|
PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 65222
|
| Min. Negotiated Rate |
$46.37 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$62.14
|
| Rate for Payer: Aetna Medicare |
$46.37
|
| Rate for Payer: BCBS Complete |
$73.20
|
| Rate for Payer: BCBS MAPPO |
$46.37
|
| Rate for Payer: BCN Medicare Advantage |
$46.37
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$66.77
|
| Rate for Payer: Cofinity Commercial |
$62.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.37
|
| Rate for Payer: Healthscope Commercial |
$55.64
|
| Rate for Payer: Healthscope Whirlpool |
$55.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.69
|
| Rate for Payer: Nomi Health Commercial |
$55.64
|
| Rate for Payer: PACE SWMI |
$46.37
|
| Rate for Payer: PHP Medicare Advantage |
$46.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health Medicare |
$46.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.37
|
| Rate for Payer: UHC Medicare Advantage |
$46.37
|
| Rate for Payer: UHCCP DNSP |
$46.37
|
|
|
PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 65210
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$44.94
|
| Rate for Payer: Aetna Medicare |
$33.54
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS MAPPO |
$33.54
|
| Rate for Payer: BCN Medicare Advantage |
$33.54
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Cofinity Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.54
|
| Rate for Payer: Healthscope Commercial |
$40.25
|
| Rate for Payer: Healthscope Whirlpool |
$40.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.22
|
| Rate for Payer: Nomi Health Commercial |
$40.25
|
| Rate for Payer: PACE SWMI |
$33.54
|
| Rate for Payer: PHP Medicare Advantage |
$33.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health Medicare |
$33.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.54
|
| Rate for Payer: UHC Medicare Advantage |
$33.54
|
| Rate for Payer: UHCCP DNSP |
$33.54
|
|
|
PR RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
HCPCS 45915
|
| Min. Negotiated Rate |
$219.66 |
| Max. Negotiated Rate |
$398.45 |
| Rate for Payer: Aetna Commercial |
$294.34
|
| Rate for Payer: Aetna Medicare |
$219.66
|
| Rate for Payer: BCBS Complete |
$245.20
|
| Rate for Payer: BCBS MAPPO |
$219.66
|
| Rate for Payer: BCN Medicare Advantage |
$219.66
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cofinity Commercial |
$316.31
|
| Rate for Payer: Cofinity Commercial |
$294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.66
|
| Rate for Payer: Healthscope Commercial |
$263.59
|
| Rate for Payer: Healthscope Whirlpool |
$263.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.64
|
| Rate for Payer: Nomi Health Commercial |
$263.59
|
| Rate for Payer: PACE SWMI |
$219.66
|
| Rate for Payer: PHP Medicare Advantage |
$219.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.45
|
| Rate for Payer: Priority Health Medicare |
$219.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.66
|
| Rate for Payer: UHC Medicare Advantage |
$219.66
|
| Rate for Payer: UHCCP DNSP |
$219.66
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$4,326.52 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Aetna Medicare |
$2,791.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: ASR ASR |
$744.96
|
| Rate for Payer: ASR Commercial |
$744.96
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$628.92
|
| Rate for Payer: BCN Commercial |
$595.43
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$721.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$768.00
|
| Rate for Payer: Healthscope Whirlpool |
$744.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,791.30
|
| Rate for Payer: Mclaren Commercial |
$691.20
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.80
|
| Rate for Payer: Nomi Health Commercial |
$629.76
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,070.43
|
| Rate for Payer: PHP Medicaid |
$1,496.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$672.92
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$538.37
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$675.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$4,326.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP DNSP |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: ASR ASR |
$744.96
|
| Rate for Payer: ASR Commercial |
$744.96
|
| Rate for Payer: BCBS Trust/PPO |
$625.84
|
| Rate for Payer: BCN Commercial |
$595.43
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$721.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Healthscope Commercial |
$768.00
|
| Rate for Payer: Healthscope Whirlpool |
$744.96
|
| Rate for Payer: Mclaren Commercial |
$691.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.80
|
| Rate for Payer: Nomi Health Commercial |
$629.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$675.84
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Min. Negotiated Rate |
