|
PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 90673
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$141.35 |
| Rate for Payer: Aetna Commercial |
$131.53
|
| Rate for Payer: Aetna Medicare |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$98.16
|
| Rate for Payer: BCBS Trust/PPO |
$86.23
|
| Rate for Payer: BCN Commercial |
$72.06
|
| Rate for Payer: BCN Medicare Advantage |
$98.16
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Cofinity Commercial |
$141.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.16
|
| Rate for Payer: Healthscope Commercial |
$117.79
|
| Rate for Payer: Healthscope Whirlpool |
$117.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.98
|
| Rate for Payer: Nomi Health Commercial |
$117.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.50
|
| Rate for Payer: PACE SWMI |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$98.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.45
|
| Rate for Payer: Priority Health Medicare |
$98.16
|
| Rate for Payer: Priority Health Narrow Network |
$42.45
|
| Rate for Payer: Railroad Medicare Medicare |
$98.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$98.16
|
| Rate for Payer: UHC Exchange |
$98.16
|
| Rate for Payer: UHCCP DNSP |
$98.16
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 90682
|
| Min. Negotiated Rate |
$64.51 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: BCBS Trust/PPO |
$64.51
|
| Rate for Payer: BCN Commercial |
$73.62
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.40
|
| Rate for Payer: UHC Exchange |
$73.40
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$2,888.00
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$1,246.88 |
| Max. Negotiated Rate |
$2,225.83 |
| Rate for Payer: Aetna Commercial |
$1,670.82
|
| Rate for Payer: Aetna Commercial |
$1,670.82
|
| Rate for Payer: Aetna Medicare |
$1,246.88
|
| Rate for Payer: Aetna Medicare |
$1,246.88
|
| Rate for Payer: BCBS MAPPO |
$1,246.88
|
| Rate for Payer: BCBS MAPPO |
$1,246.88
|
| Rate for Payer: BCN Commercial |
$1,953.58
|
| Rate for Payer: BCN Commercial |
$1,953.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,246.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,246.88
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cash Price |
$2,405.60
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cash Price |
$2,405.60
|
| Rate for Payer: Cofinity Commercial |
$1,670.82
|
| Rate for Payer: Cofinity Commercial |
$1,795.51
|
| Rate for Payer: Cofinity Commercial |
$1,670.82
|
| Rate for Payer: Cofinity Commercial |
$1,795.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,246.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,246.88
|
| Rate for Payer: Healthscope Commercial |
$1,496.26
|
| Rate for Payer: Healthscope Commercial |
$1,496.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,496.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,496.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,309.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,309.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,371.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,371.57
|
| Rate for Payer: Nomi Health Commercial |
$1,496.26
|
| Rate for Payer: Nomi Health Commercial |
$1,496.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,255.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,166.00
|
| Rate for Payer: PACE SWMI |
$1,246.88
|
| Rate for Payer: PACE SWMI |
$1,246.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,246.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,246.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,856.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,856.77
|
| Rate for Payer: Priority Health Medicare |
$1,246.88
|
| Rate for Payer: Priority Health Medicare |
$1,246.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,856.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,856.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,246.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,246.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,225.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,225.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,246.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,246.88
|
| Rate for Payer: UHC Exchange |
$2,225.83
|
