80
|
| Rate for Payer: BCBS MAPPO |
$719.58
|
| Rate for Payer: BCN Medicare Advantage |
$719.58
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cofinity Commercial |
$964.24
|
| Rate for Payer: Cofinity Commercial |
$1,036.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.56
|
| Rate for Payer: Nomi Health Commercial |
$863.50
|
| Rate for Payer: PACE SWMI |
$719.58
|
| Rate for Payer: PHP Medicare Advantage |
$719.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.30
|
| Rate for Payer: Priority Health Medicare |
$726.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.58
|
| Rate for Payer: UHC Exchange |
$719.58
|
| Rate for Payer: UHC Medicare Advantage |
$719.58
|
|
|
PR REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$2,232.00
|
|
|
Service Code
|
HCPCS 22852
|
| Min. Negotiated Rate |
$691.80 |
| Max. Negotiated Rate |
$1,450.80 |
| Rate for Payer: Aetna Commercial |
$927.01
|
| Rate for Payer: Aetna Medicare |
$719.47
|
| Rate for Payer: BCBS Complete |
$892.80
|
| Rate for Payer: BCBS MAPPO |
$691.80
|
| Rate for Payer: BCN Medicare Advantage |
$691.80
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cofinity Commercial |
$996.19
|
| Rate for Payer: Cofinity Commercial |
$927.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$691.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$726.39
|
| Rate for Payer: Nomi Health Commercial |
$830.16
|
| Rate for Payer: PACE SWMI |
$691.80
|
| Rate for Payer: PHP Medicare Advantage |
$691.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,450.80
|
| Rate for Payer: Priority Health Medicare |
$698.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$691.80
|
| Rate for Payer: UHC Exchange |
$691.80
|
| Rate for Payer: UHC Medicare Advantage |
$691.80
|
|
|
PR REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 23333
|
| Min. Negotiated Rate |
$379.20 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$616.49
|
| Rate for Payer: Aetna Medicare |
$478.47
|
| Rate for Payer: BCBS Complete |
$379.20
|
| Rate for Payer: BCBS MAPPO |
$460.07
|
| Rate for Payer: BCN Medicare Advantage |
$460.07
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cofinity Commercial |
$662.50
|
| Rate for Payer: Cofinity Commercial |
$616.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.07
|
| Rate for Payer: Nomi Health Commercial |
$552.08
|
| Rate for Payer: PACE SWMI |
$460.07
|
| Rate for Payer: PHP Medicare Advantage |
$460.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.20
|
| Rate for Payer: Priority Health Medicare |
$464.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$460.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$460.07
|
| Rate for Payer: UHC Exchange |
$460.07
|
| Rate for Payer: UHC Medicare Advantage |
$460.07
|
|
|
PR REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 33286
|
| Min. Negotiated Rate |
$81.75 |
| Max. Negotiated Rate |
$174.20 |
| Rate for Payer: Aetna Commercial |
$109.55
|
| Rate for Payer: Aetna Medicare |
$85.02
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS MAPPO |
$81.75
|
| Rate for Payer: BCN Medicare Advantage |
$81.75
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$117.72
|
| Rate for Payer: Cofinity Commercial |
$109.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.84
|
| Rate for Payer: Nomi Health Commercial |
$98.10
|
| Rate for Payer: PACE SWMI |
$81.75
|
| Rate for Payer: PHP Medicare Advantage |
$81.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.20
|
| Rate for Payer: Priority Health Medicare |
$82.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.75
|
| Rate for Payer: UHC Exchange |
$81.75
|
| Rate for Payer: UHC Medicare Advantage |
$81.75
|
|
|
PR REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 15854
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$12.76
|
| Rate for Payer: BCN Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Cofinity Commercial |
$17.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.40
|
| Rate for Payer: Nomi Health Commercial |
$15.31
|
| Rate for Payer: PACE SWMI |
$12.76
|
| Rate for Payer: PHP Medicare Advantage |
$12.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$12.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.76
|
| Rate for Payer: UHC Exchange |