$238.48 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$319.56
|
| Rate for Payer: Aetna Medicare |
$238.48
|
| Rate for Payer: BCBS Complete |
$307.20
|
| Rate for Payer: BCBS MAPPO |
$238.48
|
| Rate for Payer: BCN Medicare Advantage |
$238.48
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$343.41
|
| Rate for Payer: Cofinity Commercial |
$319.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.48
|
| Rate for Payer: Healthscope Commercial |
$286.18
|
| Rate for Payer: Healthscope Whirlpool |
$286.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.40
|
| Rate for Payer: Nomi Health Commercial |
$286.18
|
| Rate for Payer: PACE SWMI |
$238.48
|
| Rate for Payer: PHP Medicare Advantage |
$238.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health Medicare |
$238.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.48
|
| Rate for Payer: UHC Medicare Advantage |
$238.48
|
| Rate for Payer: UHCCP DNSP |
$238.48
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
20525
|
| Min. Negotiated Rate |
$238.48 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$319.56
|
| Rate for Payer: Aetna Medicare |
$238.48
|
| Rate for Payer: BCBS Complete |
$307.20
|
| Rate for Payer: BCBS MAPPO |
$238.48
|
| Rate for Payer: BCN Medicare Advantage |
$238.48
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$343.41
|
| Rate for Payer: Cofinity Commercial |
$319.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.48
|
| Rate for Payer: Healthscope Commercial |
$286.18
|
| Rate for Payer: Healthscope Whirlpool |
$286.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.40
|
| Rate for Payer: Nomi Health Commercial |
$286.18
|
| Rate for Payer: PACE SWMI |
$238.48
|
| Rate for Payer: PHP Medicare Advantage |
$238.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health Medicare |
$238.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.48
|
| Rate for Payer: UHC Medicare Advantage |
$238.48
|
| Rate for Payer: UHCCP DNSP |
$238.48
|
|
|
PR RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 27086
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$263.90 |
| Rate for Payer: Aetna Commercial |
$216.77
|
| Rate for Payer: Aetna Medicare |
$161.77
|
| Rate for Payer: BCBS Complete |
$162.40
|
| Rate for Payer: BCBS MAPPO |
$161.77
|
| Rate for Payer: BCN Medicare Advantage |
$161.77
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$232.95
|
| Rate for Payer: Cofinity Commercial |
$216.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.77
|
| Rate for Payer: Healthscope Commercial |
$194.12
|
| Rate for Payer: Healthscope Whirlpool |
$194.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.86
|
| Rate for Payer: Nomi Health Commercial |
$194.12
|
| Rate for Payer: PACE SWMI |
$161.77
|
| Rate for Payer: PHP Medicare Advantage |
$161.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health Medicare |
$161.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.77
|
| Rate for Payer: UHC Medicare Advantage |
$161.77
|
| Rate for Payer: UHCCP DNSP |
$161.77
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| 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 |
$318.16
|
| Rate for Payer: ASR Commercial |
$318.16
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$268.60
|
| Rate for Payer: BCN Commercial |
$254.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$308.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| 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 |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| 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 |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.39
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$229.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
| 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 RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: ASR Commercial |
$318.16
|
| Rate for Payer: BCBS Trust/PPO |
$267.29
|
| Rate for Payer: BCN Commercial |
$254.30
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$308.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$184.08
|
| Rate for Payer: Aetna Medicare |
$137.37
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$137.37
|
| Rate for Payer: BCN Medicare Advantage |
$137.37
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$197.81
|
| Rate for Payer: Cofinity Commercial |
$184.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.37
|
| Rate for Payer: Healthscope Commercial |
$164.84
|
| Rate for Payer: Healthscope Whirlpool |
$164.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.24
|
| Rate for Payer: Nomi Health Commercial |
$164.84
|
| Rate for Payer: PACE SWMI |
$137.37
|
| Rate for Payer: PHP Medicare Advantage |
$137.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$137.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.37
|
| Rate for Payer: UHC Medicare Advantage |
$137.37
|
| Rate for Payer: UHCCP DNSP |
