|
PR REM INTERROG PM/LDLS PM <90 D PHYS/QHP
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 93294
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna Commercial |
$37.12
|
| Rate for Payer: Aetna Medicare |
$27.70
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$27.70
|
| Rate for Payer: BCN Medicare Advantage |
$27.70
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Cofinity Commercial |
$37.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.70
|
| Rate for Payer: Healthscope Commercial |
$33.24
|
| Rate for Payer: Healthscope Whirlpool |
$33.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.09
|
| Rate for Payer: Nomi Health Commercial |
$33.24
|
| Rate for Payer: PACE SWMI |
$27.70
|
| Rate for Payer: PHP Medicare Advantage |
$27.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health Medicare |
$27.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.70
|
| Rate for Payer: UHC Medicare Advantage |
$27.70
|
| Rate for Payer: UHCCP DNSP |
$27.70
|
|
|
PR REM INTERROG PM/LDLS PM/IDS <90 D TECH REVIEW
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 93296
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Commercial |
$23.81
|
| Rate for Payer: Aetna Medicare |
$17.77
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$17.77
|
| Rate for Payer: BCN Medicare Advantage |
$17.77
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Cofinity Commercial |
$23.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.77
|
| Rate for Payer: Healthscope Commercial |
$21.32
|
| Rate for Payer: Healthscope Whirlpool |
$21.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.66
|
| Rate for Payer: Nomi Health Commercial |
$21.32
|
| Rate for Payer: PACE SWMI |
$17.77
|
| Rate for Payer: PHP Medicare Advantage |
$17.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$17.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.77
|
| Rate for Payer: UHCCP DNSP |
$17.77
|
|
|
PR REM INTERROG SCRMS <30 D PHYS/QHP
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 93298
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$130.80 |
| Rate for Payer: Aetna Commercial |
$121.71
|
| Rate for Payer: Aetna Medicare |
$90.83
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS MAPPO |
$90.83
|
| Rate for Payer: BCN Medicare Advantage |
$90.83
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$130.80
|
| Rate for Payer: Cofinity Commercial |
$121.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.83
|
| Rate for Payer: Healthscope Commercial |
$109.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$109.00
|
| Rate for Payer: PACE SWMI |
$90.83
|
| Rate for Payer: PHP Medicare Advantage |
$90.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health Medicare |
$90.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.83
|
| Rate for Payer: UHC Medicare Advantage |
$90.83
|
| Rate for Payer: UHCCP DNSP |
$90.83
|
|
|
PR REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 99454
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$72.15 |
| Rate for Payer: Aetna Commercial |
$52.64
|
| Rate for Payer: Aetna Medicare |
$39.28
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$39.28
|
| Rate for Payer: BCN Medicare Advantage |
$39.28
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$56.56
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.28
|
| Rate for Payer: Healthscope Commercial |
$43.21
|
| Rate for Payer: Healthscope Whirlpool |
$43.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.24
|
| Rate for Payer: Nomi Health Commercial |
$47.14
|
| Rate for Payer: PACE SWMI |
$39.28
|
| Rate for Payer: PHP Medicare Advantage |
$39.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$39.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.28
|
| Rate for Payer: UHC Medicare Advantage |
$39.28
|
| Rate for Payer: UHCCP DNSP |
$39.28
|
|
|
PR REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 99453
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$26.12 |
| Rate for Payer: Aetna Commercial |
$24.31
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$26.12
|
| Rate for Payer: Cofinity Commercial |
$24.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$19.95
|
| Rate for Payer: Healthscope Whirlpool |
$19.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Nomi Health Commercial |
$21.77
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP DNSP |
$18.14
|
|
|
PR REMOTE MNTR WIRELESS P-ART PRS SNR UP TO 30 D
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 93264
|
| Min. Negotiated Rate |
$33.55 |
| Max. Negotiated Rate |
$65.65 |
| Rate for Payer: Aetna Commercial |
$44.96
|
| Rate for Payer: Aetna Medicare |
$33.55
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$33.55
|
| Rate for Payer: BCN Medicare Advantage |
$33.55
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Cofinity Commercial |
$44.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.55
|
| Rate for Payer: Healthscope Commercial |
$40.26
|
| Rate for Payer: Healthscope Whirlpool |
