|
PR RHYTIDECTOMY SMAS FLAP
|
Professional
|
Both
|
$4,896.00
|
|
|
Service Code
|
HCPCS 15829
|
| Min. Negotiated Rate |
$1,958.40 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 93451
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$1,055.72 |
| Rate for Payer: Aetna Commercial |
$982.41
|
| Rate for Payer: Aetna Medicare |
$733.14
|
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: BCBS MAPPO |
$733.14
|
| Rate for Payer: BCN Medicare Advantage |
$733.14
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$982.41
|
| Rate for Payer: Cofinity Commercial |
$1,055.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.14
|
| Rate for Payer: Healthscope Commercial |
$879.77
|
| Rate for Payer: Healthscope Whirlpool |
$879.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$769.80
|
| Rate for Payer: Nomi Health Commercial |
$879.77
|
| Rate for Payer: PACE SWMI |
$733.14
|
| Rate for Payer: PHP Medicare Advantage |
$733.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health Medicare |
$733.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.14
|
| Rate for Payer: UHC Medicare Advantage |
$733.14
|
| Rate for Payer: UHCCP DNSP |
$733.14
|
|
|
PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 35697
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$188.86
|
| Rate for Payer: Aetna Medicare |
$140.94
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$140.94
|
| Rate for Payer: BCN Medicare Advantage |
$140.94
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$202.95
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.94
|
| Rate for Payer: Healthscope Commercial |
$169.13
|
| Rate for Payer: Healthscope Whirlpool |
$169.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.99
|
| Rate for Payer: Nomi Health Commercial |
$169.13
|
| Rate for Payer: PACE SWMI |
$140.94
|
| Rate for Payer: PHP Medicare Advantage |
$140.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$140.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.94
|
| Rate for Payer: UHC Medicare Advantage |
$140.94
|
| Rate for Payer: UHCCP DNSP |
$140.94
|
|
|
PR RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J7120
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna Medicare |
$2.41
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$2.41
|
| Rate for Payer: BCN Medicare Advantage |
$2.41
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Healthscope Whirlpool |
$2.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: PACE SWMI |
$2.41
|
| Rate for Payer: PHP Medicare Advantage |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$2.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.41
|
| Rate for Payer: UHC Medicare Advantage |
$2.41
|
| Rate for Payer: UHCCP DNSP |
$2.41
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$747.82 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna Commercial |
$1,002.08
|
| Rate for Payer: Aetna Medicare |
$747.82
|
| Rate for Payer: BCBS Complete |
$1,052.80
|
| Rate for Payer: BCBS MAPPO |
$747.82
|
| Rate for Payer: BCN Medicare Advantage |
$747.82
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,076.86
|
| Rate for Payer: Cofinity Commercial |
$1,002.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.82
|
| Rate for Payer: Healthscope Commercial |
$897.38
|
| Rate for Payer: Healthscope Whirlpool |
$897.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.21
|
| Rate for Payer: Nomi Health Commercial |
$897.38
|
| Rate for Payer: PACE SWMI |
$747.82
|
| Rate for Payer: PHP Medicare Advantage |
$747.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health Medicare |
$747.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.82
|
| Rate for Payer: UHC Medicare Advantage |
$747.82
|
| Rate for Payer: UHCCP DNSP |
$747.82
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
OP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,710.80 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$2,368.80
|
| Rate for Payer: Aetna Medicare |
$6,967.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: ASR ASR |
$2,553.04
|
| Rate for Payer: ASR Commercial |
$2,553.04
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,155.34
|
| Rate for Payer: BCN Commercial |
$2,040.59
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$2,474.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,632.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,553.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$2,368.80
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: Nomi Health Commercial |
$2,158.24
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$7,663.85
|