| Rate for Payer: UHC Exchange |
$2,225.83
|
| Rate for Payer: UHCCP DNSP |
$1,246.88
|
| Rate for Payer: UHCCP DNSP |
$1,246.88
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,266.00
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$949.50 |
| Max. Negotiated Rate |
$1,989.11 |
| Rate for Payer: Aetna Commercial |
$1,515.65
|
| Rate for Payer: Aetna Medicare |
$1,131.08
|
| Rate for Payer: BCBS MAPPO |
$1,131.08
|
| Rate for Payer: BCN Commercial |
$1,770.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,131.08
|
| Rate for Payer: Cash Price |
$1,012.80
|
| Rate for Payer: Cash Price |
$1,012.80
|
| Rate for Payer: Cofinity Commercial |
$1,515.65
|
| Rate for Payer: Cofinity Commercial |
$1,628.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,131.08
|
| Rate for Payer: Healthscope Commercial |
$1,357.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,357.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,187.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,244.19
|
| Rate for Payer: Nomi Health Commercial |
$1,357.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$949.50
|
| Rate for Payer: PACE SWMI |
$1,131.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,131.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,683.07
|
| Rate for Payer: Priority Health Medicare |
$1,131.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,683.07
|
| Rate for Payer: Railroad Medicare Medicare |
$1,131.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,989.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,131.08
|
| Rate for Payer: UHC Exchange |
$1,989.11
|
| Rate for Payer: UHCCP DNSP |
$1,131.08
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$692.00
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$519.00 |
| Max. Negotiated Rate |
$1,810.35 |
| Rate for Payer: Aetna Commercial |
$1,398.08
|
| Rate for Payer: Aetna Medicare |
$1,043.34
|
| Rate for Payer: BCBS MAPPO |
$1,043.34
|
| Rate for Payer: BCN Commercial |
$1,630.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,043.34
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cofinity Commercial |
$1,398.08
|
| Rate for Payer: Cofinity Commercial |
$1,502.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,043.34
|
| Rate for Payer: Healthscope Commercial |
$1,252.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,252.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,095.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,147.67
|
| Rate for Payer: Nomi Health Commercial |
$1,252.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.00
|
| Rate for Payer: PACE SWMI |
$1,043.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,043.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,550.08
|
| Rate for Payer: Priority Health Medicare |
$1,043.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,550.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,043.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,810.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,043.34
|
| Rate for Payer: UHC Exchange |
$1,810.35
|
| Rate for Payer: UHCCP DNSP |
$1,043.34
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$488.84 |
| Max. Negotiated Rate |
$1,532.37 |
| Rate for Payer: Aetna Commercial |
$1,020.73
|
| Rate for Payer: Aetna Medicare |
$761.74
|
| Rate for Payer: BCBS Complete |
$513.28
|
| Rate for Payer: BCBS MAPPO |
$761.74
|
| Rate for Payer: BCN Commercial |
$1,268.85
|
| Rate for Payer: BCN Medicare Advantage |
$761.74
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,096.91
|
| Rate for Payer: Cofinity Commercial |
$1,020.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$761.74
|
| Rate for Payer: Healthscope Commercial |
$914.09
|
| Rate for Payer: Healthscope Whirlpool |
$914.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$799.83
|
| Rate for Payer: Meridian Medicaid |
$513.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$837.91
|
| Rate for Payer: Nomi Health Commercial |
$914.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,387.50
|
| Rate for Payer: PACE SWMI |
$761.74
|
| Rate for Payer: PHP Medicare Advantage |
$761.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,364.50
|
| Rate for Payer: Priority Health Medicare |
$761.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,364.50
|
| Rate for Payer: Railroad Medicare Medicare |