$40.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.23
|
| Rate for Payer: Nomi Health Commercial |
$40.26
|
| Rate for Payer: PACE SWMI |
$33.55
|
| Rate for Payer: PHP Medicare Advantage |
$33.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health Medicare |
$33.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.55
|
| Rate for Payer: UHC Medicare Advantage |
$33.55
|
| Rate for Payer: UHCCP DNSP |
$33.55
|
|
|
PR REMOTE PHYSIOLOGIC MONITORING 1ST 20 MIN MONTH
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99457
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$28.32
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS MAPPO |
$28.32
|
| Rate for Payer: BCN Medicare Advantage |
$28.32
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$37.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.32
|
| Rate for Payer: Healthscope Commercial |
$31.15
|
| Rate for Payer: Healthscope Whirlpool |
$31.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.74
|
| Rate for Payer: Nomi Health Commercial |
$33.98
|
| Rate for Payer: PACE SWMI |
$28.32
|
| Rate for Payer: PHP Medicare Advantage |
$28.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Medicare |
$28.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.32
|
| Rate for Payer: UHC Medicare Advantage |
$28.32
|
| Rate for Payer: UHCCP DNSP |
$28.32
|
|
|
PR REMOTE PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 99458
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$28.32
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$28.32
|
| Rate for Payer: BCN Medicare Advantage |
$28.32
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$37.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.32
|
| Rate for Payer: Healthscope Commercial |
$31.15
|
| Rate for Payer: Healthscope Whirlpool |
$31.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.74
|
| Rate for Payer: Nomi Health Commercial |
$33.98
|
| Rate for Payer: PACE SWMI |
$28.32
|
| Rate for Payer: PHP Medicare Advantage |
$28.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$28.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.32
|
| Rate for Payer: UHC Medicare Advantage |
$28.32
|
| Rate for Payer: UHCCP DNSP |
$28.32
|
|
|
PR REMOT IMAGE SUBMIT BY PT
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS G2010
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$8.56
|
| Rate for Payer: BCN Medicare Advantage |
$8.56
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.56
|
| Rate for Payer: Healthscope Commercial |
$10.27
|
| Rate for Payer: Healthscope Whirlpool |
$10.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.99
|
| Rate for Payer: Nomi Health Commercial |
$10.27
|
| Rate for Payer: PACE SWMI |
$8.56
|
| Rate for Payer: PHP Medicare Advantage |
$8.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$8.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.56
|
| Rate for Payer: UHC Medicare Advantage |
$8.56
|
| Rate for Payer: UHCCP DNSP |
$8.56
|
|
|
PR REMOVAL ANAL SETON OTHER MARKER
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 46030
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Aetna Commercial |
$111.89
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$83.50
|
| Rate for Payer: BCN Medicare Advantage |
$83.50
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$120.24
|
| Rate for Payer: Cofinity Commercial |
$111.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.50
|
| Rate for Payer: Healthscope Commercial |
$100.20
|
| Rate for Payer: Healthscope Whirlpool |
$100.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.67
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: PACE SWMI |
$83.50
|
| Rate for Payer: PHP Medicare Advantage |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$83.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.50
|
| Rate for Payer: UHC Medicare Advantage |
$83.50
|
| Rate for Payer: UHCCP DNSP |
$83.50
|
|
|
PR REMOVAL ANKLE IMPLANT
|
Professional
|
Both
|
$1,822.00
|
|
|
Service Code
|
HCPCS 27704
|
| Min. Negotiated Rate |
$543.42 |
| Max. Negotiated Rate |
$1,184.30 |
| Rate for Payer: Aetna Commercial |
$728.18
|
| Rate for Payer: Aetna Medicare |
$543.42
|
| Rate for Payer: BCBS Complete |
$728.80
|
| Rate for Payer: BCBS MAPPO |
$543.42
|
| Rate for Payer: BCN Medicare Advantage |
$543.42
|
| Rate for Payer: Cash Price |
$1,457.60
|
| Rate for Payer: Cash Price |
$1,457.60
|
| Rate for Payer: Cofinity Commercial |
$782.52
|
| Rate for Payer: Cofinity Commercial |
$728.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.42
|
| Rate for Payer: Healthscope Commercial |
$652.10
|
| Rate for Payer: Healthscope Whirlpool |
$652.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$570.59
|
| Rate for Payer: Nomi Health Commercial |
$652.10
|
| Rate for Payer: PACE SWMI |
$543.42
|
| Rate for Payer: PHP Medicare Advantage |
$543.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,184.30
|
| Rate for Payer: Priority Health Medicare |
$543.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$543.42