| Rate for Payer: PHP Medicaid |
$3,734.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,306.16
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,845.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,316.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$10,799.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP DNSP |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Min. Negotiated Rate |
$747.82 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna Commercial |
$1,002.08
|
| Rate for Payer: Aetna Medicare |
$747.82
|
| Rate for Payer: BCBS Complete |
$1,052.80
|
| Rate for Payer: BCBS MAPPO |
$747.82
|
| Rate for Payer: BCN Medicare Advantage |
$747.82
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,076.86
|
| Rate for Payer: Cofinity Commercial |
$1,002.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.82
|
| Rate for Payer: Healthscope Commercial |
$897.38
|
| Rate for Payer: Healthscope Whirlpool |
$897.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.21
|
| Rate for Payer: Nomi Health Commercial |
$897.38
|
| Rate for Payer: PACE SWMI |
$747.82
|
| Rate for Payer: PHP Medicare Advantage |
$747.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health Medicare |
$747.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.82
|
| Rate for Payer: UHC Medicare Advantage |
$747.82
|
| Rate for Payer: UHCCP DNSP |
$747.82
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
IP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,710.80 |
| Max. Negotiated Rate |
$2,632.00 |
| Rate for Payer: Aetna Commercial |
$2,368.80
|
| Rate for Payer: ASR ASR |
$2,553.04
|
| Rate for Payer: ASR Commercial |
$2,553.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,144.82
|
| Rate for Payer: BCN Commercial |
$2,040.59
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$2,474.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Healthscope Commercial |
$2,632.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,553.04
|
| Rate for Payer: Mclaren Commercial |
$2,368.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: Nomi Health Commercial |
$2,158.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,316.16
|
|
|
PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 90673
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$141.35 |
| Rate for Payer: Aetna Commercial |
$131.53
|
| Rate for Payer: Aetna Medicare |
$98.16
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$98.16
|
| Rate for Payer: BCN Medicare Advantage |
$98.16
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$141.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| 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: Nomi Health Commercial |
$117.79
|
| Rate for Payer: PACE SWMI |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$98.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$98.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.16
|
| Rate for Payer: UHC Medicare Advantage |
$98.16
|
| Rate for Payer: UHCCP DNSP |
$98.16
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 90682
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Aetna Medicare |
$46.50
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$2,919.00
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$1,897.35 |
| Rate for Payer: Aetna Commercial |
$1,596.72
|
| Rate for Payer: Aetna Commercial |
$1,596.72
|
| Rate for Payer: Aetna Medicare |
$1,191.58
|
| Rate for Payer: Aetna Medicare |
$1,191.58
|
| Rate for Payer: BCBS Complete |
$1,121.60
|
| Rate for Payer: BCBS Complete |
$1,167.60
|
| Rate for Payer: BCBS MAPPO |
$1,191.58
|
| Rate for Payer: BCBS MAPPO |
$1,191.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.58
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cofinity Commercial |
$1,596.72
|
| Rate for Payer: Cofinity Commercial |
$1,715.88
|
| Rate for Payer: Cofinity Commercial |
$1,596.72
|
| Rate for Payer: Cofinity Commercial |
$1,715.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.58
|
| Rate for Payer: Healthscope Commercial |
$1,429.90
|
| Rate for Payer: Healthscope Commercial |
$1,429.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,429.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,429.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.16
|
| Rate for Payer: Nomi Health Commercial |
$1,429.90
|
| Rate for Payer: Nomi Health Commercial |
$1,429.90
|
| Rate for Payer: PACE SWMI |
$1,191.58
|
| Rate for Payer: PACE SWMI |
$1,191.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.35
|
| Rate for Payer: Priority Health Medicare |
$1,191.58
|
| Rate for Payer: Priority Health Medicare |