$12.76
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
|
|
PR REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 15853
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$10.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.10
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: PACE SWMI |
$10.10
|
| Rate for Payer: PHP Medicare Advantage |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.10
|
| Rate for Payer: UHC Exchange |
$10.10
|
| Rate for Payer: UHC Medicare Advantage |
$10.10
|
|
|
PR REMOVAL SUTURES/STAPLES REQUIRING ANESTHESIA
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 15851
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$83.51
|
| Rate for Payer: Aetna Medicare |
$64.81
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS MAPPO |
$62.32
|
| Rate for Payer: BCN Medicare Advantage |
$62.32
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$89.74
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$74.78
|
| Rate for Payer: PACE SWMI |
$62.32
|
| Rate for Payer: PHP Medicare Advantage |
$62.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health Medicare |
$62.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.32
|
| Rate for Payer: UHC Exchange |
$62.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.32
|
|
|
PR REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 15850
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Medicare |
$113.00
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
|
|
PR REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 11971
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$760.28 |
| Rate for Payer: Aetna Commercial |
$707.48
|
| Rate for Payer: Aetna Medicare |
$549.09
|
| Rate for Payer: BCBS Complete |
$372.00
|
| Rate for Payer: BCBS MAPPO |
$527.97
|
| Rate for Payer: BCN Medicare Advantage |
$527.97
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cofinity Commercial |
$760.28
|
| Rate for Payer: Cofinity Commercial |
$707.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$554.37
|
| Rate for Payer: Nomi Health Commercial |
$633.56
|
| Rate for Payer: PACE SWMI |
$527.97
|
| Rate for Payer: PHP Medicare Advantage |
$527.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health Medicare |
$533.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.97
|
| Rate for Payer: UHC Exchange |
$527.97
|
| Rate for Payer: UHC Medicare Advantage |
$527.97
|
|
|
PR REMOVAL TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$981.00
|
|
|
Service Code
|
HCPCS 49422
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$637.65 |
| Rate for Payer: Aetna Commercial |
$286.09
|
| Rate for Payer: Aetna Medicare |
$222.04
|
| Rate for Payer: BCBS Complete |
$392.40
|
| Rate for Payer: BCBS MAPPO |
$213.50
|
| Rate for Payer: BCN Medicare Advantage |
$213.50
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cofinity Commercial |
$286.09
|
| Rate for Payer: Cofinity Commercial |
$307.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.18
|
| Rate for Payer: Nomi Health Commercial |
$256.20
|
| Rate for Payer: PACE SWMI |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$213.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.65
|
| Rate for Payer: Priority Health Medicare |
$215.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.50
|
| Rate for Payer: UHC Exchange |
$213.50
|
| Rate for Payer: UHC Medicare Advantage |
$213.50
|
|
|
PR REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE
|
Professional
|
Both
|
$3,380.00
|
|
|
Service Code
|
HCPCS 33977
|
| Min. Negotiated Rate |
$1,077.13 |
| Max. Negotiated Rate |
$2,197.00 |
| Rate for Payer: Aetna Commercial |
$1,443.35
|
| Rate for Payer: Aetna Medicare |
$1,120.22
|
| Rate for Payer: BCBS Complete |
$1,352.00
|
| Rate for Payer: BCBS MAPPO |
$1,077.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,077.13
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cofinity Commercial |
$1,551.07
|
| Rate for Payer: Cofinity Commercial |
$1,443.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,077.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,130.99
|
| Rate for Payer: Nomi Health Commercial |
$1,292.56
|
| Rate for Payer: PACE SWMI |
