|
PR RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 63746
|
| Min. Negotiated Rate |
$214.49 |
| Max. Negotiated Rate |
$1,137.50 |
| Rate for Payer: Aetna Commercial |
$820.00
|
| Rate for Payer: Aetna Medicare |
$611.94
|
| Rate for Payer: BCBS Complete |
$420.68
|
| Rate for Payer: BCBS MAPPO |
$611.94
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: BCN Commercial |
$999.20
|
| Rate for Payer: BCN Medicare Advantage |
$611.94
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cofinity Commercial |
$820.00
|
| Rate for Payer: Cofinity Commercial |
$881.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$611.94
|
| Rate for Payer: Healthscope Commercial |
$734.33
|
| Rate for Payer: Healthscope Whirlpool |
$734.33
|
| Rate for Payer: Meridian Medicaid |
$420.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$642.54
|
| Rate for Payer: PACE SWMI |
$611.94
|
| Rate for Payer: PHP Medicare Advantage |
$611.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,051.48
|
| Rate for Payer: Priority Health Medicare |
$611.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,051.48
|
| Rate for Payer: UHC Medicare Advantage |
$630.30
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$61.34 |
| Max. Negotiated Rate |
$1,749.20 |
| Rate for Payer: Aetna Commercial |
$125.37
|
| Rate for Payer: Aetna Medicare |
$93.56
|
| Rate for Payer: BCBS Complete |
$64.41
|
| Rate for Payer: BCBS MAPPO |
$93.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.20
|
| Rate for Payer: BCN Commercial |
$140.74
|
| Rate for Payer: BCN Medicare Advantage |
$93.56
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$134.73
|
| Rate for Payer: Cofinity Commercial |
$125.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.56
|
| Rate for Payer: Healthscope Commercial |
$112.27
|
| Rate for Payer: Healthscope Whirlpool |
$112.27
|
| Rate for Payer: Meridian Medicaid |
$64.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.24
|
| Rate for Payer: PACE SWMI |
$93.56
|
| Rate for Payer: PHP Medicare Advantage |
$93.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.79
|
| Rate for Payer: Priority Health Medicare |
$93.56
|
| Rate for Payer: Priority Health Narrow Network |
$135.79
|
| Rate for Payer: UHC Medicare Advantage |
$96.37
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$1,294.34 |
| Rate for Payer: Aetna Commercial |
$62.27
|
| Rate for Payer: Aetna Medicare |
$46.47
|
| Rate for Payer: BCBS Complete |
$31.76
|
| Rate for Payer: BCBS MAPPO |
$46.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,294.34
|
| Rate for Payer: BCN Commercial |
$117.77
|
| Rate for Payer: BCN Medicare Advantage |
$46.47
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$62.27
|
| Rate for Payer: Cofinity Commercial |
$66.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.47
|
| Rate for Payer: Healthscope Commercial |
$55.76
|
| Rate for Payer: Healthscope Whirlpool |
$55.76
|
| Rate for Payer: Meridian Medicaid |
$31.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.79
|
| Rate for Payer: PACE SWMI |
$46.47
|
| Rate for Payer: PHP Medicare Advantage |
$46.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.47
|
| Rate for Payer: Priority Health Medicare |
$46.47
|
| Rate for Payer: Priority Health Narrow Network |
$66.47
|
| Rate for Payer: UHC Medicare Advantage |
$47.86
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$303.77 |
| Rate for Payer: Aetna Commercial |
$54.50
|
| Rate for Payer: Aetna Medicare |
$40.67
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS MAPPO |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$303.77
|
| Rate for Payer: BCN Commercial |
$87.96
|
| Rate for Payer: BCN Medicare Advantage |
$40.67
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$58.56
|
| Rate for Payer: Cofinity Commercial |
$54.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.67
|
| Rate for Payer: Healthscope Commercial |
$48.80
|
| Rate for Payer: Healthscope Whirlpool |
$48.80
|
| Rate for Payer: Meridian Medicaid |
$27.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.70
|
| Rate for Payer: PACE SWMI |
$40.67
|
| Rate for Payer: PHP Medicare Advantage |
$40.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.00
|
| Rate for Payer: Priority Health Medicare |
$40.67
|
| Rate for Payer: Priority Health Narrow Network |
