|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,841.00
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$586.82 |
| Max. Negotiated Rate |
$1,941.01 |
| Rate for Payer: Aetna Commercial |
$1,215.19
|
| Rate for Payer: Aetna Medicare |
$906.86
|
| Rate for Payer: BCBS Complete |
$616.16
|
| Rate for Payer: BCBS MAPPO |
$906.86
|
| Rate for Payer: BCN Commercial |
$1,593.04
|
| Rate for Payer: BCN Medicare Advantage |
$906.86
|
| Rate for Payer: Cash Price |
$1,472.80
|
| Rate for Payer: Cash Price |
$1,472.80
|
| Rate for Payer: Cofinity Commercial |
$1,305.88
|
| Rate for Payer: Cofinity Commercial |
$1,215.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$906.86
|
| Rate for Payer: Healthscope Commercial |
$1,088.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,088.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$952.20
|
| Rate for Payer: Meridian Medicaid |
$616.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$997.55
|
| Rate for Payer: Nomi Health Commercial |
$1,088.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,380.75
|
| Rate for Payer: PACE SWMI |
$906.86
|
| Rate for Payer: PHP Medicare Advantage |
$906.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,941.01
|
| Rate for Payer: Priority Health Medicare |
$906.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,941.01
|
| Rate for Payer: Railroad Medicare Medicare |
$906.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,842.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$906.86
|
| Rate for Payer: UHC Exchange |
$1,842.36
|
| Rate for Payer: UHC Medicaid |
$586.82
|
| Rate for Payer: UHCCP DNSP |
$906.86
|
| Rate for Payer: UHCCP Medicaid |
$586.82
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$355.28 |
| Max. Negotiated Rate |
$1,157.09 |
| Rate for Payer: Aetna Commercial |
$731.95
|
| Rate for Payer: Aetna Medicare |
$546.23
|
| Rate for Payer: BCBS Complete |
$373.04
|
| Rate for Payer: BCBS MAPPO |
$546.23
|
| Rate for Payer: BCN Commercial |
$949.65
|
| Rate for Payer: BCN Medicare Advantage |
$546.23
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cofinity Commercial |
$786.57
|
| Rate for Payer: Cofinity Commercial |
$731.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.23
|
| Rate for Payer: Healthscope Commercial |
$655.48
|
| Rate for Payer: Healthscope Whirlpool |
$655.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.54
|
| Rate for Payer: Meridian Medicaid |
$373.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$600.85
|
| Rate for Payer: Nomi Health Commercial |
$655.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.00
|
| Rate for Payer: PACE SWMI |
$546.23
|
| Rate for Payer: PHP Medicare Advantage |
$546.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,157.09
|
| Rate for Payer: Priority Health Medicare |
$546.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,157.09
|
| Rate for Payer: Railroad Medicare Medicare |
$546.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,087.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$546.23
|
| Rate for Payer: UHC Exchange |
$1,087.71
|
| Rate for Payer: UHC Medicaid |
$355.28
|
| Rate for Payer: UHCCP DNSP |
$546.23
|
| Rate for Payer: UHCCP Medicaid |
$355.28
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$654.12 |
| Max. Negotiated Rate |
$2,172.18 |
| Rate for Payer: Aetna Commercial |
$1,356.41
|
| Rate for Payer: Aetna Medicare |
$1,012.25
|
| Rate for Payer: BCBS Complete |
$686.83
|
| Rate for Payer: BCBS MAPPO |
$1,012.25
|
| Rate for Payer: BCN Commercial |
$1,782.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,012.25
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cofinity Commercial |
$1,457.64
|
| Rate for Payer: Cofinity Commercial |
$1,356.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,012.25
|
| Rate for Payer: Healthscope Commercial |
$1,214.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,214.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,062.86
|
| Rate for Payer: Meridian Medicaid |
$686.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,113.47
|
| Rate for Payer: Nomi Health Commercial |
$1,214.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,569.75
|
| Rate for Payer: PACE SWMI |
$1,012.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,012.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,172.18
|
| Rate for Payer: Priority Health Medicare |
$1,012.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,172.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,012.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,071.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,012.25
|
| Rate for Payer: UHC Exchange |
$2,071.70
|
| Rate for Payer: UHC Medicaid |
$654.12
|
| Rate for Payer: UHCCP DNSP |
$1,012.25
|
| Rate for Payer: UHCCP Medicaid |
$654.12
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH
|
Professional
|
Both
|
$2,784.00
