|
PR REMOVAL FOREIGN BODY PELVIS/HIP DEEP
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS 27087
|
| Min. Negotiated Rate |
$401.51 |
| Max. Negotiated Rate |
$1,172.30 |
| Rate for Payer: Aetna Commercial |
$821.49
|
| Rate for Payer: Aetna Medicare |
$683.50
|
| Rate for Payer: BCBS Complete |
$421.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,172.30
|
| Rate for Payer: BCN Commercial |
$906.01
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Meridian Medicaid |
$421.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$401.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.55
|
| Rate for Payer: Priority Health Narrow Network |
$950.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$723.88
|
| Rate for Payer: UHC Exchange |
$723.88
|
| Rate for Payer: UHCCP Medicaid |
$401.51
|
|
|
PR REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 42809
|
| Min. Negotiated Rate |
$81.37 |
| Max. Negotiated Rate |
$300.53 |
| Rate for Payer: Aetna Commercial |
$165.73
|
| Rate for Payer: Aetna Medicare |
$151.50
|
| Rate for Payer: BCBS Complete |
$85.44
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: BCN Commercial |
$300.53
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Meridian Medicaid |
$85.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.08
|
| Rate for Payer: Priority Health Narrow Network |
$229.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.68
|
| Rate for Payer: UHC Exchange |
$158.68
|
| Rate for Payer: UHCCP Medicaid |
$81.37
|
|
|
PR REMOVAL FOREIGN BODY SCROTUM
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 55120
|
| Min. Negotiated Rate |
$230.04 |
| Max. Negotiated Rate |
$3,266.48 |
| Rate for Payer: Aetna Commercial |
$452.80
|
| Rate for Payer: Aetna Medicare |
$334.50
|
| Rate for Payer: BCBS Complete |
$241.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,266.48
|
| Rate for Payer: BCN Commercial |
$514.58
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Meridian Medicaid |
$241.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.94
|
| Rate for Payer: Priority Health Narrow Network |
$570.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.94
|
| Rate for Payer: UHC Exchange |
$423.94
|
| Rate for Payer: UHCCP Medicaid |
$230.04
|
|
|
PR REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 23330
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$444.20 |
| Rate for Payer: Aetna Commercial |
$220.75
|
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: BCBS Complete |
$115.41
|
| Rate for Payer: BCBS Trust/PPO |
$64.52
|
| Rate for Payer: BCN Commercial |
$444.20
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Meridian Medicaid |
$115.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.03
|
| Rate for Payer: Priority Health Narrow Network |
$260.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.17
|
| Rate for Payer: UHC Exchange |
$170.17
|
| Rate for Payer: UHCCP Medicaid |
$109.91
|
|
|
PR REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS 24201
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$810.72 |
| Rate for Payer: Aetna Commercial |
$485.08
|
| Rate for Payer: Aetna Medicare |
$453.50
|
| Rate for Payer: BCBS Complete |
$277.33
|
| Rate for Payer: BCBS Trust/PPO |
$162.72
|
| Rate for Payer: BCN Commercial |
$810.72
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Meridian Medicaid |
$277.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$589.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$624.38
|
| Rate for Payer: Priority Health Narrow Network |
$624.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.94
|
| Rate for Payer: UHC Exchange |
$412.94
|
| Rate for Payer: UHCCP Medicaid |
$264.12
|
|
|
PR REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 27090
|
| Min. Negotiated Rate |
$412.60 |
| Max. Negotiated Rate |
$1,368.25 |
| Rate for Payer: Aetna Commercial |
$1,106.89
|
| Rate for Payer: Aetna Medicare |
$1,052.50
|
| Rate for Payer: BCBS Complete |
$565.83
|
| Rate for Payer: BCBS Trust/PPO |
$412.60
|
| Rate for Payer: BCN Commercial |
$1,222.67
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Meridian Medicaid |
$565.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$538.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,368.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,278.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,278.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.76
|
| Rate for Payer: UHC Exchange |
$952.76
|
| Rate for Payer: UHCCP Medicaid |
$538.89
|
|
|
PR REMOVAL HYPOGLOSSAL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 64584
|
| Min. Negotiated Rate |
$468.17 |
| Max. Negotiated Rate |
$1,630.85 |
| Rate for Payer: Aetna Commercial |
$856.83
|
| Rate for Payer: Aetna Medicare |
$1,254.50
|
| Rate for Payer: BCBS Complete |
$491.58
|
| Rate for Payer: BCN Commercial |
$1,064.34
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Meridian Medicaid |
$491.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$468.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,244.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,244.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$862.33
|
| Rate for Payer: UHC Exchange |
$862.33
|
| Rate for Payer: UHCCP Medicaid |
$468.17
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 69210
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$2,090.48 |
| Rate for Payer: Aetna Commercial |
$37.88
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: BCBS Complete |
$21.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,090.48
|
| Rate for Payer: BCN Commercial |
$55.76
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Meridian Medicaid |
$21.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.18
|
| Rate for Payer: Priority Health Narrow Network |
$47.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.73
|
| Rate for Payer: UHC Exchange |
$36.73
|
| Rate for Payer: UHCCP Medicaid |
$20.45