|
| Rate for Payer: UHC Medicare Advantage |
$543.42
|
| Rate for Payer: UHCCP DNSP |
$543.42
|
|
|
PR REMOVAL ANTERIOR INSTRUMENTATION
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
HCPCS 22855
|
| Min. Negotiated Rate |
$1,083.15 |
| Max. Negotiated Rate |
$2,627.95 |
| Rate for Payer: Aetna Commercial |
$1,451.42
|
| Rate for Payer: Aetna Medicare |
$1,083.15
|
| Rate for Payer: BCBS Complete |
$1,617.20
|
| Rate for Payer: BCBS MAPPO |
$1,083.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,083.15
|
| Rate for Payer: Cash Price |
$3,234.40
|
| Rate for Payer: Cash Price |
$3,234.40
|
| Rate for Payer: Cofinity Commercial |
$1,559.74
|
| Rate for Payer: Cofinity Commercial |
$1,451.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,083.15
|
| Rate for Payer: Healthscope Commercial |
$1,299.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,299.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,137.31
|
| Rate for Payer: Nomi Health Commercial |
$1,299.78
|
| Rate for Payer: PACE SWMI |
$1,083.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,083.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,627.95
|
| Rate for Payer: Priority Health Medicare |
$1,083.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,083.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,083.15
|
| Rate for Payer: UHCCP DNSP |
$1,083.15
|
|
|
PR REMOVAL/BIVALVING FULL ARM/FULL LEG CAST
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 29705
|
| Min. Negotiated Rate |
$43.37 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Aetna Commercial |
$58.12
|
| Rate for Payer: Aetna Medicare |
$43.37
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$43.37
|
| Rate for Payer: BCN Medicare Advantage |
$43.37
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$62.45
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.37
|
| Rate for Payer: Healthscope Commercial |
$52.04
|
| Rate for Payer: Healthscope Whirlpool |
$52.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: PACE SWMI |
$43.37
|
| Rate for Payer: PHP Medicare Advantage |
$43.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$43.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.37
|
| Rate for Payer: UHC Medicare Advantage |
$43.37
|
| Rate for Payer: UHCCP DNSP |
$43.37
|
|
|
PR REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 59871
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$240.50 |
| Rate for Payer: Aetna Commercial |
$173.82
|
| Rate for Payer: Aetna Medicare |
$129.72
|
| Rate for Payer: BCBS Complete |
$148.00
|
| Rate for Payer: BCBS MAPPO |
$129.72
|
| Rate for Payer: BCN Medicare Advantage |
$129.72
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$186.80
|
| Rate for Payer: Cofinity Commercial |
$173.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$155.66
|
| Rate for Payer: Healthscope Whirlpool |
$155.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.21
|
| Rate for Payer: Nomi Health Commercial |
$155.66
|
| Rate for Payer: PACE SWMI |
$129.72
|
| Rate for Payer: PHP Medicare Advantage |
$129.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health Medicare |
$129.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.72
|
| Rate for Payer: UHC Medicare Advantage |
$129.72
|
| Rate for Payer: UHCCP DNSP |
$129.72
|
|
|
PR REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
HCPCS 21029
|
| Min. Negotiated Rate |
$598.30 |
| Max. Negotiated Rate |
$1,006.85 |
| Rate for Payer: Aetna Commercial |
$801.72
|
| Rate for Payer: Aetna Medicare |
$598.30
|
| Rate for Payer: BCBS Complete |
$619.60
|
| Rate for Payer: BCBS MAPPO |
$598.30
|
| Rate for Payer: BCN Medicare Advantage |
$598.30
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cofinity Commercial |
$861.55
|
| Rate for Payer: Cofinity Commercial |
$801.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.30
|
| Rate for Payer: Healthscope Commercial |
$717.96
|
| Rate for Payer: Healthscope Whirlpool |
$717.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$628.22
|
| Rate for Payer: Nomi Health Commercial |
$717.96
|
| Rate for Payer: PACE SWMI |
$598.30
|
| Rate for Payer: PHP Medicare Advantage |
$598.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.85
|
| Rate for Payer: Priority Health Medicare |
$598.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$598.30
|
| Rate for Payer: UHC Medicare Advantage |
$598.30
|
| Rate for Payer: UHCCP DNSP |
$598.30
|
|
|
PR REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 64570
|
| Min. Negotiated Rate |
$616.40 |
| Max. Negotiated Rate |
$1,049.57 |
| Rate for Payer: Aetna Commercial |
$976.69
|
| Rate for Payer: Aetna Medicare |
$728.87
|
| Rate for Payer: BCBS Complete |
$616.40
|
| Rate for Payer: BCBS MAPPO |
$728.87
|
| Rate for Payer: BCN Medicare Advantage |
$728.87
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cofinity Commercial |
$976.69
|
| Rate for Payer: Cofinity Commercial |
$1,049.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.87