|
|
|
Service Code
|
HCPCS 45135
|
| Min. Negotiated Rate |
$762.75 |
| Max. Negotiated Rate |
$2,355.43 |
| Rate for Payer: Aetna Commercial |
$1,578.47
|
| Rate for Payer: Aetna Medicare |
$1,177.96
|
| Rate for Payer: BCBS Complete |
$800.89
|
| Rate for Payer: BCBS MAPPO |
$1,177.96
|
| Rate for Payer: BCN Commercial |
$1,933.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,177.96
|
| Rate for Payer: Cash Price |
$2,227.20
|
| Rate for Payer: Cash Price |
$2,227.20
|
| Rate for Payer: Cofinity Commercial |
$1,696.26
|
| Rate for Payer: Cofinity Commercial |
$1,578.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,177.96
|
| Rate for Payer: Healthscope Commercial |
$1,413.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,413.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,236.86
|
| Rate for Payer: Meridian Medicaid |
$800.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,295.76
|
| Rate for Payer: Nomi Health Commercial |
$1,413.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,088.00
|
| Rate for Payer: PACE SWMI |
$1,177.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,177.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,355.43
|
| Rate for Payer: Priority Health Medicare |
$1,177.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,355.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,177.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,282.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,177.96
|
| Rate for Payer: UHC Exchange |
$2,282.69
|
| Rate for Payer: UHC Medicaid |
$762.75
|
| Rate for Payer: UHCCP DNSP |
$1,177.96
|
| Rate for Payer: UHCCP Medicaid |
$762.75
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH
|
Professional
|
Both
|
$2,912.00
|
|
|
Service Code
|
HCPCS 45130
|
| Min. Negotiated Rate |
$640.70 |
| Max. Negotiated Rate |
$2,184.00 |
| Rate for Payer: Aetna Commercial |
$1,330.74
|
| Rate for Payer: Aetna Medicare |
$993.09
|
| Rate for Payer: BCBS Complete |
$672.74
|
| Rate for Payer: BCBS MAPPO |
$993.09
|
| Rate for Payer: BCN Commercial |
$1,618.93
|
| Rate for Payer: BCN Medicare Advantage |
$993.09
|
| Rate for Payer: Cash Price |
$2,329.60
|
| Rate for Payer: Cash Price |
$2,329.60
|
| Rate for Payer: Cofinity Commercial |
$1,430.05
|
| Rate for Payer: Cofinity Commercial |
$1,330.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$993.09
|
| Rate for Payer: Healthscope Commercial |
$1,191.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,191.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,042.74
|
| Rate for Payer: Meridian Medicaid |
$672.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,092.40
|
| Rate for Payer: Nomi Health Commercial |
$1,191.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,184.00
|
| Rate for Payer: PACE SWMI |
$993.09
|
| Rate for Payer: PHP Medicare Advantage |
$993.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,972.56
|
| Rate for Payer: Priority Health Medicare |
$993.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,972.56
|
| Rate for Payer: Railroad Medicare Medicare |
$993.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,917.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$993.09
|
| Rate for Payer: UHC Exchange |
$1,917.57
|
| Rate for Payer: UHC Medicaid |
$640.70
|
| Rate for Payer: UHCCP DNSP |
$993.09
|
| Rate for Payer: UHCCP Medicaid |
$640.70
|
|
|
PR EXC RCT TUM INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 45172
|
| Min. Negotiated Rate |
$506.94 |
| Max. Negotiated Rate |
$1,509.01 |
| Rate for Payer: Aetna Commercial |
$1,039.49
|
| Rate for Payer: Aetna Medicare |
$775.74
|
| Rate for Payer: BCBS Complete |
$532.29
|
| Rate for Payer: BCBS MAPPO |
$775.74
|
| Rate for Payer: BCN Commercial |
$1,238.48
|
| Rate for Payer: BCN Medicare Advantage |
$775.74
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$1,117.07
|
| Rate for Payer: Cofinity Commercial |
$1,039.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$775.74
|
| Rate for Payer: Healthscope Commercial |
$930.89
|
| Rate for Payer: Healthscope Whirlpool |
$930.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.53
|
| Rate for Payer: Meridian Medicaid |
$532.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$853.31
|
| Rate for Payer: Nomi Health Commercial |
$930.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.25
|
| Rate for Payer: PACE SWMI |
$775.74
|
| Rate for Payer: PHP Medicare Advantage |
$775.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$506.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,509.01
|
| Rate for Payer: Priority Health Medicare |
$775.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,509.01
|
| Rate for Payer: Railroad Medicare Medicare |
$775.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,426.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$775.74
|
| Rate for Payer: UHC Exchange |
$1,426.24
|