$72.00
|
| Rate for Payer: UHC Medicare Advantage |
$41.89
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 65222
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$260.45 |
| Rate for Payer: Aetna Commercial |
$64.51
|
| Rate for Payer: Aetna Medicare |
$48.14
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS MAPPO |
$48.14
|
| Rate for Payer: BCBS Trust/PPO |
$260.45
|
| Rate for Payer: BCN Commercial |
$97.74
|
| Rate for Payer: BCN Medicare Advantage |
$48.14
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cofinity Commercial |
$64.51
|
| Rate for Payer: Cofinity Commercial |
$69.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$57.77
|
| Rate for Payer: Healthscope Whirlpool |
$57.77
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.55
|
| Rate for Payer: PACE SWMI |
$48.14
|
| Rate for Payer: PHP Medicare Advantage |
$48.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.05
|
| Rate for Payer: Priority Health Medicare |
$48.14
|
| Rate for Payer: Priority Health Narrow Network |
$86.05
|
| Rate for Payer: UHC Medicare Advantage |
$49.58
|
|
|
PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 65210
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$264.15 |
| Rate for Payer: Aetna Commercial |
$46.62
|
| Rate for Payer: Aetna Medicare |
$34.79
|
| Rate for Payer: BCBS Complete |
$23.71
|
| Rate for Payer: BCBS MAPPO |
$34.79
|
| Rate for Payer: BCBS Trust/PPO |
$264.15
|
| Rate for Payer: BCN Commercial |
$44.76
|
| Rate for Payer: BCN Medicare Advantage |
$34.79
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cofinity Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.79
|
| Rate for Payer: Healthscope Commercial |
$41.75
|
| Rate for Payer: Healthscope Whirlpool |
$41.75
|
| Rate for Payer: Meridian Medicaid |
$23.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.53
|
| Rate for Payer: PACE SWMI |
$34.79
|
| Rate for Payer: PHP Medicare Advantage |
$34.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.05
|
| Rate for Payer: Priority Health Medicare |
$34.79
|
| Rate for Payer: Priority Health Narrow Network |
$62.05
|
| Rate for Payer: UHC Medicare Advantage |
$35.83
|
|
|
PR RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
HCPCS 45915
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$1,239.39 |
| Rate for Payer: Aetna Commercial |
$301.02
|
| Rate for Payer: Aetna Medicare |
$224.64
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCBS MAPPO |
$224.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.39
|
| Rate for Payer: BCN Commercial |
$518.49
|
| Rate for Payer: BCN Medicare Advantage |
$224.64
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Cofinity Commercial |
$323.48
|
| Rate for Payer: Cofinity Commercial |
$301.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.64
|
| Rate for Payer: Healthscope Commercial |
$269.57
|
| Rate for Payer: Healthscope Whirlpool |
$269.57
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$235.87
|
| Rate for Payer: PACE SWMI |
$224.64
|
| Rate for Payer: PHP Medicare Advantage |
$224.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.36
|
| Rate for Payer: Priority Health Medicare |
$224.64
|
| Rate for Payer: Priority Health Narrow Network |
$403.36
|
| Rate for Payer: UHC Medicare Advantage |
$231.38
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$527.10 |
| Max. Negotiated Rate |
$3,378.18 |
| Rate for Payer: Aetna Commercial |
$677.70
|
| Rate for Payer: Aetna Medicare |
$2,525.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: ASR ASR |
$730.41
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$583.80
|
| Rate for Payer: BCN Commercial |
$583.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cofinity Commercial |
$707.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$753.00
|
| Rate for Payer: Healthscope Whirlpool |
$730.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,525.74
|
| Rate for Payer: Mclaren Commercial |
$677.70
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$640.05
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$2,778.31
|
| Rate for Payer: PHP Medicaid |
$1,381.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,378.18
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,702.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$662.64