|
| Rate for Payer: Healthscope Commercial |
$874.64
|
| Rate for Payer: Healthscope Whirlpool |
$874.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$765.31
|
| Rate for Payer: Nomi Health Commercial |
$874.64
|
| Rate for Payer: PACE SWMI |
$728.87
|
| Rate for Payer: PHP Medicare Advantage |
$728.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health Medicare |
$728.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.87
|
| Rate for Payer: UHC Medicare Advantage |
$728.87
|
| Rate for Payer: UHCCP DNSP |
$728.87
|
|
|
PR REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 67938
|
| Min. Negotiated Rate |
$105.64 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$141.56
|
| Rate for Payer: Aetna Medicare |
$105.64
|
| Rate for Payer: BCBS Complete |
$192.00
|
| Rate for Payer: BCBS MAPPO |
$105.64
|
| Rate for Payer: BCN Medicare Advantage |
$105.64
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$152.12
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.64
|
| Rate for Payer: Healthscope Commercial |
$126.77
|
| Rate for Payer: Healthscope Whirlpool |
$126.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.92
|
| Rate for Payer: Nomi Health Commercial |
$126.77
|
| Rate for Payer: PACE SWMI |
$105.64
|
| Rate for Payer: PHP Medicare Advantage |
$105.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.00
|
| Rate for Payer: Priority Health Medicare |
$105.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.64
|
| Rate for Payer: UHC Medicare Advantage |
$105.64
|
| Rate for Payer: UHCCP DNSP |
$105.64
|
|
|
PR REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 20694
|
| Min. Negotiated Rate |
$329.90 |
| Max. Negotiated Rate |
$620.10 |
| Rate for Payer: Aetna Commercial |
$442.07
|
| Rate for Payer: Aetna Medicare |
$329.90
|
| Rate for Payer: BCBS Complete |
$381.60
|
| Rate for Payer: BCBS MAPPO |
$329.90
|
| Rate for Payer: BCN Medicare Advantage |
$329.90
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cofinity Commercial |
$475.06
|
| Rate for Payer: Cofinity Commercial |
$442.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.90
|
| Rate for Payer: Healthscope Commercial |
$395.88
|
| Rate for Payer: Healthscope Whirlpool |
$395.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$346.39
|
| Rate for Payer: Nomi Health Commercial |
$395.88
|
| Rate for Payer: PACE SWMI |
$329.90
|
| Rate for Payer: PHP Medicare Advantage |
$329.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.10
|
| Rate for Payer: Priority Health Medicare |
$329.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.90
|
| Rate for Payer: UHC Medicare Advantage |
$329.90
|
| Rate for Payer: UHCCP DNSP |
$329.90
|
|
|
PR REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 65205
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Aetna Medicare |
$27.01
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$27.01
|
| Rate for Payer: BCN Medicare Advantage |
$27.01
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.01
|
| Rate for Payer: Healthscope Commercial |
$32.41
|
| Rate for Payer: Healthscope Whirlpool |
$32.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.36
|
| Rate for Payer: Nomi Health Commercial |
$32.41
|
| Rate for Payer: PACE SWMI |
$27.01
|
| Rate for Payer: PHP Medicare Advantage |
$27.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health Medicare |
$27.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.01
|
| Rate for Payer: UHC Medicare Advantage |
$27.01
|
| Rate for Payer: UHCCP DNSP |
$27.01
|
|
|
PR REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 54115
|
| Min. Negotiated Rate |
$340.00 |
| Max. Negotiated Rate |
$588.02 |
| Rate for Payer: Aetna Commercial |
$547.19
|
| Rate for Payer: Aetna Medicare |
$408.35
|
| Rate for Payer: BCBS Complete |
$340.00
|
| Rate for Payer: BCBS MAPPO |
$408.35
|
| Rate for Payer: BCN Medicare Advantage |
$408.35
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$588.02
|
| Rate for Payer: Cofinity Commercial |
$547.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.35
|
| Rate for Payer: Healthscope Commercial |
$490.02
|
| Rate for Payer: Healthscope Whirlpool |
$490.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.77
|
| Rate for Payer: Nomi Health Commercial |
$490.02
|
| Rate for Payer: PACE SWMI |
$408.35
|
| Rate for Payer: PHP Medicare Advantage |
$408.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.50
|
| Rate for Payer: Priority Health Medicare |
$408.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$408.35
|
| Rate for Payer: UHC Medicare Advantage |
$408.35
|
| Rate for Payer: UHCCP DNSP |
$408.35
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
HCPCS 27372
|
| Min. Negotiated Rate |
$387.70 |
| Max. Negotiated Rate |
$724.10 |
| Rate for Payer: Aetna Commercial |
$519.52
|
| Rate for Payer: Aetna Medicare |
$387.70
|
| Rate for Payer: BCBS Complete |
$445.60
|
| Rate for Payer: BCBS MAPPO |
$387.70
|
| Rate for Payer: BCN Medicare Advantage |
$387.70