$1,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,077.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.00
|
| Rate for Payer: Priority Health Medicare |
$1,087.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,077.13
|
| Rate for Payer: UHC Exchange |
$1,077.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,077.13
|
|
|
PR REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST
|
Professional
|
Both
|
$1,352.00
|
|
|
Service Code
|
HCPCS 25251
|
| Min. Negotiated Rate |
$540.80 |
| Max. Negotiated Rate |
$1,002.90 |
| Rate for Payer: Aetna Commercial |
$933.26
|
| Rate for Payer: Aetna Medicare |
$724.32
|
| Rate for Payer: BCBS Complete |
$540.80
|
| Rate for Payer: BCBS MAPPO |
$696.46
|
| Rate for Payer: BCN Medicare Advantage |
$696.46
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cofinity Commercial |
$933.26
|
| Rate for Payer: Cofinity Commercial |
$1,002.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$696.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$731.28
|
| Rate for Payer: Nomi Health Commercial |
$835.75
|
| Rate for Payer: PACE SWMI |
$696.46
|
| Rate for Payer: PHP Medicare Advantage |
$696.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$878.80
|
| Rate for Payer: Priority Health Medicare |
$703.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$696.46
|
| Rate for Payer: UHC Exchange |
$696.46
|
| Rate for Payer: UHC Medicare Advantage |
$696.46
|
|
|
PR REMOVE BILE DUCT STONE, PERCUT
|
Professional
|
Both
|
$904.00
|
|
|
Service Code
|
HCPCS 47630
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$587.60 |
| Rate for Payer: Aetna Medicare |
$452.00
|
| Rate for Payer: BCBS Complete |
$361.60
|
| Rate for Payer: Cash Price |
$723.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.60
|
|
|
PR REMOVE DEEP SHOULDER FOREIGN BODY
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 23331
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Medicare |
$519.50
|
| Rate for Payer: BCBS Complete |
$415.60
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.35
|
|
|
PR REMOVE INT DWELL URETERAL STENT TRANSURETHRAL
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 50386
|
| Min. Negotiated Rate |
$154.62 |
| Max. Negotiated Rate |
$1,028.30 |
| Rate for Payer: Aetna Commercial |
$207.19
|
| Rate for Payer: Aetna Medicare |
$160.80
|
| Rate for Payer: BCBS Complete |
$632.80
|
| Rate for Payer: BCBS MAPPO |
$154.62
|
| Rate for Payer: BCN Medicare Advantage |
$154.62
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: Cofinity Commercial |
$222.65
|
| Rate for Payer: Cofinity Commercial |
$207.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.35
|
| Rate for Payer: Nomi Health Commercial |
$185.54
|
| Rate for Payer: PACE SWMI |
$154.62
|
| Rate for Payer: PHP Medicare Advantage |
$154.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.30
|
| Rate for Payer: Priority Health Medicare |
$156.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.62
|
| Rate for Payer: UHC Exchange |
$154.62
|
| Rate for Payer: UHC Medicare Advantage |
$154.62
|
|
|
PR REMOVE NAIL BED/FINGER TIP
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 11752
|
| Min. Negotiated Rate |
$212.00 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Medicare |
$265.00
|
| Rate for Payer: BCBS Complete |
$212.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.50
|
|
|
PR REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 50385
|
| Min. Negotiated Rate |
$204.60 |
| Max. Negotiated Rate |
$1,360.45 |
| Rate for Payer: Aetna Commercial |
$274.16
|
| Rate for Payer: Aetna Medicare |
$212.78
|
| Rate for Payer: BCBS Complete |
$837.20
|
| Rate for Payer: BCBS MAPPO |
$204.60
|
| Rate for Payer: BCN Medicare Advantage |
$204.60
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cofinity Commercial |
$294.62
|
| Rate for Payer: Cofinity Commercial |
$274.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.83
|
| Rate for Payer: Nomi Health Commercial |
$245.52
|
| Rate for Payer: PACE SWMI |
$204.60
|
| Rate for Payer: PHP Medicare Advantage |
$204.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.45
|
| Rate for Payer: Priority Health Medicare |
$206.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.60
|
| Rate for Payer: UHC Exchange |
$204.60
|