| Rate for Payer: UHC Medicaid |
$506.94
|
| Rate for Payer: UHCCP DNSP |
$775.74
|
| Rate for Payer: UHCCP Medicaid |
$506.94
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 45171
|
| Min. Negotiated Rate |
$390.22 |
| Max. Negotiated Rate |
$1,135.24 |
| Rate for Payer: Aetna Commercial |
$794.58
|
| Rate for Payer: Aetna Medicare |
$592.97
|
| Rate for Payer: BCBS Complete |
$409.73
|
| Rate for Payer: BCBS MAPPO |
$592.97
|
| Rate for Payer: BCN Commercial |
$931.72
|
| Rate for Payer: BCN Medicare Advantage |
$592.97
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$853.88
|
| Rate for Payer: Cofinity Commercial |
$794.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.97
|
| Rate for Payer: Healthscope Commercial |
$711.56
|
| Rate for Payer: Healthscope Whirlpool |
$711.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$622.62
|
| Rate for Payer: Meridian Medicaid |
$409.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$652.27
|
| Rate for Payer: Nomi Health Commercial |
$711.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.25
|
| Rate for Payer: PACE SWMI |
$592.97
|
| Rate for Payer: PHP Medicare Advantage |
$592.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,135.24
|
| Rate for Payer: Priority Health Medicare |
$592.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,135.24
|
| Rate for Payer: Railroad Medicare Medicare |
$592.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,056.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$592.97
|
| Rate for Payer: UHC Exchange |
$1,056.88
|
| Rate for Payer: UHC Medicaid |
$390.22
|
| Rate for Payer: UHCCP DNSP |
$592.97
|
| Rate for Payer: UHCCP Medicaid |
$390.22
|
|
|
PR EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 45160
|
| Min. Negotiated Rate |
$622.60 |
| Max. Negotiated Rate |
$1,887.02 |
| Rate for Payer: Aetna Commercial |
$1,297.51
|
| Rate for Payer: Aetna Medicare |
$968.29
|
| Rate for Payer: BCBS Complete |
$653.73
|
| Rate for Payer: BCBS MAPPO |
$968.29
|
| Rate for Payer: BCN Commercial |
$1,548.72
|
| Rate for Payer: BCN Medicare Advantage |
$968.29
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Cofinity Commercial |
$1,394.34
|
| Rate for Payer: Cofinity Commercial |
$1,297.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$968.29
|
| Rate for Payer: Healthscope Commercial |
$1,161.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.70
|
| Rate for Payer: Meridian Medicaid |
$653.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,065.12
|
| Rate for Payer: Nomi Health Commercial |
$1,161.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,616.25
|
| Rate for Payer: PACE SWMI |
$968.29
|
| Rate for Payer: PHP Medicare Advantage |
$968.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$622.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,887.02
|
| Rate for Payer: Priority Health Medicare |
$968.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,887.02
|
| Rate for Payer: Railroad Medicare Medicare |
$968.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,822.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$968.29
|
| Rate for Payer: UHC Exchange |
$1,822.67
|
| Rate for Payer: UHC Medicaid |
$622.60
|
| Rate for Payer: UHCCP DNSP |
$968.29
|
| Rate for Payer: UHCCP Medicaid |
$622.60
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR
|
Professional
|
Both
|
$1,595.00
|
|
|
Service Code
|
HCPCS 15936
|
| Min. Negotiated Rate |
$534.42 |
| Max. Negotiated Rate |
$1,580.18 |
| Rate for Payer: Aetna Commercial |
$1,104.03
|
| Rate for Payer: Aetna Medicare |
$823.90
|
| Rate for Payer: BCBS Complete |
$561.14
|
| Rate for Payer: BCBS MAPPO |
$823.90
|
| Rate for Payer: BCN Commercial |
$1,340.57
|
| Rate for Payer: BCN Medicare Advantage |
$823.90
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cofinity Commercial |
$1,186.42
|
| Rate for Payer: Cofinity Commercial |
$1,104.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.90
|
| Rate for Payer: Healthscope Commercial |
$988.68
|
| Rate for Payer: Healthscope Whirlpool |
$988.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$865.10
|
| Rate for Payer: Meridian Medicaid |
$561.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$906.29
|
| Rate for Payer: Nomi Health Commercial |
$988.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,196.25
|
| Rate for Payer: PACE SWMI |
$823.90
|
| Rate for Payer: PHP Medicare Advantage |
$823.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$534.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,226.97
|
| Rate for Payer: Priority Health Medicare |
$823.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,226.97
|
| Rate for Payer: Railroad Medicare Medicare |
$823.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,580.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$823.90
|
| Rate for Payer: UHC Exchange |
$1,580.18
|
| Rate for Payer: UHC Medicaid |
$534.42
|
