|
PR REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 28192
|
| Min. Negotiated Rate |
$297.77 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$399.01
|
| Rate for Payer: Aetna Medicare |
$297.77
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$297.77
|
| Rate for Payer: BCN Medicare Advantage |
$297.77
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$428.79
|
| Rate for Payer: Cofinity Commercial |
$399.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.77
|
| Rate for Payer: Healthscope Commercial |
$357.32
|
| Rate for Payer: Healthscope Whirlpool |
$357.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.66
|
| Rate for Payer: Nomi Health Commercial |
$357.32
|
| Rate for Payer: PACE SWMI |
$297.77
|
| Rate for Payer: PHP Medicare Advantage |
$297.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$297.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.77
|
| Rate for Payer: UHC Medicare Advantage |
$297.77
|
| Rate for Payer: UHCCP DNSP |
$297.77
|
|
|
PR REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
HCPCS 28190
|
| Min. Negotiated Rate |
$125.94 |
| Max. Negotiated Rate |
$388.70 |
| Rate for Payer: Aetna Commercial |
$168.76
|
| Rate for Payer: Aetna Medicare |
$125.94
|
| Rate for Payer: BCBS Complete |
$239.20
|
| Rate for Payer: BCBS MAPPO |
$125.94
|
| Rate for Payer: BCN Medicare Advantage |
$125.94
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cofinity Commercial |
$181.35
|
| Rate for Payer: Cofinity Commercial |
$168.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.94
|
| Rate for Payer: Healthscope Commercial |
$151.13
|
| Rate for Payer: Healthscope Whirlpool |
$151.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.24
|
| Rate for Payer: Nomi Health Commercial |
$151.13
|
| Rate for Payer: PACE SWMI |
$125.94
|
| Rate for Payer: PHP Medicare Advantage |
$125.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.70
|
| Rate for Payer: Priority Health Medicare |
$125.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.94
|
| Rate for Payer: UHC Medicare Advantage |
$125.94
|
| Rate for Payer: UHCCP DNSP |
$125.94
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 30310
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$275.80 |
| Rate for Payer: Aetna Commercial |
$256.65
|
| Rate for Payer: Aetna Medicare |
$191.53
|
| Rate for Payer: BCBS Complete |
$147.60
|
| Rate for Payer: BCBS MAPPO |
$191.53
|
| Rate for Payer: BCN Medicare Advantage |
$191.53
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cofinity Commercial |
$275.80
|
| Rate for Payer: Cofinity Commercial |
$256.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.53
|
| Rate for Payer: Healthscope Commercial |
$229.84
|
| Rate for Payer: Healthscope Whirlpool |
$229.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.11
|
| Rate for Payer: Nomi Health Commercial |
$229.84
|
| Rate for Payer: PACE SWMI |
$191.53
|
| Rate for Payer: PHP Medicare Advantage |
$191.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.85
|
| Rate for Payer: Priority Health Medicare |
$191.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.53
|
| Rate for Payer: UHC Medicare Advantage |
$191.53
|
| Rate for Payer: UHCCP DNSP |
$191.53
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 30300
|
| Min. Negotiated Rate |
$112.35 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna Medicare |
$112.35
|
| Rate for Payer: BCBS Complete |
$156.80
|
| Rate for Payer: BCBS MAPPO |
$112.35
|
| Rate for Payer: BCN Medicare Advantage |
$112.35
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$161.78
|
| Rate for Payer: Cofinity Commercial |
$150.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.35
|
| Rate for Payer: Healthscope Commercial |
$134.82
|
| Rate for Payer: Healthscope Whirlpool |
$134.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.97
|
| Rate for Payer: Nomi Health Commercial |
$134.82
|
| Rate for Payer: PACE SWMI |
$112.35
|
| Rate for Payer: PHP Medicare Advantage |
$112.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health Medicare |
$112.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.35
|
| Rate for Payer: UHC Medicare Advantage |
$112.35
|
| Rate for Payer: UHCCP DNSP |
$112.35
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
20520
|
| Min. Negotiated Rate |
$140.83 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Medicare |
$140.83
|
| Rate for Payer: BCBS Complete |
$162.00
|
| Rate for Payer: BCBS MAPPO |
$140.83
|
| Rate for Payer: BCN Medicare Advantage |
$140.83
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$202.80
|
| Rate for Payer: Cofinity Commercial |