$1,191.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,191.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,191.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,191.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,191.58
|
| Rate for Payer: UHCCP DNSP |
$1,191.58
|
| Rate for Payer: UHCCP DNSP |
$1,191.58
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$1,555.33 |
| Rate for Payer: Aetna Commercial |
$1,447.32
|
| Rate for Payer: Aetna Medicare |
$1,080.09
|
| Rate for Payer: BCBS Complete |
$491.60
|
| Rate for Payer: BCBS MAPPO |
$1,080.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,080.09
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,555.33
|
| Rate for Payer: Cofinity Commercial |
$1,447.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,080.09
|
| Rate for Payer: Healthscope Commercial |
$1,296.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,296.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,134.09
|
| Rate for Payer: Nomi Health Commercial |
$1,296.11
|
| Rate for Payer: PACE SWMI |
$1,080.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,080.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: Priority Health Medicare |
$1,080.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,080.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.09
|
| Rate for Payer: UHCCP DNSP |
$1,080.09
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$268.80 |
| Max. Negotiated Rate |
$1,428.81 |
| Rate for Payer: Aetna Commercial |
$1,329.59
|
| Rate for Payer: Aetna Medicare |
$992.23
|
| Rate for Payer: BCBS Complete |
$268.80
|
| Rate for Payer: BCBS MAPPO |
$992.23
|
| Rate for Payer: BCN Medicare Advantage |
$992.23
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$1,428.81
|
| Rate for Payer: Cofinity Commercial |
$1,329.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.23
|
| Rate for Payer: Healthscope Commercial |
$1,190.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,190.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.84
|
| Rate for Payer: Nomi Health Commercial |
$1,190.68
|
| Rate for Payer: PACE SWMI |
$992.23
|
| Rate for Payer: PHP Medicare Advantage |
$992.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.80
|
| Rate for Payer: Priority Health Medicare |
$992.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.23
|
| Rate for Payer: UHC Medicare Advantage |
$992.23
|
| Rate for Payer: UHCCP DNSP |
$992.23
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,796.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$718.40 |
| Max. Negotiated Rate |
$1,176.24 |
| Rate for Payer: Aetna Commercial |
$1,094.55
|
| Rate for Payer: Aetna Medicare |
$816.83
|
| Rate for Payer: BCBS Complete |
$718.40
|
| Rate for Payer: BCBS MAPPO |
$816.83
|
| Rate for Payer: BCN Medicare Advantage |
$816.83
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cofinity Commercial |
$1,176.24
|
| Rate for Payer: Cofinity Commercial |
$1,094.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.83
|
| Rate for Payer: Healthscope Commercial |
$980.20
|
| Rate for Payer: Healthscope Whirlpool |
$980.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$857.67
|
| Rate for Payer: Nomi Health Commercial |
$980.20
|
| Rate for Payer: PACE SWMI |
$816.83
|
| Rate for Payer: PHP Medicare Advantage |
$816.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.40
|
| Rate for Payer: Priority Health Medicare |
$816.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$816.83
|
| Rate for Payer: UHC Medicare Advantage |
$816.83
|
| Rate for Payer: UHCCP DNSP |
$816.83
|
|
|
PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA
|
Professional
|
Both
|
$2,480.00
|
|
|
Service Code
|
HCPCS 33974
|
| Min. Negotiated Rate |
$852.73 |
| Max. Negotiated Rate |
$1,612.00 |
| Rate for Payer: Aetna Commercial |
$1,142.66
|
| Rate for Payer: Aetna Medicare |
$852.73
|
| Rate for Payer: BCBS Complete |
$992.00
|
| Rate for Payer: BCBS MAPPO |
$852.73
|
| Rate for Payer: BCN Medicare Advantage |
$852.73
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cofinity Commercial |
$1,227.93
|
| Rate for Payer: Cofinity Commercial |
$1,142.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.73
|
| Rate for Payer: Healthscope Commercial |
$1,023.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,023.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.37
|
| Rate for Payer: Nomi Health Commercial |
$1,023.28
|
| Rate for Payer: PACE SWMI |
$852.73
|
| Rate for Payer: PHP Medicare Advantage |
$852.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.00
|
| Rate for Payer: Priority Health Medicare |
