|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
11042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$219.05 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: ASR ASR |
$326.89
|
| Rate for Payer: ASR Commercial |
$326.89
|
| Rate for Payer: BCBS Trust/PPO |
$274.62
|
| Rate for Payer: BCN Commercial |
$261.28
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$316.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.60
|
| Rate for Payer: Healthscope Commercial |
$337.00
|
| Rate for Payer: Healthscope Whirlpool |
$326.89
|
| Rate for Payer: Mclaren Commercial |
$303.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.45
|
| Rate for Payer: Nomi Health Commercial |
$276.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.56
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
11042
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$77.24
|
| Rate for Payer: Aetna Medicare |
$57.64
|
| Rate for Payer: BCBS Complete |
$134.80
|
| Rate for Payer: BCBS MAPPO |
$57.64
|
| Rate for Payer: BCN Medicare Advantage |
$57.64
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$83.00
|
| Rate for Payer: Cofinity Commercial |
$77.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.64
|
| Rate for Payer: Healthscope Commercial |
$69.17
|
| Rate for Payer: Healthscope Whirlpool |
$69.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$69.17
|
| Rate for Payer: PACE SWMI |
$57.64
|
| Rate for Payer: PHP Medicare Advantage |
$57.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health Medicare |
$57.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.64
|
| Rate for Payer: UHC Medicare Advantage |
$57.64
|
| Rate for Payer: UHCCP DNSP |
$57.64
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
11042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$326.89
|
| Rate for Payer: ASR Commercial |
$326.89
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$275.97
|
| Rate for Payer: BCN Commercial |
$261.28
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$316.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$337.00
|
| Rate for Payer: Healthscope Whirlpool |
$326.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$303.30
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.45
|
| Rate for Payer: Nomi Health Commercial |
$276.34
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.28
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$236.24
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 11042
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$77.24
|
| Rate for Payer: Aetna Medicare |
$57.64
|
| Rate for Payer: BCBS Complete |
$134.80
|
| Rate for Payer: BCBS MAPPO |
$57.64
|
| Rate for Payer: BCN Medicare Advantage |
$57.64
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$83.00
|
| Rate for Payer: Cofinity Commercial |
$77.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.64
|
| Rate for Payer: Healthscope Commercial |
$69.17
|
| Rate for Payer: Healthscope Whirlpool |
$69.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$69.17
|
| Rate for Payer: PACE SWMI |
$57.64
|
| Rate for Payer: PHP Medicare Advantage |
$57.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health Medicare |
$57.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.64
|
| Rate for Payer: UHC Medicare Advantage |
$57.64
|
| Rate for Payer: UHCCP DNSP |
$57.64
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
11045
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: ASR Commercial |
$67.90
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$57.32
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.90
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.33
|
| Rate for Payer: Priority Health Narrow Network |
$49.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
11045
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Aetna Commercial |
$31.95
|
| Rate for Payer: Aetna Medicare |
$23.84
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS MAPPO |
$23.84
|
| Rate for Payer: BCN Medicare Advantage |
$23.84
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$34.33
|
| Rate for Payer: Cofinity Commercial |
$31.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.84