| Rate for Payer: UHC Medicare Advantage |
$204.60
|
|
|
PR REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$1,924.00
|
|
|
Service Code
|
HCPCS 53446
|
| Min. Negotiated Rate |
$614.46 |
| Max. Negotiated Rate |
$1,250.60 |
| Rate for Payer: Aetna Commercial |
$823.38
|
| Rate for Payer: Aetna Medicare |
$639.04
|
| Rate for Payer: BCBS Complete |
$769.60
|
| Rate for Payer: BCBS MAPPO |
$614.46
|
| Rate for Payer: BCN Medicare Advantage |
$614.46
|
| Rate for Payer: Cash Price |
$1,539.20
|
| Rate for Payer: Cash Price |
$1,539.20
|
| Rate for Payer: Cofinity Commercial |
$884.82
|
| Rate for Payer: Cofinity Commercial |
$823.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.18
|
| Rate for Payer: Nomi Health Commercial |
$737.35
|
| Rate for Payer: PACE SWMI |
$614.46
|
| Rate for Payer: PHP Medicare Advantage |
$614.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.60
|
| Rate for Payer: Priority Health Medicare |
$620.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.46
|
| Rate for Payer: UHC Exchange |
$614.46
|
| Rate for Payer: UHC Medicare Advantage |
$614.46
|
|
|
PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 33227
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$462.61 |
| Rate for Payer: Aetna Commercial |
$430.49
|
| Rate for Payer: Aetna Medicare |
$334.11
|
| Rate for Payer: BCBS Complete |
$280.80
|
| Rate for Payer: BCBS MAPPO |
$321.26
|
| Rate for Payer: BCN Medicare Advantage |
$321.26
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$462.61
|
| Rate for Payer: Cofinity Commercial |
$430.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$321.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$337.32
|
| Rate for Payer: Nomi Health Commercial |
$385.51
|
| Rate for Payer: PACE SWMI |
$321.26
|
| Rate for Payer: PHP Medicare Advantage |
$321.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.30
|
| Rate for Payer: Priority Health Medicare |
$324.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$321.26
|
| Rate for Payer: UHC Exchange |
$321.26
|
| Rate for Payer: UHC Medicare Advantage |
$321.26
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 33228
|
| Min. Negotiated Rate |
$290.80 |
| Max. Negotiated Rate |
$484.66 |
| Rate for Payer: Aetna Commercial |
$451.00
|
| Rate for Payer: Aetna Medicare |
$350.03
|
| Rate for Payer: BCBS Complete |
$290.80
|
| Rate for Payer: BCBS MAPPO |
$336.57
|
| Rate for Payer: BCN Medicare Advantage |
$336.57
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cofinity Commercial |
$484.66
|
| Rate for Payer: Cofinity Commercial |
$451.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$353.40
|
| Rate for Payer: Nomi Health Commercial |
$403.88
|
| Rate for Payer: PACE SWMI |
$336.57
|
| Rate for Payer: PHP Medicare Advantage |
$336.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.55
|
| Rate for Payer: Priority Health Medicare |
$339.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.57
|
| Rate for Payer: UHC Exchange |
$336.57
|
| Rate for Payer: UHC Medicare Advantage |
$336.57
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 33229
|
| Min. Negotiated Rate |
$231.20 |
| Max. Negotiated Rate |
$507.90 |
| Rate for Payer: Aetna Commercial |
$472.63
|
| Rate for Payer: Aetna Medicare |
$366.82
|
| Rate for Payer: BCBS Complete |
$231.20
|
| Rate for Payer: BCBS MAPPO |
$352.71
|
| Rate for Payer: BCN Medicare Advantage |
$352.71
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cofinity Commercial |
$507.90
|
| Rate for Payer: Cofinity Commercial |
$472.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.35
|
| Rate for Payer: Nomi Health Commercial |
$423.25
|
| Rate for Payer: PACE SWMI |
$352.71
|
| Rate for Payer: PHP Medicare Advantage |
$352.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.70
|
| Rate for Payer: Priority Health Medicare |
$356.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.71
|
| Rate for Payer: UHC Exchange |
$352.71
|
| Rate for Payer: UHC Medicare Advantage |
$352.71
|
|
|
PR REMV TISSUE FOR GRAFT OTHR
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 20926
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$532.35 |
| Rate for Payer: Aetna Medicare |
$409.50
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
|