| Rate for Payer: UHCCP DNSP |
$823.90
|
| Rate for Payer: UHCCP Medicaid |
$534.42
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC
|
Professional
|
Both
|
$2,170.00
|
|
|
Service Code
|
HCPCS 15937
|
| Min. Negotiated Rate |
$586.39 |
| Max. Negotiated Rate |
$1,827.49 |
| Rate for Payer: Aetna Commercial |
$1,208.73
|
| Rate for Payer: Aetna Medicare |
$902.04
|
| Rate for Payer: BCBS Complete |
$615.71
|
| Rate for Payer: BCBS MAPPO |
$902.04
|
| Rate for Payer: BCN Commercial |
$1,479.50
|
| Rate for Payer: BCN Medicare Advantage |
$902.04
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Cofinity Commercial |
$1,298.94
|
| Rate for Payer: Cofinity Commercial |
$1,208.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.04
|
| Rate for Payer: Healthscope Commercial |
$1,082.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,082.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.14
|
| Rate for Payer: Meridian Medicaid |
$615.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$992.24
|
| Rate for Payer: Nomi Health Commercial |
$1,082.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,627.50
|
| Rate for Payer: PACE SWMI |
$902.04
|
| Rate for Payer: PHP Medicare Advantage |
$902.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,354.12
|
| Rate for Payer: Priority Health Medicare |
$902.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,354.12
|
| Rate for Payer: Railroad Medicare Medicare |
$902.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,827.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$902.04
|
| Rate for Payer: UHC Exchange |
$1,827.49
|
| Rate for Payer: UHC Medicaid |
$586.39
|
| Rate for Payer: UHCCP DNSP |
$902.04
|
| Rate for Payer: UHCCP Medicaid |
$586.39
|
|
|
PR EXC SUBLINGUAL SALIVARY CYST RANULA
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 42408
|
| Min. Negotiated Rate |
$206.82 |
| Max. Negotiated Rate |
$644.38 |
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: Aetna Medicare |
$313.99
|
| Rate for Payer: BCBS Complete |
$217.16
|
| Rate for Payer: BCBS MAPPO |
$313.99
|
| Rate for Payer: BCN Commercial |
$528.85
|
| Rate for Payer: BCN Medicare Advantage |
$313.99
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$452.15
|
| Rate for Payer: Cofinity Commercial |
$420.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.99
|
| Rate for Payer: Healthscope Commercial |
$376.79
|
| Rate for Payer: Healthscope Whirlpool |
$376.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.69
|
| Rate for Payer: Meridian Medicaid |
$217.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$345.39
|
| Rate for Payer: Nomi Health Commercial |
$376.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$562.50
|
| Rate for Payer: PACE SWMI |
$313.99
|
| Rate for Payer: PHP Medicare Advantage |
$313.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$206.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$644.38
|
| Rate for Payer: Priority Health Medicare |
$313.99
|
| Rate for Payer: Priority Health Narrow Network |
$644.38
|
| Rate for Payer: Railroad Medicare Medicare |
$313.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$313.99
|
| Rate for Payer: UHC Exchange |
$602.93
|
| Rate for Payer: UHC Medicaid |
$206.82
|
| Rate for Payer: UHCCP DNSP |
$313.99
|
| Rate for Payer: UHCCP Medicaid |
$206.82
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 25109
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$657.91
|
| Rate for Payer: Aetna Medicare |
$490.98
|
| Rate for Payer: BCBS Complete |
$338.83
|
| Rate for Payer: BCBS MAPPO |
$490.98
|
| Rate for Payer: BCN Commercial |
$826.65
|
| Rate for Payer: BCN Medicare Advantage |
$490.98
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$707.01
|
| Rate for Payer: Cofinity Commercial |
$657.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.98
|
| Rate for Payer: Healthscope Commercial |
$589.18
|
| Rate for Payer: Healthscope Whirlpool |
$589.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.53
|
| Rate for Payer: Meridian Medicaid |
$338.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$540.08
|
| Rate for Payer: Nomi Health Commercial |
$589.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE SWMI |
$490.98
|
| Rate for Payer: PHP Medicare Advantage |
$490.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$883.66
|
| Rate for Payer: Priority Health Medicare |
$490.98
|
| Rate for Payer: Priority Health Narrow Network |
$883.66
|
| Rate for Payer: Railroad Medicare Medicare |
$490.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$933.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$490.98
|
| Rate for Payer: UHC Exchange |
$933.04
|
| Rate for Payer: UHC Medicaid |
$322.70
|
| Rate for Payer: UHCCP DNSP |
$490.98
|
| Rate for Payer: UHCCP Medicaid |
$322.70
|
|
|
PR EXC THROMBOSED HEMORRHOID XTRNL
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 46320