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: VA VA |
$2,525.74
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 20525
|
| Min. Negotiated Rate |
$158.69 |
| Max. Negotiated Rate |
$684.64 |
| Rate for Payer: Aetna Commercial |
$324.88
|
| Rate for Payer: Aetna Medicare |
$242.45
|
| Rate for Payer: BCBS Complete |
$166.62
|
| Rate for Payer: BCBS MAPPO |
$242.45
|
| Rate for Payer: BCBS Trust/PPO |
$195.38
|
| Rate for Payer: BCN Commercial |
$684.64
|
| Rate for Payer: BCN Medicare Advantage |
$242.45
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cofinity Commercial |
$324.88
|
| Rate for Payer: Cofinity Commercial |
$349.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.45
|
| Rate for Payer: Healthscope Commercial |
$290.94
|
| Rate for Payer: Healthscope Whirlpool |
$290.94
|
| Rate for Payer: Meridian Medicaid |
$166.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$254.57
|
| Rate for Payer: PACE SWMI |
$242.45
|
| Rate for Payer: PHP Medicare Advantage |
$242.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.38
|
| Rate for Payer: Priority Health Medicare |
$242.45
|
| Rate for Payer: Priority Health Narrow Network |
$377.38
|
| Rate for Payer: UHC Medicare Advantage |
$249.72
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
20525
|
| Min. Negotiated Rate |
$158.69 |
| Max. Negotiated Rate |
$684.64 |
| Rate for Payer: Aetna Commercial |
$324.88
|
| Rate for Payer: Aetna Medicare |
$242.45
|
| Rate for Payer: BCBS Complete |
$166.62
|
| Rate for Payer: BCBS MAPPO |
$242.45
|
| Rate for Payer: BCBS Trust/PPO |
$195.38
|
| Rate for Payer: BCN Commercial |
$684.64
|
| Rate for Payer: BCN Medicare Advantage |
$242.45
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cofinity Commercial |
$349.13
|
| Rate for Payer: Cofinity Commercial |
$324.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.45
|
| Rate for Payer: Healthscope Commercial |
$290.94
|
| Rate for Payer: Healthscope Whirlpool |
$290.94
|
| Rate for Payer: Meridian Medicaid |
$166.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$254.57
|
| Rate for Payer: PACE SWMI |
$242.45
|
| Rate for Payer: PHP Medicare Advantage |
$242.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.38
|
| Rate for Payer: Priority Health Medicare |
$242.45
|
| Rate for Payer: Priority Health Narrow Network |
$377.38
|
| Rate for Payer: UHC Medicare Advantage |
$249.72
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$527.10 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$677.70
|
| Rate for Payer: ASR ASR |
$730.41
|
| Rate for Payer: BCBS Trust/PPO |
$583.80
|
| Rate for Payer: BCN Commercial |
$583.80
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cofinity Commercial |
$707.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.40
|
| Rate for Payer: Healthscope Commercial |
$753.00
|
| Rate for Payer: Healthscope Whirlpool |
$730.41
|
| Rate for Payer: Mclaren Commercial |
$677.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$640.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$662.64
|
|
|
PR RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 27086
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$459.36 |
| Rate for Payer: Aetna Commercial |
$220.34
|
| Rate for Payer: Aetna Medicare |
$164.43
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS MAPPO |
$164.43
|
| Rate for Payer: BCBS Trust/PPO |
$227.17
|
| Rate for Payer: BCN Commercial |
$459.36
|
| Rate for Payer: BCN Medicare Advantage |
$164.43
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Commercial |
$236.78
|
| Rate for Payer: Cofinity Commercial |
$220.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.43
|
| Rate for Payer: Healthscope Commercial |
$197.32
|
| Rate for Payer: Healthscope Whirlpool |
$197.32
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.65
|
| Rate for Payer: PACE SWMI |
$164.43
|
| Rate for Payer: PHP Medicare Advantage |
$164.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.90
|
| Rate for Payer: Priority Health Medicare |
$164.43
|
| Rate for Payer: Priority Health Narrow Network |
$258.90
|
| Rate for Payer: UHC Medicare Advantage |
$169.36
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$1,801.41 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$312.34
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$249.65