|
| Rate for Payer: Healthscope Commercial |
$28.61
|
| Rate for Payer: Healthscope Whirlpool |
$28.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.03
|
| Rate for Payer: Nomi Health Commercial |
$28.61
|
| Rate for Payer: PACE SWMI |
$23.84
|
| Rate for Payer: PHP Medicare Advantage |
$23.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Medicare |
$23.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.84
|
| Rate for Payer: UHC Medicare Advantage |
$23.84
|
| Rate for Payer: UHCCP DNSP |
$23.84
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 11045
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Aetna Commercial |
$31.95
|
| Rate for Payer: Aetna Medicare |
$23.84
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS MAPPO |
$23.84
|
| Rate for Payer: BCN Medicare Advantage |
$23.84
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$34.33
|
| Rate for Payer: Cofinity Commercial |
$31.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.84
|
| Rate for Payer: Healthscope Commercial |
$28.61
|
| Rate for Payer: Healthscope Whirlpool |
$28.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.03
|
| Rate for Payer: Nomi Health Commercial |
$28.61
|
| Rate for Payer: PACE SWMI |
$23.84
|
| Rate for Payer: PHP Medicare Advantage |
$23.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Medicare |
$23.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.84
|
| Rate for Payer: UHC Medicare Advantage |
$23.84
|
| Rate for Payer: UHCCP DNSP |
$23.84
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
11045
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: ASR Commercial |
$67.90
|
| Rate for Payer: BCBS Trust/PPO |
$57.04
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.90
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
PR DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 36593
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$44.38 |
| Rate for Payer: Aetna Commercial |
$41.30
|
| Rate for Payer: Aetna Medicare |
$30.82
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS MAPPO |
$30.82
|
| Rate for Payer: BCN Medicare Advantage |
$30.82
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$44.38
|
| Rate for Payer: Cofinity Commercial |
$41.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.82
|
| Rate for Payer: Healthscope Commercial |
$36.98
|
| Rate for Payer: Healthscope Whirlpool |
$36.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.36
|
| Rate for Payer: Nomi Health Commercial |
$36.98
|
| Rate for Payer: PACE SWMI |
$30.82
|
| Rate for Payer: PHP Medicare Advantage |
$30.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: Priority Health Medicare |
$30.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.82
|
| Rate for Payer: UHC Medicare Advantage |
$30.82
|
| Rate for Payer: UHCCP DNSP |
$30.82
|
|
|
PR DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI
|
Professional
|
Both
|
$1,834.00
|
|
|
Service Code
|
HCPCS 27027
|
| Min. Negotiated Rate |
$733.60 |
| Max. Negotiated Rate |
$1,228.82 |
| Rate for Payer: Aetna Commercial |
$1,143.49
|
| Rate for Payer: Aetna Medicare |
$853.35
|
| Rate for Payer: BCBS Complete |
$733.60
|
| Rate for Payer: BCBS MAPPO |
$853.35
|
| Rate for Payer: BCN Medicare Advantage |
$853.35
|
| Rate for Payer: Cash Price |
$1,467.20
|
| Rate for Payer: Cash Price |
$1,467.20
|
| Rate for Payer: Cofinity Commercial |
$1,228.82
|
| Rate for Payer: Cofinity Commercial |
$1,143.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$853.35
|
| Rate for Payer: Healthscope Commercial |
$1,024.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,024.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$896.02
|
| Rate for Payer: Nomi Health Commercial |
$1,024.02
|
| Rate for Payer: PACE SWMI |
$853.35
|
| Rate for Payer: PHP Medicare Advantage |
$853.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.10
|
| Rate for Payer: Priority Health Medicare |
$853.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$853.35
|
| Rate for Payer: UHC Medicare Advantage |
$853.35
|
| Rate for Payer: UHCCP DNSP |
$853.35
|
|
|
PR DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 27496
|
| Min. Negotiated Rate |
$379.20 |