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$141.33
|
| Rate for Payer: Aetna Medicare |
$105.47
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS MAPPO |
$105.47
|
| Rate for Payer: BCN Commercial |
$171.30
|
| Rate for Payer: BCN Medicare Advantage |
$105.47
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$151.88
|
| Rate for Payer: Cofinity Commercial |
$141.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.47
|
| Rate for Payer: Healthscope Commercial |
$126.56
|
| Rate for Payer: Healthscope Whirlpool |
$126.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.74
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.02
|
| Rate for Payer: Nomi Health Commercial |
$126.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.50
|
| Rate for Payer: PACE SWMI |
$105.47
|
| Rate for Payer: PHP Medicare Advantage |
$105.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$208.72
|
| Rate for Payer: Priority Health Medicare |
$105.47
|
| Rate for Payer: Priority Health Narrow Network |
$208.72
|
| Rate for Payer: Railroad Medicare Medicare |
$105.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$105.47
|
| Rate for Payer: UHC Exchange |
$195.25
|
| Rate for Payer: UHC Medicaid |
$69.01
|
| Rate for Payer: UHCCP DNSP |
$105.47
|
| Rate for Payer: UHCCP Medicaid |
$69.01
|
|
|
PR EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 15950
|
| Min. Negotiated Rate |
$375.31 |
| Max. Negotiated Rate |
$1,063.61 |
| Rate for Payer: Aetna Commercial |
$764.52
|
| Rate for Payer: Aetna Medicare |
$570.54
|
| Rate for Payer: BCBS Complete |
$394.08
|
| Rate for Payer: BCBS MAPPO |
$570.54
|
| Rate for Payer: BCN Commercial |
$964.59
|
| Rate for Payer: BCN Medicare Advantage |
$570.54
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cofinity Commercial |
$821.58
|
| Rate for Payer: Cofinity Commercial |
$764.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.54
|
| Rate for Payer: Healthscope Commercial |
$684.65
|
| Rate for Payer: Healthscope Whirlpool |
$684.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.07
|
| Rate for Payer: Meridian Medicaid |
$394.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$627.59
|
| Rate for Payer: Nomi Health Commercial |
$684.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.25
|
| Rate for Payer: PACE SWMI |
$570.54
|
| Rate for Payer: PHP Medicare Advantage |
$570.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$882.85
|
| Rate for Payer: Priority Health Medicare |
$570.54
|
| Rate for Payer: Priority Health Narrow Network |
$882.85
|
| Rate for Payer: Railroad Medicare Medicare |
$570.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,063.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$570.54
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicaid |
$375.31
|
| Rate for Payer: UHCCP DNSP |
$570.54
|
| Rate for Payer: UHCCP Medicaid |
$375.31
|
|
|
PR EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$2,055.00
|
|
|
Service Code
|
HCPCS 15956
|
| Min. Negotiated Rate |
$697.15 |
| Max. Negotiated Rate |
$2,046.45 |
| Rate for Payer: Aetna Commercial |
$1,436.48
|
| Rate for Payer: Aetna Medicare |
$1,072.00
|
| Rate for Payer: BCBS Complete |
$732.01
|
| Rate for Payer: BCBS MAPPO |
$1,072.00
|
| Rate for Payer: BCN Commercial |
$1,754.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cofinity Commercial |
$1,543.68
|
| Rate for Payer: Cofinity Commercial |
$1,436.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,072.00
|
| Rate for Payer: Healthscope Commercial |
$1,286.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,286.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,125.60
|
| Rate for Payer: Meridian Medicaid |
$732.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,179.20
|
| Rate for Payer: Nomi Health Commercial |
$1,286.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,541.25
|
| Rate for Payer: PACE SWMI |
$1,072.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,072.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$697.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,606.17
|
| Rate for Payer: Priority Health Medicare |
$1,072.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,606.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,072.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,046.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,072.00
|
| Rate for Payer: UHC Exchange |
$2,046.45
|
| Rate for Payer: UHC Medicaid |
$697.15
|
| Rate for Payer: UHCCP DNSP |
$1,072.00
|
| Rate for Payer: UHCCP Medicaid |
$697.15
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,295.00
|
|
|
Service Code
|
HCPCS 25073
|
| Min. Negotiated Rate |
$323.97 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Aetna Commercial |
$662.80
|
| Rate for Payer: Aetna Medicare |
$494.63
|
| Rate for Payer: BCBS Complete |
$340.17
|
| Rate for Payer: BCBS MAPPO |
$494.63
|
| Rate for Payer: BCN Commercial |