$188.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.83
|
| Rate for Payer: Healthscope Commercial |
$169.00
|
| Rate for Payer: Healthscope Whirlpool |
$169.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.87
|
| Rate for Payer: Nomi Health Commercial |
$169.00
|
| Rate for Payer: PACE SWMI |
$140.83
|
| Rate for Payer: PHP Medicare Advantage |
$140.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.25
|
| Rate for Payer: Priority Health Medicare |
$140.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.83
|
| Rate for Payer: UHC Medicare Advantage |
$140.83
|
| Rate for Payer: UHCCP DNSP |
$140.83
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
20520
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$263.25 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$364.50
|
| Rate for Payer: ASR ASR |
$392.85
|
| Rate for Payer: ASR Commercial |
$392.85
|
| Rate for Payer: BCBS Trust/PPO |
$330.03
|
| Rate for Payer: BCN Commercial |
$314.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$380.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Healthscope Whirlpool |
$392.85
|
| Rate for Payer: Mclaren Commercial |
$364.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.25
|
| Rate for Payer: Nomi Health Commercial |
$332.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.40
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 20520
|
| Min. Negotiated Rate |
$140.83 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Medicare |
$140.83
|
| Rate for Payer: BCBS Complete |
$162.00
|
| Rate for Payer: BCBS MAPPO |
$140.83
|
| Rate for Payer: BCN Medicare Advantage |
$140.83
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$202.80
|
| Rate for Payer: Cofinity Commercial |
$188.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.83
|
| Rate for Payer: Healthscope Commercial |
$169.00
|
| Rate for Payer: Healthscope Whirlpool |
$169.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.87
|
| Rate for Payer: Nomi Health Commercial |
$169.00
|
| Rate for Payer: PACE SWMI |
$140.83
|
| Rate for Payer: PHP Medicare Advantage |
$140.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.25
|
| Rate for Payer: Priority Health Medicare |
$140.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.83
|
| Rate for Payer: UHC Medicare Advantage |
$140.83
|
| Rate for Payer: UHCCP DNSP |
$140.83
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
20520
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$263.25 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$364.50
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$392.85
|
| Rate for Payer: ASR Commercial |
$392.85
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$331.65
|
| Rate for Payer: BCN Commercial |
$314.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$380.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Healthscope Whirlpool |
$392.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$364.50
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.25
|
| Rate for Payer: Nomi Health Commercial |
$332.10
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.86
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$283.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR REMOVAL FOREIGN BODY PELVIS/HIP DEEP
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS 27087
|
| Min. Negotiated Rate |
$546.80 |
| Max. Negotiated Rate |
$888.55 |
| Rate for Payer: Aetna Commercial |
$801.32
|
| Rate for Payer: Aetna Medicare |
$598.00
|
| Rate for Payer: BCBS Complete |
$546.80
|
| Rate for Payer: BCBS MAPPO |
$598.00
|
| Rate for Payer: BCN Medicare Advantage |
$598.00
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cofinity Commercial |
$861.12
|
| Rate for Payer: Cofinity Commercial |
$801.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.00
|
| Rate for Payer: Healthscope Commercial |
$717.60
|
| Rate for Payer: Healthscope Whirlpool |
$717.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.90
|
| Rate for Payer: Nomi Health Commercial |
$717.60
|
| Rate for Payer: PACE SWMI |
$598.00
|
| Rate for Payer: PHP Medicare Advantage |
$598.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.55
|
| Rate for Payer: Priority Health Medicare |
$598.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$598.00
|
| Rate for Payer: UHC Medicare Advantage |
$598.00
|
| Rate for Payer: UHCCP DNSP |
$598.00
|
|
|
PR REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 42809
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$196.95 |
| Rate for Payer: Aetna Commercial |
$161.31
|
| Rate for Payer: Aetna Medicare |
$120.38
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: BCBS MAPPO |