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 69209
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$2,108.45 |
| Rate for Payer: Aetna Commercial |
$16.11
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.45
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.35
|
| Rate for Payer: Priority Health Narrow Network |
$23.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.73
|
| Rate for Payer: UHC Exchange |
$14.73
|
|
|
PR REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 57415
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$1,989.05 |
| Rate for Payer: Aetna Commercial |
$205.66
|
| Rate for Payer: Aetna Medicare |
$166.00
|
| Rate for Payer: BCBS Complete |
$118.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,989.05
|
| Rate for Payer: BCN Commercial |
$257.53
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Meridian Medicaid |
$118.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.90
|
| Rate for Payer: Priority Health Narrow Network |
$263.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.62
|
| Rate for Payer: UHC Exchange |
$181.62
|
| Rate for Payer: UHCCP Medicaid |
$112.68
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$156.65 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: ASR ASR |
$233.77
|
| Rate for Payer: ASR Commercial |
$233.77
|
| Rate for Payer: BCBS Trust/PPO |
$196.39
|
| Rate for Payer: BCN Commercial |
$186.85
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$226.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.80
|
| Rate for Payer: Healthscope Commercial |
$241.00
|
| Rate for Payer: Healthscope Whirlpool |
$233.77
|
| Rate for Payer: Mclaren Commercial |
$216.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.85
|
| Rate for Payer: Nomi Health Commercial |
$197.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.08
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
11976
|
| Min. Negotiated Rate |
$58.79 |
| Max. Negotiated Rate |
$268.22 |
| Rate for Payer: Aetna Commercial |
$102.24
|
| Rate for Payer: Aetna Medicare |
$120.50
|
| Rate for Payer: BCBS Complete |
$61.73
|
| Rate for Payer: BCBS Trust/PPO |
$268.22
|
| Rate for Payer: BCN Commercial |
$212.08
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Meridian Medicaid |
$61.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.08
|
| Rate for Payer: Priority Health Narrow Network |
$125.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.89
|
| Rate for Payer: UHC Exchange |
$104.89
|
| Rate for Payer: UHCCP Medicaid |
$58.79
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$156.65 |
| Max. Negotiated Rate |
$1,068.51 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Medicare |
$689.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: ASR ASR |
$233.77
|
| Rate for Payer: ASR Commercial |
$233.77
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$197.35
|
| Rate for Payer: BCN Commercial |
$186.85
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$226.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$241.00
|
| Rate for Payer: Healthscope Whirlpool |
$233.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$216.90
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.85
|
| Rate for Payer: Nomi Health Commercial |
$197.62
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$758.30
|
| Rate for Payer: PHP Medicaid |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.70
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$615.76
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,068.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP DNSP |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 11976
|
| Min. Negotiated Rate |
$58.79 |
| Max. Negotiated Rate |
$268.22 |
| Rate for Payer: Aetna Commercial |
$102.24
|
| Rate for Payer: Aetna Medicare |
$120.50
|
| Rate for Payer: BCBS Complete |
$61.73
|
| Rate for Payer: BCBS Trust/PPO |
$268.22
|
| Rate for Payer: BCN Commercial |
$212.08
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Meridian Medicaid |
$61.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.08
|
| Rate for Payer: Priority Health Narrow Network |
$125.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.89
|
| Rate for Payer: UHC Exchange |
$104.89
|
| Rate for Payer: UHCCP Medicaid |
$58.79
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 33241
|
| Min. Negotiated Rate |
$136.32 |
| Max. Negotiated Rate |
$1,338.18 |
| Rate for Payer: Aetna Commercial |
$287.03
|
| Rate for Payer: Aetna Medicare |
$219.00
|
| Rate for Payer: BCBS Complete |
$143.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,338.18
|
| Rate for Payer: BCN Commercial |
$311.29
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Meridian Medicaid |
$143.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.77
|
| Rate for Payer: Priority Health Narrow Network |
$338.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.41
|
| Rate for Payer: UHC Exchange |
$300.41
|
| Rate for Payer: UHCCP Medicaid |
$136.32
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$557.80
|
| Rate for Payer: Aetna Medicare |
$542.50
|
| Rate for Payer: BCBS Complete |
$286.27
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$883.04
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Meridian Medicaid |
$286.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$646.76
|
| Rate for Payer: Priority Health Narrow Network |
$646.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$483.70
|
| Rate for Payer: UHC Exchange |
$483.70
|
| Rate for Payer: UHCCP Medicaid |
$272.64
|
|
|
PR REMOVAL IMPLANT DEEP
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$705.25 |
| Max. Negotiated Rate |
$1,085.00 |
| Rate for Payer: Aetna Commercial |
$976.50
|
| Rate for Payer: ASR ASR |
$1,052.45
|
| Rate for Payer: ASR Commercial |
$1,052.45
|
| Rate for Payer: BCBS Trust/PPO |
$884.17
|
| Rate for Payer: BCN Commercial |
$841.20
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$1,019.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.00