$761.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,532.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$761.74
|
| Rate for Payer: UHC Exchange |
$1,532.37
|
| Rate for Payer: UHC Medicaid |
$488.84
|
| Rate for Payer: UHCCP DNSP |
$761.74
|
| Rate for Payer: UHCCP Medicaid |
$488.84
|
|
|
PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 33974
|
| Min. Negotiated Rate |
$555.93 |
| Max. Negotiated Rate |
$1,915.50 |
| Rate for Payer: Aetna Commercial |
$1,157.41
|
| Rate for Payer: Aetna Medicare |
$863.74
|
| Rate for Payer: BCBS Complete |
$583.73
|
| Rate for Payer: BCBS MAPPO |
$863.74
|
| Rate for Payer: BCN Commercial |
$1,318.65
|
| Rate for Payer: BCN Medicare Advantage |
$863.74
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cofinity Commercial |
$1,243.79
|
| Rate for Payer: Cofinity Commercial |
$1,157.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$863.74
|
| Rate for Payer: Healthscope Commercial |
$1,036.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,036.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$906.93
|
| Rate for Payer: Meridian Medicaid |
$583.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$950.11
|
| Rate for Payer: Nomi Health Commercial |
$1,036.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,915.50
|
| Rate for Payer: PACE SWMI |
$863.74
|
| Rate for Payer: PHP Medicare Advantage |
$863.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$555.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,418.05
|
| Rate for Payer: Priority Health Medicare |
$863.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,418.05
|
| Rate for Payer: Railroad Medicare Medicare |
$863.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,574.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$863.74
|
| Rate for Payer: UHC Exchange |
$1,574.73
|
| Rate for Payer: UHC Medicaid |
$555.93
|
| Rate for Payer: UHCCP DNSP |
$863.74
|
| Rate for Payer: UHCCP Medicaid |
$555.93
|
|
|
PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$3,472.00
|
|
|
Service Code
|
HCPCS 62142
|
| Min. Negotiated Rate |
$574.67 |
| Max. Negotiated Rate |
$2,604.00 |
| Rate for Payer: Aetna Commercial |
$1,192.25
|
| Rate for Payer: Aetna Medicare |
$889.74
|
| Rate for Payer: BCBS Complete |
$603.40
|
| Rate for Payer: BCBS MAPPO |
$889.74
|
| Rate for Payer: BCN Commercial |
$1,895.37
|
| Rate for Payer: BCN Medicare Advantage |
$889.74
|
| Rate for Payer: Cash Price |
$2,777.60
|
| Rate for Payer: Cash Price |
$2,777.60
|
| Rate for Payer: Cofinity Commercial |
$1,281.23
|
| Rate for Payer: Cofinity Commercial |
$1,192.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.74
|
| Rate for Payer: Healthscope Commercial |
$1,067.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,067.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.23
|
| Rate for Payer: Meridian Medicaid |
$603.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$978.71
|
| Rate for Payer: Nomi Health Commercial |
$1,067.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,604.00
|
| Rate for Payer: PACE SWMI |
$889.74
|
| Rate for Payer: PHP Medicare Advantage |
$889.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,593.49
|
| Rate for Payer: Priority Health Medicare |
$889.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,593.49
|
| Rate for Payer: Railroad Medicare Medicare |
$889.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,551.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$889.74
|
| Rate for Payer: UHC Exchange |
$1,551.68
|
| Rate for Payer: UHC Medicaid |
$574.67
|
| Rate for Payer: UHCCP DNSP |
$889.74
|
| Rate for Payer: UHCCP Medicaid |
$574.67
|
|
|
PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT
|
Professional
|
Both
|
$2,273.00
|
|
|
Service Code
|
HCPCS 62256
|
| Min. Negotiated Rate |
$408.11 |
| Max. Negotiated Rate |
$1,704.75 |
| Rate for Payer: Aetna Commercial |
$839.79
|
| Rate for Payer: Aetna Medicare |
$626.71
|
| Rate for Payer: BCBS Complete |
$428.52
|
| Rate for Payer: BCBS MAPPO |
$626.71
|
| Rate for Payer: BCN Commercial |
$1,298.20
|
| Rate for Payer: BCN Medicare Advantage |
$626.71
|
| Rate for Payer: Cash Price |
$1,818.40
|
| Rate for Payer: Cash Price |
$1,818.40
|
| Rate for Payer: Cofinity Commercial |
$902.46
|
| Rate for Payer: Cofinity Commercial |