$822.16
|
| Rate for Payer: BCN Medicare Advantage |
$494.63
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cofinity Commercial |
$712.27
|
| Rate for Payer: Cofinity Commercial |
$662.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$494.63
|
| Rate for Payer: Healthscope Commercial |
$593.56
|
| Rate for Payer: Healthscope Whirlpool |
$593.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.36
|
| Rate for Payer: Meridian Medicaid |
$340.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$544.09
|
| Rate for Payer: Nomi Health Commercial |
$593.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,721.25
|
| Rate for Payer: PACE SWMI |
$494.63
|
| Rate for Payer: PHP Medicare Advantage |
$494.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$878.87
|
| Rate for Payer: Priority Health Medicare |
$494.63
|
| Rate for Payer: Priority Health Narrow Network |
$878.87
|
| Rate for Payer: Railroad Medicare Medicare |
$494.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$932.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$494.63
|
| Rate for Payer: UHC Exchange |
$932.08
|
| Rate for Payer: UHC Medicaid |
$323.97
|
| Rate for Payer: UHCCP DNSP |
$494.63
|
| Rate for Payer: UHCCP Medicaid |
$323.97
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 21552
|
| Min. Negotiated Rate |
$273.71 |
| Max. Negotiated Rate |
$952.50 |
| Rate for Payer: Aetna Commercial |
$564.25
|
| Rate for Payer: Aetna Medicare |
$421.08
|
| Rate for Payer: BCBS Complete |
$287.40
|
| Rate for Payer: BCBS MAPPO |
$421.08
|
| Rate for Payer: BCN Commercial |
$680.24
|
| Rate for Payer: BCN Medicare Advantage |
$421.08
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$606.36
|
| Rate for Payer: Cofinity Commercial |
$564.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.08
|
| Rate for Payer: Healthscope Commercial |
$505.30
|
| Rate for Payer: Healthscope Whirlpool |
$505.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.13
|
| Rate for Payer: Meridian Medicaid |
$287.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$463.19
|
| Rate for Payer: Nomi Health Commercial |
$505.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$952.50
|
| Rate for Payer: PACE SWMI |
$421.08
|
| Rate for Payer: PHP Medicare Advantage |
$421.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$727.15
|
| Rate for Payer: Priority Health Medicare |
$421.08
|
| Rate for Payer: Priority Health Narrow Network |
$727.15
|
| Rate for Payer: Railroad Medicare Medicare |
$421.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$782.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$421.08
|
| Rate for Payer: UHC Exchange |
$782.83
|
| Rate for Payer: UHC Medicaid |
$273.71
|
| Rate for Payer: UHCCP DNSP |
$421.08
|
| Rate for Payer: UHCCP Medicaid |
$273.71
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$1,221.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
21933
|
| Min. Negotiated Rate |
$446.45 |
| Max. Negotiated Rate |
$1,301.00 |
| Rate for Payer: Aetna Commercial |
$924.26
|
| Rate for Payer: Aetna Medicare |
$689.75
|
| Rate for Payer: BCBS Complete |
$468.77
|
| Rate for Payer: BCBS MAPPO |
$689.75
|
| Rate for Payer: BCN Commercial |
$1,117.47
|
| Rate for Payer: BCN Medicare Advantage |
$689.75
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cofinity Commercial |
$993.24
|
| Rate for Payer: Cofinity Commercial |
$924.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.75
|
| Rate for Payer: Healthscope Commercial |
$827.70
|
| Rate for Payer: Healthscope Whirlpool |
$827.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$724.24
|
| Rate for Payer: Meridian Medicaid |
$468.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$758.73
|
| Rate for Payer: Nomi Health Commercial |
$827.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.75
|
| Rate for Payer: PACE SWMI |
$689.75
|
| Rate for Payer: PHP Medicare Advantage |
$689.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,194.55
|
| Rate for Payer: Priority Health Medicare |
$689.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,194.55
|
| Rate for Payer: Railroad Medicare Medicare |
$689.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,301.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$689.75
|
| Rate for Payer: UHC Exchange |
$1,301.00
|
| Rate for Payer: UHC Medicaid |
$446.45
|
| Rate for Payer: UHCCP DNSP |
$689.75
|
| Rate for Payer: UHCCP Medicaid |
$446.45
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$1,221.00
|
|
|
Service Code
|
HCPCS 21933
|
| Min. Negotiated Rate |
$446.45 |
| Max. Negotiated Rate |
$1,301.00 |
| Rate for Payer: Aetna Commercial |
$924.26
|
| Rate for Payer: Aetna Medicare |
$689.75
|
| Rate for Payer: BCBS Complete |
$468.77
|
| Rate for Payer: BCBS MAPPO |
$689.75
|
| Rate for Payer: BCN Commercial |
$1,117.47
|
| Rate for Payer: BCN Medicare Advantage |
$689.75