$137.37
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 24200
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$184.08
|
| Rate for Payer: Aetna Medicare |
$137.37
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$137.37
|
| Rate for Payer: BCN Medicare Advantage |
$137.37
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$197.81
|
| Rate for Payer: Cofinity Commercial |
$184.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.37
|
| Rate for Payer: Healthscope Commercial |
$164.84
|
| Rate for Payer: Healthscope Whirlpool |
$164.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.24
|
| Rate for Payer: Nomi Health Commercial |
$164.84
|
| Rate for Payer: PACE SWMI |
$137.37
|
| Rate for Payer: PHP Medicare Advantage |
$137.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$137.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.37
|
| Rate for Payer: UHC Medicare Advantage |
$137.37
|
| Rate for Payer: UHCCP DNSP |
$137.37
|
|
|
PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA
|
Professional
|
Both
|
$3,292.00
|
|
|
Service Code
|
HCPCS 27091
|
| Min. Negotiated Rate |
$1,316.80 |
| Max. Negotiated Rate |
$2,208.15 |
| Rate for Payer: Aetna Commercial |
$2,054.81
|
| Rate for Payer: Aetna Medicare |
$1,533.44
|
| Rate for Payer: BCBS Complete |
$1,316.80
|
| Rate for Payer: BCBS MAPPO |
$1,533.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,533.44
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cofinity Commercial |
$2,208.15
|
| Rate for Payer: Cofinity Commercial |
$2,054.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,533.44
|
| Rate for Payer: Healthscope Commercial |
$1,840.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,840.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,610.11
|
| Rate for Payer: Nomi Health Commercial |
$1,840.13
|
| Rate for Payer: PACE SWMI |
$1,533.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,533.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.80
|
| Rate for Payer: Priority Health Medicare |
$1,533.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,533.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,533.44
|
| Rate for Payer: UHCCP DNSP |
$1,533.44
|
|
|
PR RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF
|
Professional
|
Both
|
$2,625.00
|
|
|
Service Code
|
HCPCS 33971
|
| Min. Negotiated Rate |
$676.18 |
| Max. Negotiated Rate |
$1,706.25 |
| Rate for Payer: Aetna Commercial |
$906.08
|
| Rate for Payer: Aetna Medicare |
$676.18
|
| Rate for Payer: BCBS Complete |
$1,050.00
|
| Rate for Payer: BCBS MAPPO |
$676.18
|
| Rate for Payer: BCN Medicare Advantage |
$676.18
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cofinity Commercial |
$973.70
|
| Rate for Payer: Cofinity Commercial |
$906.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.18
|
| Rate for Payer: Healthscope Commercial |
$811.42
|
| Rate for Payer: Healthscope Whirlpool |
$811.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.99
|
| Rate for Payer: Nomi Health Commercial |
$811.42
|
| Rate for Payer: PACE SWMI |
$676.18
|
| Rate for Payer: PHP Medicare Advantage |
$676.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,706.25
|
| Rate for Payer: Priority Health Medicare |
$676.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.18
|
| Rate for Payer: UHC Medicare Advantage |
$676.18
|
| Rate for Payer: UHCCP DNSP |
$676.18
|
|
|
PR RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 33284
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Aetna Medicare |
$245.00
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 33262
|
| Min. Negotiated Rate |
$268.40 |
| Max. Negotiated Rate |
$507.57 |
| Rate for Payer: Aetna Commercial |
$472.32
|
| Rate for Payer: Aetna Medicare |
$352.48
|
| Rate for Payer: BCBS Complete |
$268.40
|
| Rate for Payer: BCBS MAPPO |
$352.48
|
| Rate for Payer: BCN Medicare Advantage |
$352.48
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cofinity Commercial |
$507.57
|
| Rate for Payer: Cofinity Commercial |
$472.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.48
|
| Rate for Payer: Healthscope Commercial |
$422.98
|
| Rate for Payer: Healthscope Whirlpool |
$422.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.10
|
| Rate for Payer: Nomi Health Commercial |
$422.98
|
| Rate for Payer: PACE SWMI |
$352.48
|
| Rate for Payer: PHP Medicare Advantage |
$352.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.15
|
| Rate for Payer: Priority Health Medicare |
$352.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.48
|
| Rate for Payer: UHC Medicare Advantage |
$352.48
|
| Rate for Payer: UHCCP DNSP |
$352.48
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 33263
|
| Min. Negotiated Rate |
$314.80 |
| Max. Negotiated Rate |
$528.34 |
| Rate for Payer: Aetna Commercial |
$491.65
|
| Rate for Payer: Aetna Medicare |
$366.90
|
| Rate for Payer: BCBS Complete |
$314.80