$839.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.71
|
| Rate for Payer: Healthscope Commercial |
$752.05
|
| Rate for Payer: Healthscope Whirlpool |
$752.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$658.05
|
| Rate for Payer: Meridian Medicaid |
$428.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$689.38
|
| Rate for Payer: Nomi Health Commercial |
$752.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,704.75
|
| Rate for Payer: PACE SWMI |
$626.71
|
| Rate for Payer: PHP Medicare Advantage |
$626.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,091.44
|
| Rate for Payer: Priority Health Medicare |
$626.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,091.44
|
| Rate for Payer: Railroad Medicare Medicare |
$626.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$626.71
|
| Rate for Payer: UHC Exchange |
$1,051.69
|
| Rate for Payer: UHC Medicaid |
$408.11
|
| Rate for Payer: UHCCP DNSP |
$626.71
|
| Rate for Payer: UHCCP Medicaid |
$408.11
|
|
|
PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
|
Professional
|
Both
|
$5,281.00
|
|
|
Service Code
|
HCPCS 62258
|
| Min. Negotiated Rate |
$704.82 |
| Max. Negotiated Rate |
$3,960.75 |
| Rate for Payer: Aetna Commercial |
$1,470.23
|
| Rate for Payer: Aetna Medicare |
$1,097.19
|
| Rate for Payer: BCBS Complete |
$740.06
|
| Rate for Payer: BCBS MAPPO |
$1,097.19
|
| Rate for Payer: BCN Commercial |
$2,341.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,097.19
|
| Rate for Payer: Cash Price |
$4,224.80
|
| Rate for Payer: Cash Price |
$4,224.80
|
| Rate for Payer: Cofinity Commercial |
$1,579.95
|
| Rate for Payer: Cofinity Commercial |
$1,470.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,097.19
|
| Rate for Payer: Healthscope Commercial |
$1,316.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,316.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,152.05
|
| Rate for Payer: Meridian Medicaid |
$740.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,206.91
|
| Rate for Payer: Nomi Health Commercial |
$1,316.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,960.75
|
| Rate for Payer: PACE SWMI |
$1,097.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,097.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$704.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,968.85
|
| Rate for Payer: Priority Health Medicare |
$1,097.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,968.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,097.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,952.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,097.19
|
| Rate for Payer: UHC Exchange |
$1,952.87
|
| Rate for Payer: UHC Medicaid |
$704.82
|
| Rate for Payer: UHCCP DNSP |
$1,097.19
|
| Rate for Payer: UHCCP Medicaid |
$704.82
|
|
|
PR RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 65435
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Aetna Commercial |
$78.15
|
| Rate for Payer: Aetna Medicare |
$58.32
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS MAPPO |
$58.32
|
| Rate for Payer: BCN Commercial |
$103.08
|
| Rate for Payer: BCN Medicare Advantage |
$58.32
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Cofinity Commercial |
$78.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.32
|
| Rate for Payer: Healthscope Commercial |
$69.98
|
| Rate for Payer: Healthscope Whirlpool |
$69.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.24
|
| Rate for Payer: Meridian Medicaid |
$40.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.15
|
| Rate for Payer: Nomi Health Commercial |
$69.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.00
|
| Rate for Payer: PACE SWMI |
$58.32
|
| Rate for Payer: PHP Medicare Advantage |
$58.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$120.75
|
| Rate for Payer: Priority Health Medicare |
$58.32
|
| Rate for Payer: Priority Health Narrow Network |
$120.75
|
| Rate for Payer: Railroad Medicare Medicare |
$58.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.32
|
| Rate for Payer: UHC Exchange |
$119.10
|
| Rate for Payer: UHC Medicaid |
$38.55
|
| Rate for Payer: UHCCP DNSP |
$58.32
|
| Rate for Payer: UHCCP Medicaid |
$38.55
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$185.78 |
| Rate for Payer: Aetna Commercial |
$89.75