| Max. Negotiated Rate |
$766.01 |
| Rate for Payer: Aetna Commercial |
$712.81
|
| Rate for Payer: Aetna Medicare |
$531.95
|
| Rate for Payer: BCBS Complete |
$379.20
|
| Rate for Payer: BCBS MAPPO |
$531.95
|
| Rate for Payer: BCN Medicare Advantage |
$531.95
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cofinity Commercial |
$766.01
|
| Rate for Payer: Cofinity Commercial |
$712.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.95
|
| Rate for Payer: Healthscope Commercial |
$638.34
|
| Rate for Payer: Healthscope Whirlpool |
$638.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.55
|
| Rate for Payer: Nomi Health Commercial |
$638.34
|
| Rate for Payer: PACE SWMI |
$531.95
|
| Rate for Payer: PHP Medicare Advantage |
$531.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.20
|
| Rate for Payer: Priority Health Medicare |
$531.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.95
|
| Rate for Payer: UHC Medicare Advantage |
$531.95
|
| Rate for Payer: UHCCP DNSP |
$531.95
|
|
|
PR DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
HCPCS 24495
|
| Min. Negotiated Rate |
$676.80 |
| Max. Negotiated Rate |
$1,231.26 |
| Rate for Payer: Aetna Commercial |
$1,145.75
|
| Rate for Payer: Aetna Medicare |
$855.04
|
| Rate for Payer: BCBS Complete |
$676.80
|
| Rate for Payer: BCBS MAPPO |
$855.04
|
| Rate for Payer: BCN Medicare Advantage |
$855.04
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cofinity Commercial |
$1,231.26
|
| Rate for Payer: Cofinity Commercial |
$1,145.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.04
|
| Rate for Payer: Healthscope Commercial |
$1,026.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,026.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$897.79
|
| Rate for Payer: Nomi Health Commercial |
$1,026.05
|
| Rate for Payer: PACE SWMI |
$855.04
|
| Rate for Payer: PHP Medicare Advantage |
$855.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.80
|
| Rate for Payer: Priority Health Medicare |
$855.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$855.04
|
| Rate for Payer: UHC Medicare Advantage |
$855.04
|
| Rate for Payer: UHCCP DNSP |
$855.04
|
|
|
PR DECOMPRESSION FINGERS&/HAND INJECTION INJURY
|
Professional
|
Both
|
$2,186.00
|
|
|
Service Code
|
HCPCS 26035
|
| Min. Negotiated Rate |
$831.14 |
| Max. Negotiated Rate |
$1,420.90 |
| Rate for Payer: Aetna Commercial |
$1,113.73
|
| Rate for Payer: Aetna Medicare |
$831.14
|
| Rate for Payer: BCBS Complete |
$874.40
|
| Rate for Payer: BCBS MAPPO |
$831.14
|
| Rate for Payer: BCN Medicare Advantage |
$831.14
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Cofinity Commercial |
$1,196.84
|
| Rate for Payer: Cofinity Commercial |
$1,113.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$831.14
|
| Rate for Payer: Healthscope Commercial |
$997.37
|
| Rate for Payer: Healthscope Whirlpool |
$997.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.70
|
| Rate for Payer: Nomi Health Commercial |
$997.37
|
| Rate for Payer: PACE SWMI |
$831.14
|
| Rate for Payer: PHP Medicare Advantage |
$831.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,420.90
|
| Rate for Payer: Priority Health Medicare |
$831.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$831.14
|
| Rate for Payer: UHC Medicare Advantage |
$831.14
|
| Rate for Payer: UHCCP DNSP |
$831.14
|
|
|
PR DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH
|
Professional
|
Both
|
$5,746.00
|
|
|
Service Code
|
HCPCS 61330
|
| Min. Negotiated Rate |
$1,780.68 |
| Max. Negotiated Rate |
$3,734.90 |
| Rate for Payer: Aetna Commercial |
$2,386.11
|
| Rate for Payer: Aetna Medicare |
$1,780.68
|
| Rate for Payer: BCBS Complete |
$2,298.40
|
| Rate for Payer: BCBS MAPPO |
$1,780.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,780.68
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Cofinity Commercial |
$2,564.18
|
| Rate for Payer: Cofinity Commercial |
$2,386.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,780.68
|
| Rate for Payer: Healthscope Commercial |
$2,136.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,136.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,869.71
|