$852.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.73
|
| Rate for Payer: UHC Medicare Advantage |
$852.73
|
| Rate for Payer: UHCCP DNSP |
$852.73
|
|
|
PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 62142
|
| Min. Negotiated Rate |
$885.13 |
| Max. Negotiated Rate |
$2,191.15 |
| Rate for Payer: Aetna Commercial |
$1,186.07
|
| Rate for Payer: Aetna Medicare |
$885.13
|
| Rate for Payer: BCBS Complete |
$1,348.40
|
| Rate for Payer: BCBS MAPPO |
$885.13
|
| Rate for Payer: BCN Medicare Advantage |
$885.13
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cofinity Commercial |
$1,274.59
|
| Rate for Payer: Cofinity Commercial |
$1,186.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.13
|
| Rate for Payer: Healthscope Commercial |
$1,062.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,062.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$929.39
|
| Rate for Payer: Nomi Health Commercial |
$1,062.16
|
| Rate for Payer: PACE SWMI |
$885.13
|
| Rate for Payer: PHP Medicare Advantage |
$885.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,191.15
|
| Rate for Payer: Priority Health Medicare |
$885.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.13
|
| Rate for Payer: UHC Medicare Advantage |
$885.13
|
| Rate for Payer: UHCCP DNSP |
$885.13
|
|
|
PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 62256
|
| Min. Negotiated Rate |
$602.64 |
| Max. Negotiated Rate |
$1,434.55 |
| Rate for Payer: Aetna Commercial |
$807.54
|
| Rate for Payer: Aetna Medicare |
$602.64
|
| Rate for Payer: BCBS Complete |
$882.80
|
| Rate for Payer: BCBS MAPPO |
$602.64
|
| Rate for Payer: BCN Medicare Advantage |
$602.64
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cofinity Commercial |
$867.80
|
| Rate for Payer: Cofinity Commercial |
$807.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.64
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Healthscope Whirlpool |
$723.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.77
|
| Rate for Payer: Nomi Health Commercial |
$723.17
|
| Rate for Payer: PACE SWMI |
$602.64
|
| Rate for Payer: PHP Medicare Advantage |
$602.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.55
|
| Rate for Payer: Priority Health Medicare |
$602.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.64
|
| Rate for Payer: UHC Medicare Advantage |
$602.64
|
| Rate for Payer: UHCCP DNSP |
$602.64
|
|
|
PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
|
Professional
|
Both
|
$5,127.00
|
|
|
Service Code
|
HCPCS 62258
|
| Min. Negotiated Rate |
$1,098.19 |
| Max. Negotiated Rate |
$3,332.55 |
| Rate for Payer: Aetna Commercial |
$1,471.57
|
| Rate for Payer: Aetna Medicare |
$1,098.19
|
| Rate for Payer: BCBS Complete |
$2,050.80
|
| Rate for Payer: BCBS MAPPO |
$1,098.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,098.19
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,581.39
|
| Rate for Payer: Cofinity Commercial |
$1,471.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,098.19
|
| Rate for Payer: Healthscope Commercial |
$1,317.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,317.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,153.10
|
| Rate for Payer: Nomi Health Commercial |
$1,317.83
|
| Rate for Payer: PACE SWMI |
$1,098.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,098.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.55
|
| Rate for Payer: Priority Health Medicare |
$1,098.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,098.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,098.19
|
| Rate for Payer: UHCCP DNSP |
$1,098.19
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 40805
|
| Min. Negotiated Rate |
$189.19 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$253.51
|
| Rate for Payer: Aetna Medicare |
$189.19
|
| Rate for Payer: BCBS Complete |
$282.00
|
| Rate for Payer: BCBS MAPPO |
$189.19
|
| Rate for Payer: BCN Medicare Advantage |
$189.19
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$272.43
|
| Rate for Payer: Cofinity Commercial |
$253.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.19
|
| Rate for Payer: Healthscope Commercial |
$227.03
|
| Rate for Payer: Healthscope Whirlpool |
$227.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.65
|
| Rate for Payer: Nomi Health Commercial |
$227.03
|
| Rate for Payer: PACE SWMI |
$189.19
|
| Rate for Payer: PHP Medicare Advantage |
$189.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health Medicare |
$189.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.19
|
| Rate for Payer: UHC Medicare Advantage |
$189.19
|