|
| Rate for Payer: BCBS MAPPO |
$366.90
|
| Rate for Payer: BCN Medicare Advantage |
$366.90
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cofinity Commercial |
$528.34
|
| Rate for Payer: Cofinity Commercial |
$491.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.90
|
| Rate for Payer: Healthscope Commercial |
$440.28
|
| Rate for Payer: Healthscope Whirlpool |
$440.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$385.25
|
| Rate for Payer: Nomi Health Commercial |
$440.28
|
| Rate for Payer: PACE SWMI |
$366.90
|
| Rate for Payer: PHP Medicare Advantage |
$366.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.55
|
| Rate for Payer: Priority Health Medicare |
$366.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.90
|
| Rate for Payer: UHC Medicare Advantage |
$366.90
|
| Rate for Payer: UHCCP DNSP |
$366.90
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 33264
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$550.67 |
| Rate for Payer: Aetna Commercial |
$512.43
|
| Rate for Payer: Aetna Medicare |
$382.41
|
| Rate for Payer: BCBS Complete |
$328.80
|
| Rate for Payer: BCBS MAPPO |
$382.41
|
| Rate for Payer: BCN Medicare Advantage |
$382.41
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$550.67
|
| Rate for Payer: Cofinity Commercial |
$512.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.41
|
| Rate for Payer: Healthscope Commercial |
$458.89
|
| Rate for Payer: Healthscope Whirlpool |
$458.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$401.53
|
| Rate for Payer: Nomi Health Commercial |
$458.89
|
| Rate for Payer: PACE SWMI |
$382.41
|
| Rate for Payer: PHP Medicare Advantage |
$382.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.30
|
| Rate for Payer: Priority Health Medicare |
$382.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$382.41
|
| Rate for Payer: UHC Medicare Advantage |
$382.41
|
| Rate for Payer: UHCCP DNSP |
$382.41
|
|
|
PR RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH
|
Professional
|
Both
|
$1,392.00
|
|
|
Service Code
|
HCPCS 54406
|
| Min. Negotiated Rate |
$556.80 |
| Max. Negotiated Rate |
$1,007.28 |
| Rate for Payer: Aetna Commercial |
$937.33
|
| Rate for Payer: Aetna Medicare |
$699.50
|
| Rate for Payer: BCBS Complete |
$556.80
|
| Rate for Payer: BCBS MAPPO |
$699.50
|
| Rate for Payer: BCN Medicare Advantage |
$699.50
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cofinity Commercial |
$937.33
|
| Rate for Payer: Cofinity Commercial |
$1,007.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$699.50
|
| Rate for Payer: Healthscope Commercial |
$839.40
|
| Rate for Payer: Healthscope Whirlpool |
$839.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$734.48
|
| Rate for Payer: Nomi Health Commercial |
$839.40
|
| Rate for Payer: PACE SWMI |
$699.50
|
| Rate for Payer: PHP Medicare Advantage |
$699.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$904.80
|
| Rate for Payer: Priority Health Medicare |
$699.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$699.50
|
| Rate for Payer: UHC Medicare Advantage |
$699.50
|
| Rate for Payer: UHCCP DNSP |
$699.50
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY
|
Professional
|
Both
|
$3,691.00
|
|
|
Service Code
|
HCPCS 32484
|
| Min. Negotiated Rate |
$1,378.86 |
| Max. Negotiated Rate |
$2,399.15 |
| Rate for Payer: Aetna Commercial |
$1,847.67
|
| Rate for Payer: Aetna Medicare |
$1,378.86
|
| Rate for Payer: BCBS Complete |
$1,476.40
|
| Rate for Payer: BCBS MAPPO |
$1,378.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.86
|
| Rate for Payer: Cash Price |
$2,952.80
|
| Rate for Payer: Cash Price |
$2,952.80
|
| Rate for Payer: Cofinity Commercial |
$1,985.56
|
| Rate for Payer: Cofinity Commercial |
$1,847.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.86
|
| Rate for Payer: Healthscope Commercial |
$1,654.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,654.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,447.80
|
| Rate for Payer: Nomi Health Commercial |
$1,654.63
|
| Rate for Payer: PACE SWMI |
$1,378.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,399.15
|
| Rate for Payer: Priority Health Medicare |
$1,378.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,378.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,378.86
|
| Rate for Payer: UHCCP DNSP |
$1,378.86
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC
|
Professional
|
Both
|
$5,362.00
|
|
|
Service Code
|
HCPCS 32482
|
| Min. Negotiated Rate |
$1,520.63 |
| Max. Negotiated Rate |
$3,485.30 |
| Rate for Payer: Aetna Commercial |
$2,037.64
|
| Rate for Payer: Aetna Medicare |
$1,520.63
|
| Rate for Payer: BCBS Complete |
$2,144.80
|
| Rate for Payer: BCBS MAPPO |
$1,520.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,520.63
|
| Rate for Payer: Cash Price |
$4,289.60
|
| Rate for Payer: Cash Price |
$4,289.60
|
| Rate for Payer: Cofinity Commercial |