|
| Rate for Payer: Healthscope Commercial |
$1,085.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.45
|
| Rate for Payer: Mclaren Commercial |
$976.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.25
|
| Rate for Payer: Nomi Health Commercial |
$889.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$954.80
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 20680
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$557.80
|
| Rate for Payer: Aetna Medicare |
$542.50
|
| Rate for Payer: BCBS Complete |
$286.27
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$883.04
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Meridian Medicaid |
$286.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$646.76
|
| Rate for Payer: Priority Health Narrow Network |
$646.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$483.70
|
| Rate for Payer: UHC Exchange |
$483.70
|
| Rate for Payer: UHCCP Medicaid |
$272.64
|
|
|
PR REMOVAL IMPLANT DEEP
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$705.25 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$976.50
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$1,052.45
|
| Rate for Payer: ASR Commercial |
$1,052.45
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$888.51
|
| Rate for Payer: BCN Commercial |
$841.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$1,019.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$1,085.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$976.50
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.25
|
| Rate for Payer: Nomi Health Commercial |
$889.70
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.68
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$760.58
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$954.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 36262
|
| Min. Negotiated Rate |
$204.48 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Aetna Commercial |
$417.45
|
| Rate for Payer: Aetna Medicare |
$416.50
|
| Rate for Payer: BCBS Complete |
$214.70
|
| Rate for Payer: BCBS Trust/PPO |
$244.60
|
| Rate for Payer: BCN Commercial |
$460.83
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Meridian Medicaid |
$214.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.36
|
| Rate for Payer: Priority Health Narrow Network |
$507.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.19
|
| Rate for Payer: UHC Exchange |
$352.19
|
| Rate for Payer: UHCCP Medicaid |
$204.48
|
|
|
PR REMOVAL IMPLANT FROM FINGER/HAND
|
Professional
|
Both
|
$1,044.00
|
|
|
Service Code
|
HCPCS 26320
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$678.60 |
| Rate for Payer: Aetna Commercial |
$463.71
|
| Rate for Payer: Aetna Medicare |
$522.00
|
| Rate for Payer: BCBS Complete |
$243.11
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$519.46
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Meridian Medicaid |
$243.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.52
|
| Rate for Payer: Priority Health Narrow Network |
$546.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$383.41
|
| Rate for Payer: UHC Exchange |
$383.41
|
| Rate for Payer: UHCCP Medicaid |
$231.53
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$597.35 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$827.10
|
| Rate for Payer: ASR ASR |
$891.43
|
| Rate for Payer: ASR Commercial |
$891.43
|
| Rate for Payer: BCBS Trust/PPO |
$748.89
|
| Rate for Payer: BCN Commercial |
$712.50
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$863.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.20
|
| Rate for Payer: Healthscope Commercial |
$919.00
|
| Rate for Payer: Healthscope Whirlpool |
$891.43
|
| Rate for Payer: Mclaren Commercial |
$827.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.15
|
| Rate for Payer: Nomi Health Commercial |
$753.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.72
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$597.35 |
| Max. Negotiated Rate |
$2,734.04 |
| Rate for Payer: Aetna Commercial |
$827.10
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$891.43
|
| Rate for Payer: ASR Commercial |
$891.43
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$752.57
|
| Rate for Payer: BCN Commercial |
$712.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$863.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$919.00
|
| Rate for Payer: Healthscope Whirlpool |
$891.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$827.10
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.15
|
| Rate for Payer: Nomi Health Commercial |
$753.58
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,734.04
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,187.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$22,818.32 |
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: Aetna Medicare |
$459.50
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS Trust/PPO |
$22,818.32
|
| Rate for Payer: BCN Commercial |
$422.50
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Meridian Medicaid |
$98.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.88
|
| Rate for Payer: Priority Health Narrow Network |
$222.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.07
|
| Rate for Payer: UHC Exchange |
$168.07
|
| Rate for Payer: UHCCP Medicaid |
$94.15
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$22,818.32 |
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: Aetna Medicare |
$459.50
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS Trust/PPO |
$22,818.32
|
| Rate for Payer: BCN Commercial |
$422.50
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Meridian Medicaid |
$98.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.88
|
| Rate for Payer: Priority Health Narrow Network |
$222.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.07
|
| Rate for Payer: UHC Exchange |
$168.07
|
| Rate for Payer: UHCCP Medicaid |
$94.15
|
|