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCN Commercial |
$185.78
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.57
|
| Rate for Payer: Priority Health Narrow Network |
$109.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.19
|
| Rate for Payer: UHC Exchange |
$72.19
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 40805
|
| Min. Negotiated Rate |
$117.36 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Aetna Commercial |
$238.65
|
| Rate for Payer: Aetna Medicare |
$178.10
|
| Rate for Payer: BCBS Complete |
$123.23
|
| Rate for Payer: BCBS MAPPO |
$178.10
|
| Rate for Payer: BCN Commercial |
$302.28
|
| Rate for Payer: BCN Medicare Advantage |
$178.10
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$256.46
|
| Rate for Payer: Cofinity Commercial |
$238.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.10
|
| Rate for Payer: Healthscope Commercial |
$213.72
|
| Rate for Payer: Healthscope Whirlpool |
$213.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.00
|
| Rate for Payer: Meridian Medicaid |
$123.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.91
|
| Rate for Payer: Nomi Health Commercial |
$213.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$544.50
|
| Rate for Payer: PACE SWMI |
$178.10
|
| Rate for Payer: PHP Medicare Advantage |
$178.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$368.30
|
| Rate for Payer: Priority Health Medicare |
$178.10
|
| Rate for Payer: Priority Health Narrow Network |
$368.30
|
| Rate for Payer: Railroad Medicare Medicare |
$178.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178.10
|
| Rate for Payer: UHC Exchange |
$360.96
|
| Rate for Payer: UHC Medicaid |
$117.36
|
| Rate for Payer: UHCCP DNSP |
$178.10
|
| Rate for Payer: UHCCP Medicaid |
$117.36
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 40804
|
| Min. Negotiated Rate |
$73.70 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna Commercial |
$148.16
|
| Rate for Payer: Aetna Medicare |
$110.57
|
| Rate for Payer: BCBS Complete |
$77.39
|
| Rate for Payer: BCBS MAPPO |
$110.57
|
| Rate for Payer: BCN Commercial |
$178.77
|
| Rate for Payer: BCN Medicare Advantage |
$110.57
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$159.22
|
| Rate for Payer: Cofinity Commercial |
$148.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.57
|
| Rate for Payer: Healthscope Commercial |
$132.68
|
| Rate for Payer: Healthscope Whirlpool |
$132.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.10
|
| Rate for Payer: Meridian Medicaid |
$77.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.63
|
| Rate for Payer: Nomi Health Commercial |
$132.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.50
|
| Rate for Payer: PACE SWMI |
$110.57
|
| Rate for Payer: PHP Medicare Advantage |
$110.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.82
|
| Rate for Payer: Priority Health Medicare |
$110.57
|
| Rate for Payer: Priority Health Narrow Network |
$217.82
|
| Rate for Payer: Railroad Medicare Medicare |
$110.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.57
|
| Rate for Payer: UHC Exchange |
$202.68
|
| Rate for Payer: UHC Medicaid |
$73.70
|
| Rate for Payer: UHCCP DNSP |
$110.57
|
| Rate for Payer: UHCCP Medicaid |
$73.70
|
|
|
PR RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS 63746
|
| Min. Negotiated Rate |
$410.24 |
| Max. Negotiated Rate |
$1,281.00 |
| Rate for Payer: Aetna Commercial |
$843.97
|
| Rate for Payer: Aetna Medicare |
$629.83
|
| Rate for Payer: BCBS Complete |
$430.75
|
| Rate for Payer: BCBS MAPPO |
$629.83
|
| Rate for Payer: BCN Commercial |
$1,035.60
|
| Rate for Payer: BCN Medicare Advantage |
$629.83
|
| Rate for Payer: Cash Price |
$1,366.40
|
| Rate for Payer: Cash Price |
$1,366.40
|
| Rate for Payer: Cofinity Commercial |
$906.96
|
| Rate for Payer: Cofinity Commercial |
$843.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$629.83
|
| Rate for Payer: Healthscope Commercial |
$755.80
|
| Rate for Payer: Healthscope Whirlpool |
$755.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$661.32
|
| Rate for Payer: Meridian Medicaid |
$430.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$692.81
|
| Rate for Payer: Nomi Health Commercial |
$755.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,281.00
|
| Rate for Payer: PACE SWMI |
$629.83
|