| Rate for Payer: Nomi Health Commercial |
$2,136.82
|
| Rate for Payer: PACE SWMI |
$1,780.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,780.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.90
|
| Rate for Payer: Priority Health Medicare |
$1,780.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,780.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,780.68
|
| Rate for Payer: UHCCP DNSP |
$1,780.68
|
|
|
PR DECOMPRESSION PLANTAR DIGITAL NERVE
|
Professional
|
Both
|
$1,573.00
|
|
|
Service Code
|
HCPCS 64726
|
| Min. Negotiated Rate |
$258.79 |
| Max. Negotiated Rate |
$1,022.45 |
| Rate for Payer: Aetna Commercial |
$346.78
|
| Rate for Payer: Aetna Medicare |
$258.79
|
| Rate for Payer: BCBS Complete |
$629.20
|
| Rate for Payer: BCBS MAPPO |
$258.79
|
| Rate for Payer: BCN Medicare Advantage |
$258.79
|
| Rate for Payer: Cash Price |
$1,258.40
|
| Rate for Payer: Cash Price |
$1,258.40
|
| Rate for Payer: Cofinity Commercial |
$372.66
|
| Rate for Payer: Cofinity Commercial |
$346.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.79
|
| Rate for Payer: Healthscope Commercial |
$310.55
|
| Rate for Payer: Healthscope Whirlpool |
$310.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.73
|
| Rate for Payer: Nomi Health Commercial |
$310.55
|
| Rate for Payer: PACE SWMI |
$258.79
|
| Rate for Payer: PHP Medicare Advantage |
$258.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.45
|
| Rate for Payer: Priority Health Medicare |
$258.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.79
|
| Rate for Payer: UHC Medicare Advantage |
$258.79
|
| Rate for Payer: UHCCP DNSP |
$258.79
|
|
|
PR DECOMPRESSION UNSPECIFIED NERVE
|
Professional
|
Both
|
$1,783.00
|
|
|
Service Code
|
HCPCS 64722
|
| Min. Negotiated Rate |
$358.88 |
| Max. Negotiated Rate |
$1,158.95 |
| Rate for Payer: Aetna Commercial |
$480.90
|
| Rate for Payer: Aetna Medicare |
$358.88
|
| Rate for Payer: BCBS Complete |
$713.20
|
| Rate for Payer: BCBS MAPPO |
$358.88
|
| Rate for Payer: BCN Medicare Advantage |
$358.88
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cofinity Commercial |
$516.79
|
| Rate for Payer: Cofinity Commercial |
$480.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$358.88
|
| Rate for Payer: Healthscope Commercial |
$430.66
|
| Rate for Payer: Healthscope Whirlpool |
$430.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$376.82
|
| Rate for Payer: Nomi Health Commercial |
$430.66
|
| Rate for Payer: PACE SWMI |
$358.88
|
| Rate for Payer: PHP Medicare Advantage |
$358.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.95
|
| Rate for Payer: Priority Health Medicare |
$358.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$358.88
|
| Rate for Payer: UHC Medicare Advantage |
$358.88
|
| Rate for Payer: UHCCP DNSP |
$358.88
|
|
|
PR DECOMPRESSIVE FASCIOTOMY HAND
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 26037
|
| Min. Negotiated Rate |
$545.14 |
| Max. Negotiated Rate |
$885.95 |
| Rate for Payer: Aetna Commercial |
$730.49
|
| Rate for Payer: Aetna Medicare |
$545.14
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: BCBS MAPPO |
$545.14
|
| Rate for Payer: BCN Medicare Advantage |
$545.14
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$785.00
|
| Rate for Payer: Cofinity Commercial |
$730.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$545.14
|
| Rate for Payer: Healthscope Commercial |
$654.17
|
| Rate for Payer: Healthscope Whirlpool |
$654.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$572.40
|
| Rate for Payer: Nomi Health Commercial |
$654.17
|
| Rate for Payer: PACE SWMI |
$545.14
|
| Rate for Payer: PHP Medicare Advantage |
$545.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health Medicare |
$545.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$545.14
|
| Rate for Payer: UHC Medicare Advantage |
$545.14
|
| Rate for Payer: UHCCP DNSP |
$545.14
|
|
|
PR DECORTICATION & PARIETAL PLEURECTOMY
|
Professional
|
Both
|
$4,013.00
|
|
|
Service Code
|
HCPCS 32320
|
| Min. Negotiated Rate |
$1,541.21 |
| Max. Negotiated Rate |
$2,608.45 |
| Rate for Payer: Aetna Commercial |
$2,065.22
|
| Rate for Payer: Aetna Medicare |
$1,541.21
|
| Rate for Payer: BCBS Complete |