$120.38
|
| Rate for Payer: BCN Medicare Advantage |
$120.38
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$173.35
|
| Rate for Payer: Cofinity Commercial |
$161.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.38
|
| Rate for Payer: Healthscope Commercial |
$144.46
|
| Rate for Payer: Healthscope Whirlpool |
$144.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.40
|
| Rate for Payer: Nomi Health Commercial |
$144.46
|
| Rate for Payer: PACE SWMI |
$120.38
|
| Rate for Payer: PHP Medicare Advantage |
$120.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health Medicare |
$120.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.38
|
| Rate for Payer: UHC Medicare Advantage |
$120.38
|
| Rate for Payer: UHCCP DNSP |
$120.38
|
|
|
PR REMOVAL FOREIGN BODY SCROTUM
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 55120
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$490.42 |
| Rate for Payer: Aetna Commercial |
$456.36
|
| Rate for Payer: Aetna Medicare |
$340.57
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$340.57
|
| Rate for Payer: BCN Medicare Advantage |
$340.57
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$490.42
|
| Rate for Payer: Cofinity Commercial |
$456.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.57
|
| Rate for Payer: Healthscope Commercial |
$408.68
|
| Rate for Payer: Healthscope Whirlpool |
$408.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.60
|
| Rate for Payer: Nomi Health Commercial |
$408.68
|
| Rate for Payer: PACE SWMI |
$340.57
|
| Rate for Payer: PHP Medicare Advantage |
$340.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$340.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.57
|
| Rate for Payer: UHC Medicare Advantage |
$340.57
|
| Rate for Payer: UHCCP DNSP |
$340.57
|
|
|
PR REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 23330
|
| Min. Negotiated Rate |
$160.83 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Commercial |
$215.51
|
| Rate for Payer: Aetna Medicare |
$160.83
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS MAPPO |
$160.83
|
| Rate for Payer: BCN Medicare Advantage |
$160.83
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$231.60
|
| Rate for Payer: Cofinity Commercial |
$215.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.83
|
| Rate for Payer: Healthscope Commercial |
$193.00
|
| Rate for Payer: Healthscope Whirlpool |
$193.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.87
|
| Rate for Payer: Nomi Health Commercial |
$193.00
|
| Rate for Payer: PACE SWMI |
$160.83
|
| Rate for Payer: PHP Medicare Advantage |
$160.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health Medicare |
$160.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.83
|
| Rate for Payer: UHC Medicare Advantage |
$160.83
|
| Rate for Payer: UHCCP DNSP |
$160.83
|
|
|
PR REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS 24201
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$589.55 |
| Rate for Payer: Aetna Commercial |
$518.78
|
| Rate for Payer: Aetna Medicare |
$387.15
|
| Rate for Payer: BCBS Complete |
$362.80
|
| Rate for Payer: BCBS MAPPO |
$387.15
|
| Rate for Payer: BCN Medicare Advantage |
$387.15
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cofinity Commercial |
$557.50
|
| Rate for Payer: Cofinity Commercial |
$518.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.15
|
| Rate for Payer: Healthscope Commercial |
$464.58
|
| Rate for Payer: Healthscope Whirlpool |
$464.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.51
|
| Rate for Payer: Nomi Health Commercial |
$464.58
|
| Rate for Payer: PACE SWMI |
$387.15
|
| Rate for Payer: PHP Medicare Advantage |
$387.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$589.55
|
| Rate for Payer: Priority Health Medicare |
$387.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.15
|
| Rate for Payer: UHC Medicare Advantage |
$387.15
|
| Rate for Payer: UHCCP DNSP |
$387.15
|
|
|
PR REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 27090
|
| Min. Negotiated Rate |
$799.27 |
| Max. Negotiated Rate |
$1,368.25 |
| Rate for Payer: Aetna Commercial |
$1,071.02
|
| Rate for Payer: Aetna Medicare |
$799.27
|
| Rate for Payer: BCBS Complete |
$842.00
|
| Rate for Payer: BCBS MAPPO |
$799.27
|
| Rate for Payer: BCN Medicare Advantage |
$799.27
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cofinity Commercial |
$1,150.95
|
| Rate for Payer: Cofinity Commercial |
$1,071.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$799.27
|
| Rate for Payer: Healthscope Commercial |
$959.12
|
| Rate for Payer: Healthscope Whirlpool |