| Rate for Payer: PHP Medicare Advantage |
$629.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,094.90
|
| Rate for Payer: Priority Health Medicare |
$629.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,094.90
|
| Rate for Payer: Railroad Medicare Medicare |
$629.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,053.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$629.83
|
| Rate for Payer: UHC Exchange |
$1,053.24
|
| Rate for Payer: UHC Medicaid |
$410.24
|
| Rate for Payer: UHCCP DNSP |
$629.83
|
| Rate for Payer: UHCCP Medicaid |
$410.24
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$166.47 |
| Rate for Payer: Aetna Commercial |
$113.30
|
| Rate for Payer: Aetna Medicare |
$84.55
|
| Rate for Payer: BCBS Complete |
$58.60
|
| Rate for Payer: BCBS MAPPO |
$84.55
|
| Rate for Payer: BCN Commercial |
$142.92
|
| Rate for Payer: BCN Medicare Advantage |
$84.55
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$121.75
|
| Rate for Payer: Cofinity Commercial |
$113.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.55
|
| Rate for Payer: Healthscope Commercial |
$101.46
|
| Rate for Payer: Healthscope Whirlpool |
$101.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.78
|
| Rate for Payer: Meridian Medicaid |
$58.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.00
|
| Rate for Payer: Nomi Health Commercial |
$101.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.50
|
| Rate for Payer: PACE SWMI |
$84.55
|
| Rate for Payer: PHP Medicare Advantage |
$84.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$141.21
|
| Rate for Payer: Priority Health Medicare |
$84.55
|
| Rate for Payer: Priority Health Narrow Network |
$141.21
|
| Rate for Payer: Railroad Medicare Medicare |
$84.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$84.55
|
| Rate for Payer: UHC Exchange |
$166.47
|
| Rate for Payer: UHC Medicaid |
$55.81
|
| Rate for Payer: UHCCP DNSP |
$84.55
|
| Rate for Payer: UHCCP Medicaid |
$55.81
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$55.06
|
| Rate for Payer: Aetna Medicare |
$41.09
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$41.09
|
| Rate for Payer: BCN Commercial |
$71.71
|
| Rate for Payer: BCN Medicare Advantage |
$41.09
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$59.17
|
| Rate for Payer: Cofinity Commercial |
$55.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.09
|
| Rate for Payer: Healthscope Commercial |
$49.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.14
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.20
|
| Rate for Payer: Nomi Health Commercial |
$49.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.50
|
| Rate for Payer: PACE SWMI |
$41.09
|
| Rate for Payer: PHP Medicare Advantage |
$41.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$70.86
|
| Rate for Payer: Priority Health Medicare |
$41.09
|
| Rate for Payer: Priority Health Narrow Network |
$70.86
|
| Rate for Payer: Railroad Medicare Medicare |
$41.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.09
|
| Rate for Payer: UHC Exchange |
$82.27
|
| Rate for Payer: UHC Medicaid |
$26.63
|
| Rate for Payer: UHCCP DNSP |
$41.09
|
| Rate for Payer: UHCCP Medicaid |
$26.63
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$49.73
|
| Rate for Payer: Aetna Medicare |
$37.11
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS MAPPO |
$37.11
|
| Rate for Payer: BCN Commercial |
$60.76
|
| Rate for Payer: BCN Medicare Advantage |
$37.11
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$53.44
|
| Rate for Payer: Cofinity Commercial |
$49.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.11
|
| Rate for Payer: Healthscope Commercial |
$44.53
|
| Rate for Payer: Healthscope Whirlpool |
$44.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.97
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.82
|
| Rate for Payer: Nomi Health Commercial |
$44.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.50
|
| Rate for Payer: PACE SWMI |
$37.11
|
| Rate for Payer: PHP Medicare Advantage |
$37.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.16
|
| Rate for Payer: Priority Health Medicare |
$37.11
|
| Rate for Payer: Priority Health Narrow Network |
$71.16
|
| Rate for Payer: Railroad Medicare Medicare |
$37.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.11
|
| Rate for Payer: UHC Exchange |