$1,605.20
|
| Rate for Payer: BCBS MAPPO |
$1,541.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,541.21
|
| Rate for Payer: Cash Price |
$3,210.40
|
| Rate for Payer: Cash Price |
$3,210.40
|
| Rate for Payer: Cofinity Commercial |
$2,219.34
|
| Rate for Payer: Cofinity Commercial |
$2,065.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,541.21
|
| Rate for Payer: Healthscope Commercial |
$1,849.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,849.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,618.27
|
| Rate for Payer: Nomi Health Commercial |
$1,849.45
|
| Rate for Payer: PACE SWMI |
$1,541.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,541.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,608.45
|
| Rate for Payer: Priority Health Medicare |
$1,541.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,541.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,541.21
|
| Rate for Payer: UHCCP DNSP |
$1,541.21
|
|
|
PR DECORTICATION PULMONARY PARTIAL SEPARATE PROC
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
HCPCS 32225
|
| Min. Negotiated Rate |
$824.80 |
| Max. Negotiated Rate |
$1,377.79 |
| Rate for Payer: Aetna Commercial |
$1,282.11
|
| Rate for Payer: Aetna Medicare |
$956.80
|
| Rate for Payer: BCBS Complete |
$824.80
|
| Rate for Payer: BCBS MAPPO |
$956.80
|
| Rate for Payer: BCN Medicare Advantage |
$956.80
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cofinity Commercial |
$1,377.79
|
| Rate for Payer: Cofinity Commercial |
$1,282.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.80
|
| Rate for Payer: Healthscope Commercial |
$1,148.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,148.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.64
|
| Rate for Payer: Nomi Health Commercial |
$1,148.16
|
| Rate for Payer: PACE SWMI |
$956.80
|
| Rate for Payer: PHP Medicare Advantage |
$956.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.30
|
| Rate for Payer: Priority Health Medicare |
$956.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.80
|
| Rate for Payer: UHC Medicare Advantage |
$956.80
|
| Rate for Payer: UHCCP DNSP |
$956.80
|
|
|
PR DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,963.00
|
|
|
Service Code
|
HCPCS 32220
|
| Min. Negotiated Rate |
$1,185.20 |
| Max. Negotiated Rate |
$2,210.36 |
| Rate for Payer: Aetna Commercial |
$2,056.86
|
| Rate for Payer: Aetna Medicare |
$1,534.97
|
| Rate for Payer: BCBS Complete |
$1,185.20
|
| Rate for Payer: BCBS MAPPO |
$1,534.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,534.97
|
| Rate for Payer: Cash Price |
$2,370.40
|
| Rate for Payer: Cash Price |
$2,370.40
|
| Rate for Payer: Cofinity Commercial |
$2,210.36
|
| Rate for Payer: Cofinity Commercial |
$2,056.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,534.97
|
| Rate for Payer: Healthscope Commercial |
$1,841.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,841.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,611.72
|
| Rate for Payer: Nomi Health Commercial |
$1,841.96
|
| Rate for Payer: PACE SWMI |
$1,534.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,534.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.95
|
| Rate for Payer: Priority Health Medicare |
$1,534.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,534.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,534.97
|
| Rate for Payer: UHCCP DNSP |
$1,534.97
|
|
|
PR DEGARELIX INJECTION
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J9155
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.45
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$5.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$5.34
|
| Rate for Payer: Healthscope Whirlpool |
$5.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$5.34
|
| Rate for Payer: PACE SWMI |
$4.45
|
| Rate for Payer: PHP Medicare Advantage |
$4.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.45
|
| Rate for Payer: UHC Medicare Advantage |
$4.45
|
| Rate for Payer: UHCCP DNSP |
$4.45
|
|
|
PR DELAYED CREATION EXIT SITE EMBEDDED CATHETER
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 49436
|
| Min. Negotiated Rate |
$179.71 |
| Max. Negotiated Rate |