|
| Rate for Payer: BCN Commercial |
$249.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$322.00
|
| Rate for Payer: Healthscope Whirlpool |
$312.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$289.80
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.70
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$719.35
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$575.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: ASR ASR |
$312.34
|
| Rate for Payer: BCBS Trust/PPO |
$249.65
|
| Rate for Payer: BCN Commercial |
$249.65
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.60
|
| Rate for Payer: Healthscope Commercial |
$322.00
|
| Rate for Payer: Healthscope Whirlpool |
$312.34
|
| Rate for Payer: Mclaren Commercial |
$289.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.36
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$318.13 |
| Rate for Payer: Aetna Commercial |
$182.96
|
| Rate for Payer: Aetna Medicare |
$136.54
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS MAPPO |
$136.54
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$318.13
|
| Rate for Payer: BCN Medicare Advantage |
$136.54
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$182.96
|
| Rate for Payer: Cofinity Commercial |
$196.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.54
|
| Rate for Payer: Healthscope Commercial |
$163.85
|
| Rate for Payer: Healthscope Whirlpool |
$163.85
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.37
|
| Rate for Payer: PACE SWMI |
$136.54
|
| Rate for Payer: PHP Medicare Advantage |
$136.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.97
|
| Rate for Payer: Priority Health Medicare |
$136.54
|
| Rate for Payer: Priority Health Narrow Network |
$213.97
|
| Rate for Payer: UHC Medicare Advantage |
$140.64
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 24200
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$318.13 |
| Rate for Payer: Aetna Commercial |
$182.96
|
| Rate for Payer: Aetna Medicare |
$136.54
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS MAPPO |
$136.54
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$318.13
|
| Rate for Payer: BCN Medicare Advantage |
$136.54
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$182.96
|
| Rate for Payer: Cofinity Commercial |
$196.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.54
|
| Rate for Payer: Healthscope Commercial |
$163.85
|
| Rate for Payer: Healthscope Whirlpool |
$163.85
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.37
|
| Rate for Payer: PACE SWMI |
$136.54
|
| Rate for Payer: PHP Medicare Advantage |
$136.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.97
|
| Rate for Payer: Priority Health Medicare |
$136.54
|
| Rate for Payer: Priority Health Narrow Network |
$213.97
|
| Rate for Payer: UHC Medicare Advantage |
$140.64
|
|
|
PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA
|
Professional
|
Both
|
$3,227.94
|
|
|
Service Code
|
HCPCS 27091
|
| Min. Negotiated Rate |
$538.87 |
| Max. Negotiated Rate |
$2,429.16 |
| Rate for Payer: Aetna Commercial |
$2,102.90
|
| Rate for Payer: Aetna Medicare |
$1,569.33
|
| Rate for Payer: BCBS Complete |
$1,069.94
|
| Rate for Payer: BCBS MAPPO |
$1,569.33
|
| Rate for Payer: BCBS Trust/PPO |
$538.87
|
| Rate for Payer: BCN Commercial |
$2,324.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,569.33
|
| Rate for Payer: Cash Price |
$2,582.35
|
| Rate for Payer: Cash Price |
$2,582.35
|
| Rate for Payer: Cofinity Commercial |
$2,259.84
|
| Rate for Payer: Cofinity Commercial |
$2,102.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,569.33
|
| Rate for Payer: Healthscope Commercial |
$1,883.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,883.20
|
| Rate for Payer: Meridian Medicaid |
$1,069.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,647.80
|
| Rate for Payer: PACE SWMI |
$1,569.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,569.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,018.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,259.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,429.16
|
| Rate for Payer: Priority Health Medicare |
$1,569.33
|
| Rate for Payer: Priority Health Narrow Network |
$2,429.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,616.41
|
|
|