$959.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$839.23
|
| Rate for Payer: Nomi Health Commercial |
$959.12
|
| Rate for Payer: PACE SWMI |
$799.27
|
| Rate for Payer: PHP Medicare Advantage |
$799.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,368.25
|
| Rate for Payer: Priority Health Medicare |
$799.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$799.27
|
| Rate for Payer: UHC Medicare Advantage |
$799.27
|
| Rate for Payer: UHCCP DNSP |
$799.27
|
|
|
PR REMOVAL HYPOGLOSSAL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 64584
|
| Min. Negotiated Rate |
$696.91 |
| Max. Negotiated Rate |
$1,630.85 |
| Rate for Payer: Aetna Commercial |
$933.86
|
| Rate for Payer: Aetna Medicare |
$696.91
|
| Rate for Payer: BCBS Complete |
$1,003.60
|
| Rate for Payer: BCBS MAPPO |
$696.91
|
| Rate for Payer: BCN Medicare Advantage |
$696.91
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$933.86
|
| Rate for Payer: Cofinity Commercial |
$1,003.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$696.91
|
| Rate for Payer: Healthscope Commercial |
$836.29
|
| Rate for Payer: Healthscope Whirlpool |
$836.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$731.76
|
| Rate for Payer: Nomi Health Commercial |
$836.29
|
| Rate for Payer: PACE SWMI |
$696.91
|
| Rate for Payer: PHP Medicare Advantage |
$696.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$696.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$696.91
|
| Rate for Payer: UHC Medicare Advantage |
$696.91
|
| Rate for Payer: UHCCP DNSP |
$696.91
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 69210
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Commercial |
$41.06
|
| Rate for Payer: Aetna Medicare |
$30.64
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS MAPPO |
$30.64
|
| Rate for Payer: BCN Medicare Advantage |
$30.64
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$44.12
|
| Rate for Payer: Cofinity Commercial |
$41.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.64
|
| Rate for Payer: Healthscope Commercial |
$36.77
|
| Rate for Payer: Healthscope Whirlpool |
$36.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.17
|
| Rate for Payer: Nomi Health Commercial |
$36.77
|
| Rate for Payer: PACE SWMI |
$30.64
|
| Rate for Payer: PHP Medicare Advantage |
$30.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Medicare |
$30.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.64
|
| Rate for Payer: UHC Medicare Advantage |
$30.64
|
| Rate for Payer: UHCCP DNSP |
$30.64
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 69209
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$20.06 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$13.93
|
| Rate for Payer: BCN Medicare Advantage |
$13.93
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Whirlpool |
$16.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.63
|
| Rate for Payer: Nomi Health Commercial |
$16.72
|
| Rate for Payer: PACE SWMI |
$13.93
|
| Rate for Payer: PHP Medicare Advantage |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$13.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.93
|
| Rate for Payer: UHC Medicare Advantage |
$13.93
|
| Rate for Payer: UHCCP DNSP |
$13.93
|
|
|
PR REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 57415
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$239.67 |
| Rate for Payer: Aetna Commercial |
$223.03
|
| Rate for Payer: Aetna Medicare |
$166.44
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS MAPPO |
$166.44
|
| Rate for Payer: BCN Medicare Advantage |
$166.44
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$239.67
|
| Rate for Payer: Cofinity Commercial |
$223.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$199.73
|
| Rate for Payer: Healthscope Whirlpool |
$199.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.76
|
| Rate for Payer: Nomi Health Commercial |
$199.73
|
| Rate for Payer: PACE SWMI |
$166.44
|
| Rate for Payer: PHP Medicare Advantage |
$166.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health Medicare |
$166.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.44
|
| Rate for Payer: UHC Medicare Advantage |
$166.44
|
| Rate for Payer: UHCCP DNSP |
$166.44
|
|
|
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 |
$1,063.61 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Medicare |
$686.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: ASR ASR |
$233.77
|
| Rate for Payer: ASR Commercial |
$233.77
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCBS Trust/PPO |
$197.35
|
| Rate for Payer: BCN Commercial |
$186.85