$838.50 |
| Rate for Payer: Aetna Commercial |
$240.81
|
| Rate for Payer: Aetna Medicare |
$179.71
|
| Rate for Payer: BCBS Complete |
$516.00
|
| Rate for Payer: BCBS MAPPO |
$179.71
|
| Rate for Payer: BCN Medicare Advantage |
$179.71
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Cofinity Commercial |
$258.78
|
| Rate for Payer: Cofinity Commercial |
$240.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.71
|
| Rate for Payer: Healthscope Commercial |
$215.65
|
| Rate for Payer: Healthscope Whirlpool |
$215.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.70
|
| Rate for Payer: Nomi Health Commercial |
$215.65
|
| Rate for Payer: PACE SWMI |
$179.71
|
| Rate for Payer: PHP Medicare Advantage |
$179.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.50
|
| Rate for Payer: Priority Health Medicare |
$179.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.71
|
| Rate for Payer: UHC Medicare Advantage |
$179.71
|
| Rate for Payer: UHCCP DNSP |
$179.71
|
|
|
PR DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 15630
|
| Min. Negotiated Rate |
$325.02 |
| Max. Negotiated Rate |
$588.90 |
| Rate for Payer: Aetna Commercial |
$435.53
|
| Rate for Payer: Aetna Medicare |
$325.02
|
| Rate for Payer: BCBS Complete |
$362.40
|
| Rate for Payer: BCBS MAPPO |
$325.02
|
| Rate for Payer: BCN Medicare Advantage |
$325.02
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$468.03
|
| Rate for Payer: Cofinity Commercial |
$435.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.02
|
| Rate for Payer: Healthscope Commercial |
$390.02
|
| Rate for Payer: Healthscope Whirlpool |
$390.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.27
|
| Rate for Payer: Nomi Health Commercial |
$390.02
|
| Rate for Payer: PACE SWMI |
$325.02
|
| Rate for Payer: PHP Medicare Advantage |
$325.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.90
|
| Rate for Payer: Priority Health Medicare |
$325.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.02
|
| Rate for Payer: UHC Medicare Advantage |
$325.02
|
| Rate for Payer: UHCCP DNSP |
$325.02
|
|
|
PR DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 15620
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$470.60 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Medicare |
$309.67
|
| Rate for Payer: BCBS Complete |
$289.60
|
| Rate for Payer: BCBS MAPPO |
$309.67
|
| Rate for Payer: BCN Medicare Advantage |
$309.67
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cofinity Commercial |
$445.92
|
| Rate for Payer: Cofinity Commercial |
$414.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.67
|
| Rate for Payer: Healthscope Commercial |
$371.60
|
| Rate for Payer: Healthscope Whirlpool |
$371.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.15
|
| Rate for Payer: Nomi Health Commercial |
$371.60
|
| Rate for Payer: PACE SWMI |
$309.67
|
| Rate for Payer: PHP Medicare Advantage |
$309.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health Medicare |
$309.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.67
|
| Rate for Payer: UHC Medicare Advantage |
$309.67
|
| Rate for Payer: UHCCP DNSP |
$309.67
|
|
|
PR DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 15610
|
| Min. Negotiated Rate |
$231.95 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Commercial |
$310.81
|
| Rate for Payer: Aetna Medicare |
$231.95
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: BCBS MAPPO |
$231.95
|
| Rate for Payer: BCN Medicare Advantage |
$231.95
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$334.01
|
| Rate for Payer: Cofinity Commercial |
$310.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.95
|
| Rate for Payer: Healthscope Commercial |
$278.34
|
| Rate for Payer: Healthscope Whirlpool |
$278.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.55
|
| Rate for Payer: Nomi Health Commercial |
$278.34
|
| Rate for Payer: PACE SWMI |
$231.95
|
| Rate for Payer: PHP Medicare Advantage |
$231.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Medicare |
$231.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.95
|
| Rate for Payer: UHC Medicare Advantage |
$231.95
|
| Rate for Payer: UHCCP DNSP |
$231.95
|
|