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cofinity Commercial |
$993.24
|
| Rate for Payer: Cofinity Commercial |
$924.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.75
|
| Rate for Payer: Healthscope Commercial |
$827.70
|
| Rate for Payer: Healthscope Whirlpool |
$827.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$724.24
|
| Rate for Payer: Meridian Medicaid |
$468.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$758.73
|
| Rate for Payer: Nomi Health Commercial |
$827.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.75
|
| Rate for Payer: PACE SWMI |
$689.75
|
| Rate for Payer: PHP Medicare Advantage |
$689.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,194.55
|
| Rate for Payer: Priority Health Medicare |
$689.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,194.55
|
| Rate for Payer: Railroad Medicare Medicare |
$689.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,301.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$689.75
|
| Rate for Payer: UHC Exchange |
$1,301.00
|
| Rate for Payer: UHC Medicaid |
$446.45
|
| Rate for Payer: UHCCP DNSP |
$689.75
|
| Rate for Payer: UHCCP Medicaid |
$446.45
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
21933
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$915.75 |
| Max. Negotiated Rate |
$1,221.00 |
| Rate for Payer: Aetna Commercial |
$1,098.90
|
| Rate for Payer: ASR ASR |
$1,184.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.69
|
| Rate for Payer: BCN Commercial |
$1,002.69
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cofinity Commercial |
$1,147.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$976.80
|
| Rate for Payer: Healthscope Commercial |
$1,184.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,221.00
|
| Rate for Payer: Mclaren Commercial |
$1,098.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.85
|
| Rate for Payer: Nomi Health Commercial |
$1,001.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.75
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
21933
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$855.92 |
| Max. Negotiated Rate |
$3,617.84 |
| Rate for Payer: Aetna Commercial |
$1,098.90
|
| Rate for Payer: Aetna Medicare |
$2,894.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: ASR ASR |
$1,184.37
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.71
|
| Rate for Payer: BCN Commercial |
$1,006.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cofinity Commercial |
$1,147.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$976.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$1,184.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,221.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,894.27
|
| Rate for Payer: Mclaren Commercial |
$1,098.90
|
| Rate for Payer: Mclaren Medicaid |
$2,894.27
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$1,589.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.85
|
| Rate for Payer: Nomi Health Commercial |
$1,001.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.75
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$3,183.70
|
| Rate for Payer: PHP Medicaid |
$1,551.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,069.84
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Narrow Network |
$855.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP DNSP |
$2,894.27
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 21932
|
| Min. Negotiated Rate |
$400.01 |
| Max. Negotiated Rate |
$1,556.25 |
| Rate for Payer: Aetna Commercial |
$826.43
|
| Rate for Payer: Aetna Medicare |
$616.74
|
| Rate for Payer: BCBS Complete |
$420.01
|
| Rate for Payer: BCBS MAPPO |
$616.74
|
| Rate for Payer: BCN Commercial |
$1,009.41
|
| Rate for Payer: BCN Medicare Advantage |
$616.74
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cofinity Commercial |
$888.11
|
| Rate for Payer: Cofinity Commercial |
$826.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.74
|
| Rate for Payer: Healthscope Commercial |
$740.09
|
| Rate for Payer: Healthscope Whirlpool |
$740.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.58
|
| Rate for Payer: Meridian Medicaid |
$420.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$678.41
|
| Rate for Payer: Nomi Health Commercial |
$740.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.25
|
| Rate for Payer: PACE SWMI |
$616.74
|
| Rate for Payer: PHP Medicare Advantage |
$616.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,079.02
|
| Rate for Payer: Priority Health Medicare |
$616.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,079.02
|
| Rate for Payer: Railroad Medicare Medicare |
$616.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,165.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$616.74
|
| Rate for Payer: UHC Exchange |
$1,165.90
|
| Rate for Payer: UHC Medicaid |
$400.01
|
| Rate for Payer: UHCCP DNSP |
$616.74
|