PR RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 33971
|
| Min. Negotiated Rate |
$446.02 |
| Max. Negotiated Rate |
$1,801.80 |
| Rate for Payer: Aetna Commercial |
$929.92
|
| Rate for Payer: Aetna Medicare |
$693.97
|
| Rate for Payer: BCBS Complete |
$468.32
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.81
|
| Rate for Payer: BCN Commercial |
$1,016.94
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cofinity Commercial |
$999.32
|
| Rate for Payer: Cofinity Commercial |
$929.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$832.76
|
| Rate for Payer: Healthscope Whirlpool |
$832.76
|
| Rate for Payer: Meridian Medicaid |
$468.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.00
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,107.00
|
| Rate for Payer: UHC Medicare Advantage |
$714.79
|
|
|
PR RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 33284
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: BCBS Complete |
$192.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
HCPCS 33262
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$5,175.23 |
| Rate for Payer: Aetna Commercial |
$489.84
|
| Rate for Payer: Aetna Medicare |
$365.55
|
| Rate for Payer: BCBS Complete |
$245.79
|
| Rate for Payer: BCBS MAPPO |
$365.55
|
| Rate for Payer: BCBS Trust/PPO |
$5,175.23
|
| Rate for Payer: BCN Commercial |
$539.50
|
| Rate for Payer: BCN Medicare Advantage |
$365.55
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cofinity Commercial |
$489.84
|
| Rate for Payer: Cofinity Commercial |
$526.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$365.55
|
| Rate for Payer: Healthscope Commercial |
$438.66
|
| Rate for Payer: Healthscope Whirlpool |
$438.66
|
| Rate for Payer: Meridian Medicaid |
$245.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$383.83
|
| Rate for Payer: PACE SWMI |
$365.55
|
| Rate for Payer: PHP Medicare Advantage |
$365.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.27
|
| Rate for Payer: Priority Health Medicare |
$365.55
|
| Rate for Payer: Priority Health Narrow Network |
$587.27
|
| Rate for Payer: UHC Medicare Advantage |
$376.52
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 33263
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$6,021.04 |
| Rate for Payer: Aetna Commercial |
$508.68
|
| Rate for Payer: Aetna Medicare |
$379.61
|
| Rate for Payer: BCBS Complete |
$255.41
|
| Rate for Payer: BCBS MAPPO |
$379.61
|
| Rate for Payer: BCBS Trust/PPO |
$6,021.04
|
| Rate for Payer: BCN Commercial |
$560.02
|
| Rate for Payer: BCN Medicare Advantage |
$379.61
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cofinity Commercial |
$508.68
|
| Rate for Payer: Cofinity Commercial |
$546.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.61
|
| Rate for Payer: Healthscope Commercial |
$455.53
|
| Rate for Payer: Healthscope Whirlpool |
$455.53
|
| Rate for Payer: Meridian Medicaid |
$255.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$398.59
|
| Rate for Payer: PACE SWMI |
$379.61
|
| Rate for Payer: PHP Medicare Advantage |
$379.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$243.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$540.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.63
|
| Rate for Payer: Priority Health Medicare |
$379.61
|
| Rate for Payer: Priority Health Narrow Network |
$609.63
|
| Rate for Payer: UHC Medicare Advantage |
$391.00
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 33264
|
| Min. Negotiated Rate |
$253.68 |
| Max. Negotiated Rate |
$2,214.63 |
| Rate for Payer: Aetna Commercial |
$530.41
|
| Rate for Payer: Aetna Medicare |
$395.83
|
| Rate for Payer: BCBS Complete |
$266.36
|
| Rate for Payer: BCBS MAPPO |
$395.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.63
|
| Rate for Payer: BCN Commercial |
$583.97
|
| Rate for Payer: BCN Medicare Advantage |
$395.83
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$570.00
|
| Rate for Payer: Cofinity Commercial |
$530.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.83
|
| Rate for Payer: Healthscope Commercial |
$475.00
|
| Rate for Payer: Healthscope Whirlpool |
$475.00
|
| Rate for Payer: Meridian Medicaid |
$266.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$415.62
|
| Rate for Payer: PACE SWMI |
$395.83
|