$72.65
|
| Rate for Payer: UHC Medicaid |
$24.07
|
| Rate for Payer: UHCCP DNSP |
$37.11
|
| Rate for Payer: UHCCP Medicaid |
$24.07
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 65222
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$54.66
|
| Rate for Payer: Aetna Medicare |
$40.79
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$40.79
|
| Rate for Payer: BCN Commercial |
$73.70
|
| Rate for Payer: BCN Medicare Advantage |
$40.79
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$54.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$48.95
|
| Rate for Payer: Healthscope Whirlpool |
$48.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.83
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.87
|
| Rate for Payer: Nomi Health Commercial |
$48.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PACE SWMI |
$40.79
|
| Rate for Payer: PHP Medicare Advantage |
$40.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.32
|
| Rate for Payer: Priority Health Medicare |
$40.79
|
| Rate for Payer: Priority Health Narrow Network |
$86.32
|
| Rate for Payer: Railroad Medicare Medicare |
$40.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.79
|
| Rate for Payer: UHC Exchange |
$88.64
|
| Rate for Payer: UHC Medicaid |
$26.63
|
| Rate for Payer: UHCCP DNSP |
$40.79
|
| Rate for Payer: UHCCP Medicaid |
$26.63
|
|
|
PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 65210
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$150.75 |
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: BCBS Complete |
$20.13
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$42.31
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$35.26
|
| Rate for Payer: Healthscope Whirlpool |
$35.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$20.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.32
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.75
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.41
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health Narrow Network |
$62.41
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.38
|
| Rate for Payer: UHC Exchange |
$63.18
|
| Rate for Payer: UHC Medicaid |
$19.17
|
| Rate for Payer: UHCCP DNSP |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$19.17
|
|
|
PR RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
HCPCS 45915
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$473.25 |
| Rate for Payer: Aetna Commercial |
$301.70
|
| Rate for Payer: Aetna Medicare |
$225.15
|
| Rate for Payer: BCBS Complete |
$155.21
|
| Rate for Payer: BCBS MAPPO |
$225.15
|
| Rate for Payer: BCN Commercial |
$347.09
|
| Rate for Payer: BCN Medicare Advantage |
$225.15
|
| Rate for Payer: Cash Price |
$504.80
|
| Rate for Payer: Cash Price |
$504.80
|
| Rate for Payer: Cofinity Commercial |
$324.22
|
| Rate for Payer: Cofinity Commercial |
$301.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.15
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Healthscope Whirlpool |
$270.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.41
|
| Rate for Payer: Meridian Medicaid |
$155.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$247.66
|
| Rate for Payer: Nomi Health Commercial |
$270.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.25
|
| Rate for Payer: PACE SWMI |
$225.15
|
| Rate for Payer: PHP Medicare Advantage |
$225.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$422.92
|
| Rate for Payer: Priority Health Medicare |
$225.15
|
| Rate for Payer: Priority Health Narrow Network |
$422.92
|
| Rate for Payer: Railroad Medicare Medicare |
$225.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$225.15
|
| Rate for Payer: UHC Exchange |
$401.97
|
| Rate for Payer: UHC Medicaid |
$147.82
|
| Rate for Payer: UHCCP DNSP |
$225.15
|
| Rate for Payer: UHCCP Medicaid |
$147.82
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$593.25 |
| Max. Negotiated Rate |
$3,985.15 |
| Rate for Payer: Aetna Commercial |
$711.90
|
| 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 |
$767.27
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$652.18
|
| Rate for Payer: BCN Commercial |
$652.18
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cofinity Commercial |
$743.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$767.27
|
| Rate for Payer: Healthscope Whirlpool |