| Rate for Payer: UHCCP Medicaid |
$400.01
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 21014
|
| Min. Negotiated Rate |
$306.29 |
| Max. Negotiated Rate |
$906.73 |
| Rate for Payer: Aetna Commercial |
$627.44
|
| Rate for Payer: Aetna Medicare |
$468.24
|
| Rate for Payer: BCBS Complete |
$321.60
|
| Rate for Payer: BCBS MAPPO |
$468.24
|
| Rate for Payer: BCN Commercial |
$791.29
|
| Rate for Payer: BCN Medicare Advantage |
$468.24
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cofinity Commercial |
$674.27
|
| Rate for Payer: Cofinity Commercial |
$627.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.24
|
| Rate for Payer: Healthscope Commercial |
$561.89
|
| Rate for Payer: Healthscope Whirlpool |
$561.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.65
|
| Rate for Payer: Meridian Medicaid |
$321.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$515.06
|
| Rate for Payer: Nomi Health Commercial |
$561.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$681.75
|
| Rate for Payer: PACE SWMI |
$468.24
|
| Rate for Payer: PHP Medicare Advantage |
$468.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$306.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$845.88
|
| Rate for Payer: Priority Health Medicare |
$468.24
|
| Rate for Payer: Priority Health Narrow Network |
$845.88
|
| Rate for Payer: Railroad Medicare Medicare |
$468.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$906.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$468.24
|
| Rate for Payer: UHC Exchange |
$906.73
|
| Rate for Payer: UHC Medicaid |
$306.29
|
| Rate for Payer: UHCCP DNSP |
$468.24
|
| Rate for Payer: UHCCP Medicaid |
$306.29
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 21013
|
| Min. Negotiated Rate |
$237.07 |
| Max. Negotiated Rate |
$721.50 |
| Rate for Payer: Aetna Commercial |
$484.84
|
| Rate for Payer: Aetna Medicare |
$361.82
|
| Rate for Payer: BCBS Complete |
$248.92
|
| Rate for Payer: BCBS MAPPO |
$361.82
|
| Rate for Payer: BCN Commercial |
$609.03
|
| Rate for Payer: BCN Medicare Advantage |
$361.82
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cofinity Commercial |
$521.02
|
| Rate for Payer: Cofinity Commercial |
$484.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.82
|
| Rate for Payer: Healthscope Commercial |
$434.18
|
| Rate for Payer: Healthscope Whirlpool |
$434.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$379.91
|
| Rate for Payer: Meridian Medicaid |
$248.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$398.00
|
| Rate for Payer: Nomi Health Commercial |
$434.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$721.50
|
| Rate for Payer: PACE SWMI |
$361.82
|
| Rate for Payer: PHP Medicare Advantage |
$361.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$651.04
|
| Rate for Payer: Priority Health Medicare |
$361.82
|
| Rate for Payer: Priority Health Narrow Network |
$651.04
|
| Rate for Payer: Railroad Medicare Medicare |
$361.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$696.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$361.82
|
| Rate for Payer: UHC Exchange |
$696.75
|
| Rate for Payer: UHC Medicaid |
$237.07
|
| Rate for Payer: UHCCP DNSP |
$361.82
|
| Rate for Payer: UHCCP Medicaid |
$237.07
|
|
|
PR EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
HCPCS 25071
|
| Min. Negotiated Rate |
$257.94 |
| Max. Negotiated Rate |
$1,244.25 |
| Rate for Payer: Aetna Commercial |
$529.66
|
| Rate for Payer: Aetna Medicare |
$395.27
|
| Rate for Payer: BCBS Complete |
$270.84
|
| Rate for Payer: BCBS MAPPO |
$395.27
|
| Rate for Payer: BCN Commercial |
$648.38
|
| Rate for Payer: BCN Medicare Advantage |
$395.27
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cofinity Commercial |
$569.19
|
| Rate for Payer: Cofinity Commercial |
$529.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.27
|
| Rate for Payer: Healthscope Commercial |
$474.32
|
| Rate for Payer: Healthscope Whirlpool |
$474.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.03
|
| Rate for Payer: Meridian Medicaid |
$270.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$434.80
|
| Rate for Payer: Nomi Health Commercial |
$474.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,244.25
|
| Rate for Payer: PACE SWMI |
$395.27
|
| Rate for Payer: PHP Medicare Advantage |
$395.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$257.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$693.09
|
| Rate for Payer: Priority Health Medicare |
$395.27
|
| Rate for Payer: Priority Health Narrow Network |
$693.09
|
| Rate for Payer: Railroad Medicare Medicare |
$395.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$742.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$395.27
|
| Rate for Payer: UHC Exchange |
$742.01
|
| Rate for Payer: UHC Medicaid |
$257.94
|
| Rate for Payer: UHCCP DNSP |
$395.27
|
| Rate for Payer: UHCCP Medicaid |
$257.94
|
|