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$558.29
|
| Rate for Payer: Cofinity Commercial |
$519.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.70
|
| Rate for Payer: Healthscope Commercial |
$465.24
|
| Rate for Payer: Healthscope Whirlpool |
$465.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.08
|
| Rate for Payer: Nomi Health Commercial |
$465.24
|
| Rate for Payer: PACE SWMI |
$387.70
|
| Rate for Payer: PHP Medicare Advantage |
$387.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health Medicare |
$387.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.70
|
| Rate for Payer: UHC Medicare Advantage |
$387.70
|
| Rate for Payer: UHCCP DNSP |
$387.70
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
27372
|
| Min. Negotiated Rate |
$387.70 |
| Max. Negotiated Rate |
$724.10 |
| Rate for Payer: Aetna Commercial |
$519.52
|
| Rate for Payer: Aetna Medicare |
$387.70
|
| Rate for Payer: BCBS Complete |
$445.60
|
| Rate for Payer: BCBS MAPPO |
$387.70
|
| Rate for Payer: BCN Medicare Advantage |
$387.70
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$558.29
|
| Rate for Payer: Cofinity Commercial |
$519.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.70
|
| Rate for Payer: Healthscope Commercial |
$465.24
|
| Rate for Payer: Healthscope Whirlpool |
$465.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.08
|
| Rate for Payer: Nomi Health Commercial |
$465.24
|
| Rate for Payer: PACE SWMI |
$387.70
|
| Rate for Payer: PHP Medicare Advantage |
$387.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health Medicare |
$387.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.70
|
| Rate for Payer: UHC Medicare Advantage |
$387.70
|
| Rate for Payer: UHCCP DNSP |
$387.70
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
27372
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$724.10 |
| Max. Negotiated Rate |
$4,326.52 |
| Rate for Payer: Aetna Commercial |
$1,002.60
|
| Rate for Payer: Aetna Medicare |
$2,791.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: ASR ASR |
$1,080.58
|
| Rate for Payer: ASR Commercial |
$1,080.58
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$912.25
|
| Rate for Payer: BCN Commercial |
$863.68
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$1,047.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$1,114.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,080.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,791.30
|
| Rate for Payer: Mclaren Commercial |
$1,002.60
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$946.90
|
| Rate for Payer: Nomi Health Commercial |
$913.48
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,070.43
|
| Rate for Payer: PHP Medicaid |
$1,496.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$976.09
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$780.91
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$980.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$4,326.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP DNSP |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
27372
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$724.10 |
| Max. Negotiated Rate |
$1,114.00 |
| Rate for Payer: Aetna Commercial |
$1,002.60
|
| Rate for Payer: ASR ASR |
$1,080.58
|
| Rate for Payer: ASR Commercial |
$1,080.58
|
| Rate for Payer: BCBS Trust/PPO |
$907.80
|
| Rate for Payer: BCN Commercial |
$863.68
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$1,047.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.20
|
| Rate for Payer: Healthscope Commercial |
$1,114.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,080.58
|
| Rate for Payer: Mclaren Commercial |
$1,002.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$946.90
|
| Rate for Payer: Nomi Health Commercial |
$913.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$980.32
|
|
|
PR REMOVAL FOREIGN BODY FOOT COMPLICATED
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 28193
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$612.30 |
| Rate for Payer: Aetna Commercial |
$466.86
|
| Rate for Payer: Aetna Medicare |
$348.40
|
| Rate for Payer: BCBS Complete |
$376.80
|
| Rate for Payer: BCBS MAPPO |
$348.40
|
| Rate for Payer: BCN Medicare Advantage |
$348.40
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cofinity Commercial |
$501.70
|
| Rate for Payer: Cofinity Commercial |
$466.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.40
|
| Rate for Payer: Healthscope Commercial |
$418.08
|
| Rate for Payer: Healthscope Whirlpool |
$418.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.82
|
| Rate for Payer: Nomi Health Commercial |
$418.08
|
| Rate for Payer: PACE SWMI |
$348.40
|
| Rate for Payer: PHP Medicare Advantage |
$348.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.30
|
| Rate for Payer: Priority Health Medicare |
$348.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.40
|
| Rate for Payer: UHC Medicare Advantage |
$348.40
|
| Rate for Payer: UHCCP DNSP |
$348.40
|
|