$791.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,894.27
|
| Rate for Payer: Mclaren Commercial |
$711.90
|
| 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 |
$672.35
|
| Rate for Payer: Nomi Health Commercial |
$648.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.25
|
| 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 |
$3,985.15
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Narrow Network |
$3,188.12
|
| 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 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$791.00
|
|
|
Service Code
|
HCPCS 20525
|
| Min. Negotiated Rate |
$148.67 |
| Max. Negotiated Rate |
$593.25 |
| Rate for Payer: Aetna Commercial |
$305.04
|
| Rate for Payer: Aetna Medicare |
$227.64
|
| Rate for Payer: BCBS Complete |
$156.10
|
| Rate for Payer: BCBS MAPPO |
$227.64
|
| Rate for Payer: BCN Commercial |
$376.48
|
| Rate for Payer: BCN Medicare Advantage |
$227.64
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cofinity Commercial |
$327.80
|
| Rate for Payer: Cofinity Commercial |
$305.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$273.17
|
| Rate for Payer: Healthscope Whirlpool |
$273.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$239.02
|
| Rate for Payer: Meridian Medicaid |
$156.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$250.40
|
| Rate for Payer: Nomi Health Commercial |
$273.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.25
|
| Rate for Payer: PACE SWMI |
$227.64
|
| Rate for Payer: PHP Medicare Advantage |
$227.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$402.44
|
| Rate for Payer: Priority Health Medicare |
$227.64
|
| Rate for Payer: Priority Health Narrow Network |
$402.44
|
| Rate for Payer: Railroad Medicare Medicare |
$227.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$430.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$227.64
|
| Rate for Payer: UHC Exchange |
$430.70
|
| Rate for Payer: UHC Medicaid |
$148.67
|
| Rate for Payer: UHCCP DNSP |
$227.64
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$593.25 |
| Max. Negotiated Rate |
$791.00 |
| Rate for Payer: Aetna Commercial |
$711.90
|
| Rate for Payer: ASR ASR |
$767.27
|
| Rate for Payer: BCBS Trust/PPO |
$649.57
|
| Rate for Payer: BCN Commercial |
$649.57
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cofinity Commercial |
$743.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.80
|
| Rate for Payer: Healthscope Commercial |
$767.27
|
| Rate for Payer: Healthscope Whirlpool |
$791.00
|
| Rate for Payer: Mclaren Commercial |
$711.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.35
|
| Rate for Payer: Nomi Health Commercial |
$648.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.25
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$791.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
20525
|
| Min. Negotiated Rate |
$148.67 |
| Max. Negotiated Rate |
$593.25 |
| Rate for Payer: Aetna Commercial |
$305.04
|
| Rate for Payer: Aetna Medicare |
$227.64
|
| Rate for Payer: BCBS Complete |
$156.10
|
| Rate for Payer: BCBS MAPPO |
$227.64
|
| Rate for Payer: BCN Commercial |
$376.48
|
| Rate for Payer: BCN Medicare Advantage |
$227.64
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cofinity Commercial |
$327.80
|
| Rate for Payer: Cofinity Commercial |
$305.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$273.17
|
| Rate for Payer: Healthscope Whirlpool |
$273.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$239.02
|
| Rate for Payer: Meridian Medicaid |
$156.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$250.40
|
| Rate for Payer: Nomi Health Commercial |
$273.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.25
|
| Rate for Payer: PACE SWMI |
$227.64
|
| Rate for Payer: PHP Medicare Advantage |
$227.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$402.44
|
| Rate for Payer: Priority Health Medicare |
$227.64
|
| Rate for Payer: Priority Health Narrow Network |
$402.44
|
| Rate for Payer: Railroad Medicare Medicare |
$227.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$430.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$227.64
|
| Rate for Payer: UHC Exchange |
$430.70
|
| Rate for Payer: UHC Medicaid |
$148.67
|
| Rate for Payer: UHCCP DNSP |
$227.64
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
|