| Rate for Payer: PHP Medicare Advantage |
$395.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$635.69
|
| Rate for Payer: Priority Health Medicare |
$395.83
|
| Rate for Payer: Priority Health Narrow Network |
$635.69
|
| Rate for Payer: UHC Medicare Advantage |
$407.70
|
|
|
PR RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH
|
Professional
|
Both
|
$1,365.00
|
|
|
Service Code
|
HCPCS 54406
|
| Min. Negotiated Rate |
$466.04 |
| Max. Negotiated Rate |
$1,959.10 |
| Rate for Payer: Aetna Commercial |
$957.18
|
| Rate for Payer: Aetna Medicare |
$714.31
|
| Rate for Payer: BCBS Complete |
$489.34
|
| Rate for Payer: BCBS MAPPO |
$714.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.10
|
| Rate for Payer: BCN Commercial |
$1,055.55
|
| Rate for Payer: BCN Medicare Advantage |
$714.31
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cofinity Commercial |
$957.18
|
| Rate for Payer: Cofinity Commercial |
$1,028.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$714.31
|
| Rate for Payer: Healthscope Commercial |
$857.17
|
| Rate for Payer: Healthscope Whirlpool |
$857.17
|
| Rate for Payer: Meridian Medicaid |
$489.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$750.03
|
| Rate for Payer: PACE SWMI |
$714.31
|
| Rate for Payer: PHP Medicare Advantage |
$714.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$466.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,167.17
|
| Rate for Payer: Priority Health Medicare |
$714.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,167.17
|
| Rate for Payer: UHC Medicare Advantage |
$735.74
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY
|
Professional
|
Both
|
$3,619.00
|
|
|
Service Code
|
HCPCS 32484
|
| Min. Negotiated Rate |
$524.07 |
| Max. Negotiated Rate |
$2,533.30 |
| Rate for Payer: Aetna Commercial |
$1,891.46
|
| Rate for Payer: Aetna Medicare |
$1,411.54
|
| Rate for Payer: BCBS Complete |
$946.93
|
| Rate for Payer: BCBS MAPPO |
$1,411.54
|
| Rate for Payer: BCBS Trust/PPO |
$524.07
|
| Rate for Payer: BCN Commercial |
$2,059.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.54
|
| Rate for Payer: Cash Price |
$2,895.20
|
| Rate for Payer: Cash Price |
$2,895.20
|
| Rate for Payer: Cofinity Commercial |
$1,891.46
|
| Rate for Payer: Cofinity Commercial |
$2,032.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.54
|
| Rate for Payer: Healthscope Commercial |
$1,693.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,693.85
|
| Rate for Payer: Meridian Medicaid |
$946.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,482.12
|
| Rate for Payer: PACE SWMI |
$1,411.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,533.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,951.74
|
| Rate for Payer: Priority Health Medicare |
$1,411.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,951.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,453.89
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC
|
Professional
|
Both
|
$5,257.00
|
|
|
Service Code
|
HCPCS 32482
|
| Min. Negotiated Rate |
$550.49 |
| Max. Negotiated Rate |
$3,679.90 |
| Rate for Payer: Aetna Commercial |
$2,084.42
|
| Rate for Payer: Aetna Medicare |
$1,555.54
|
| Rate for Payer: BCBS Complete |
$1,045.57
|
| Rate for Payer: BCBS MAPPO |
$1,555.54
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$2,273.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,555.54
|
| Rate for Payer: Cash Price |
$4,205.60
|
| Rate for Payer: Cash Price |
$4,205.60
|
| Rate for Payer: Cofinity Commercial |
$2,239.98
|
| Rate for Payer: Cofinity Commercial |
$2,084.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,555.54
|
| Rate for Payer: Healthscope Commercial |
$1,866.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,866.65
|
| Rate for Payer: Meridian Medicaid |
$1,045.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,633.32
|
| Rate for Payer: PACE SWMI |
$1,555.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,555.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$995.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,679.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,154.55
|
| Rate for Payer: Priority Health Medicare |
$1,555.54
|
| Rate for Payer: Priority Health Narrow Network |
$2,154.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,602.21
|
|