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| 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 |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$241.00
|
| Rate for Payer: Healthscope Whirlpool |
$233.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$686.20
|
| Rate for Payer: Mclaren Commercial |
$216.90
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.85
|
| Rate for Payer: Nomi Health Commercial |
$197.62
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$754.82
|
| Rate for Payer: PHP Medicaid |
$367.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.16
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health Narrow Network |
$168.94
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP DNSP |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
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
|
| Min. Negotiated Rate |
$88.91 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Aetna Commercial |
$119.14
|
| Rate for Payer: Aetna Medicare |
$88.91
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$88.91
|
| Rate for Payer: BCN Medicare Advantage |
$88.91
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.91
|
| Rate for Payer: Healthscope Commercial |
$106.69
|
| Rate for Payer: Healthscope Whirlpool |
$106.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.36
|
| Rate for Payer: Nomi Health Commercial |
$106.69
|
| Rate for Payer: PACE SWMI |
$88.91
|
| Rate for Payer: PHP Medicare Advantage |
$88.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$88.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.91
|
| Rate for Payer: UHC Medicare Advantage |
$88.91
|
| Rate for Payer: UHCCP DNSP |
$88.91
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
11976
|
| Min. Negotiated Rate |
$88.91 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Aetna Commercial |
$119.14
|
| Rate for Payer: Aetna Medicare |
$88.91
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$88.91
|
| Rate for Payer: BCN Medicare Advantage |
$88.91
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.91
|
| Rate for Payer: Healthscope Commercial |
$106.69
|
| Rate for Payer: Healthscope Whirlpool |
$106.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.36
|
| Rate for Payer: Nomi Health Commercial |
$106.69
|
| Rate for Payer: PACE SWMI |
$88.91
|
| Rate for Payer: PHP Medicare Advantage |
$88.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$88.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.91
|
| Rate for Payer: UHC Medicare Advantage |
$88.91
|
| Rate for Payer: UHCCP DNSP |
$88.91
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 33241
|
| Min. Negotiated Rate |
$175.20 |
| Max. Negotiated Rate |
$292.59 |
| Rate for Payer: Aetna Commercial |
$272.27
|
| Rate for Payer: Aetna Medicare |
$203.19
|
| Rate for Payer: BCBS Complete |
$175.20
|
| Rate for Payer: BCBS MAPPO |
$203.19
|
| Rate for Payer: BCN Medicare Advantage |
$203.19
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$292.59
|
| Rate for Payer: Cofinity Commercial |
$272.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.19
|
| Rate for Payer: Healthscope Commercial |
$243.83
|
| Rate for Payer: Healthscope Whirlpool |
$243.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.35
|
| Rate for Payer: Nomi Health Commercial |
$243.83
|
| Rate for Payer: PACE SWMI |
$203.19
|
| Rate for Payer: PHP Medicare Advantage |
$203.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health Medicare |
$203.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.19
|
| Rate for Payer: UHC Medicare Advantage |
$203.19
|
| Rate for Payer: UHCCP DNSP |
$203.19
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$403.07 |
| Max. Negotiated Rate |
$705.25 |
| Rate for Payer: Aetna Commercial |
$540.11
|
| Rate for Payer: Aetna Medicare |
$403.07
|
| Rate for Payer: BCBS Complete |
$434.00
|
| Rate for Payer: BCBS MAPPO |
$403.07
|
| Rate for Payer: BCN Medicare Advantage |
$403.07
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$580.42
|
| Rate for Payer: Cofinity Commercial |
$540.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.07
|
| Rate for Payer: Healthscope Commercial |
$483.68
|
| Rate for Payer: Healthscope Whirlpool |
$483.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.22
|
| Rate for Payer: Nomi Health Commercial |
$483.68
|
| Rate for Payer: PACE SWMI |
$403.07
|
| Rate for Payer: PHP Medicare Advantage |
$403.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health Medicare |
$403.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.07
|
| Rate for Payer: UHC Medicare Advantage |
$403.07
|
| Rate for Payer: UHCCP DNSP |
$403.07
|
|
|
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
|
|