| Rate for Payer: UHCCP DNSP |
$189.19
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 40804
|
| Min. Negotiated Rate |
$110.97 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$148.70
|
| Rate for Payer: Aetna Medicare |
$110.97
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS MAPPO |
$110.97
|
| Rate for Payer: BCN Medicare Advantage |
$110.97
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$148.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.97
|
| Rate for Payer: Healthscope Commercial |
$133.16
|
| Rate for Payer: Healthscope Whirlpool |
$133.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.52
|
| Rate for Payer: Nomi Health Commercial |
$133.16
|
| Rate for Payer: PACE SWMI |
$110.97
|
| Rate for Payer: PHP Medicare Advantage |
$110.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health Medicare |
$110.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.97
|
| Rate for Payer: UHC Medicare Advantage |
$110.97
|
| Rate for Payer: UHCCP DNSP |
$110.97
|
|
|
PR RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 63746
|
| Min. Negotiated Rate |
$604.43 |
| Max. Negotiated Rate |
$1,077.70 |
| Rate for Payer: Aetna Commercial |
$809.94
|
| Rate for Payer: Aetna Medicare |
$604.43
|
| Rate for Payer: BCBS Complete |
$663.20
|
| Rate for Payer: BCBS MAPPO |
$604.43
|
| Rate for Payer: BCN Medicare Advantage |
$604.43
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cofinity Commercial |
$870.38
|
| Rate for Payer: Cofinity Commercial |
$809.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.43
|
| Rate for Payer: Healthscope Commercial |
$725.32
|
| Rate for Payer: Healthscope Whirlpool |
$725.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$634.65
|
| Rate for Payer: Nomi Health Commercial |
$725.32
|
| Rate for Payer: PACE SWMI |
$604.43
|
| Rate for Payer: PHP Medicare Advantage |
$604.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health Medicare |
$604.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$604.43
|
| Rate for Payer: UHC Medicare Advantage |
$604.43
|
| Rate for Payer: UHCCP DNSP |
$604.43
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Medicare |
$89.41
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$89.41
|
| Rate for Payer: BCN Medicare Advantage |
$89.41
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$128.75
|
| Rate for Payer: Cofinity Commercial |
$119.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.41
|
| Rate for Payer: Healthscope Commercial |
$107.29
|
| Rate for Payer: Healthscope Whirlpool |
$107.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$107.29
|
| Rate for Payer: PACE SWMI |
$89.41
|
| Rate for Payer: PHP Medicare Advantage |
$89.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Medicare |
$89.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.41
|
| Rate for Payer: UHC Medicare Advantage |
$89.41
|
| Rate for Payer: UHCCP DNSP |
$89.41
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$45.67 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$45.67
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS MAPPO |
$45.67
|
| Rate for Payer: BCN Medicare Advantage |
$45.67
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$65.76
|
| Rate for Payer: Cofinity Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.67
|
| Rate for Payer: Healthscope Commercial |
$54.80
|
| Rate for Payer: Healthscope Whirlpool |
$54.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.95
|
| Rate for Payer: Nomi Health Commercial |
$54.80
|
| Rate for Payer: PACE SWMI |
$45.67
|
| Rate for Payer: PHP Medicare Advantage |
$45.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Medicare |
$45.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.67
|
| Rate for Payer: UHC Medicare Advantage |
$45.67
|
| Rate for Payer: UHCCP DNSP |
$45.67
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Aetna Commercial |
$51.82
|
| Rate for Payer: Aetna Medicare |
$38.67
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS MAPPO |
$38.67
|
| Rate for Payer: BCN Medicare Advantage |
$38.67
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Cofinity Commercial |
$51.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.67
|
| Rate for Payer: Healthscope Commercial |
$46.40
|
| Rate for Payer: Healthscope Whirlpool |
$46.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$46.40
|
| Rate for Payer: PACE SWMI |
$38.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health Medicare |
$38.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.67
|
| Rate for Payer: UHC Medicare Advantage |
$38.67
|
| Rate for Payer: UHCCP DNSP |
$38.67
|
|