$2,189.71
|
| Rate for Payer: Cofinity Commercial |
$2,037.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,520.63
|
| Rate for Payer: Healthscope Commercial |
$1,824.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,824.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,596.66
|
| Rate for Payer: Nomi Health Commercial |
$1,824.76
|
| Rate for Payer: PACE SWMI |
$1,520.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,520.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,485.30
|
| Rate for Payer: Priority Health Medicare |
$1,520.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,520.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,520.63
|
| Rate for Payer: UHCCP DNSP |
$1,520.63
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT
|
Professional
|
Both
|
$4,766.00
|
|
|
Service Code
|
HCPCS 32480
|
| Min. Negotiated Rate |
$1,421.35 |
| Max. Negotiated Rate |
$3,097.90 |
| Rate for Payer: Aetna Commercial |
$1,904.61
|
| Rate for Payer: Aetna Medicare |
$1,421.35
|
| Rate for Payer: BCBS Complete |
$1,906.40
|
| Rate for Payer: BCBS MAPPO |
$1,421.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,421.35
|
| Rate for Payer: Cash Price |
$3,812.80
|
| Rate for Payer: Cash Price |
$3,812.80
|
| Rate for Payer: Cofinity Commercial |
$2,046.74
|
| Rate for Payer: Cofinity Commercial |
$1,904.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,421.35
|
| Rate for Payer: Healthscope Commercial |
$1,705.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,705.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,492.42
|
| Rate for Payer: Nomi Health Commercial |
$1,705.62
|
| Rate for Payer: PACE SWMI |
$1,421.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,421.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,097.90
|
| Rate for Payer: Priority Health Medicare |
$1,421.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,421.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,421.35
|
| Rate for Payer: UHCCP DNSP |
$1,421.35
|
|
|
PR RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC
|
Professional
|
Both
|
$4,483.00
|
|
|
Service Code
|
HCPCS 32488
|
| Min. Negotiated Rate |
$1,793.20 |
| Max. Negotiated Rate |
$3,307.06 |
| Rate for Payer: Aetna Commercial |
$3,077.40
|
| Rate for Payer: Aetna Medicare |
$2,296.57
|
| Rate for Payer: BCBS Complete |
$1,793.20
|
| Rate for Payer: BCBS MAPPO |
$2,296.57
|
| Rate for Payer: BCN Medicare Advantage |
$2,296.57
|
| Rate for Payer: Cash Price |
$3,586.40
|
| Rate for Payer: Cash Price |
$3,586.40
|
| Rate for Payer: Cofinity Commercial |
$3,307.06
|
| Rate for Payer: Cofinity Commercial |
$3,077.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,296.57
|
| Rate for Payer: Healthscope Commercial |
$2,755.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,755.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,411.40
|
| Rate for Payer: Nomi Health Commercial |
$2,755.88
|
| Rate for Payer: PACE SWMI |
$2,296.57
|
| Rate for Payer: PHP Medicare Advantage |
$2,296.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,913.95
|
| Rate for Payer: Priority Health Medicare |
$2,296.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,296.57
|
| Rate for Payer: UHC Medicare Advantage |
$2,296.57
|
| Rate for Payer: UHCCP DNSP |
$2,296.57
|
|
|
PR RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY
|
Professional
|
Both
|
$4,436.00
|
|
|
Service Code
|
HCPCS 32486
|
| Min. Negotiated Rate |
$1,774.40 |
| Max. Negotiated Rate |
$3,237.62 |
| Rate for Payer: Aetna Commercial |
$3,012.79
|
| Rate for Payer: Aetna Medicare |
$2,248.35
|
| Rate for Payer: BCBS Complete |
$1,774.40
|
| Rate for Payer: BCBS MAPPO |
$2,248.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,248.35
|
| Rate for Payer: Cash Price |
$3,548.80
|
| Rate for Payer: Cash Price |
$3,548.80
|
| Rate for Payer: Cofinity Commercial |
$3,237.62
|
| Rate for Payer: Cofinity Commercial |
$3,012.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,248.35
|
| Rate for Payer: Healthscope Commercial |
$2,698.02
|
| Rate for Payer: Healthscope Whirlpool |
$2,698.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,360.77
|
| Rate for Payer: Nomi Health Commercial |
$2,698.02
|
| Rate for Payer: PACE SWMI |
$2,248.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,248.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,883.40
|
| Rate for Payer: Priority Health Medicare |
$2,248.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,248.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,248.35
|
| Rate for Payer: UHCCP DNSP |
$2,248.35
|
|
|
PR RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 32552
|
| Min. Negotiated Rate |
$138.40 |
| Max. Negotiated Rate |
$224.90 |
| Rate for Payer: Aetna Commercial |
$198.25
|
| Rate for Payer: Aetna Medicare |
$147.95
|
| Rate for Payer: BCBS Complete |
$138.40
|
| Rate for Payer: BCBS MAPPO |
$147.95
|
| Rate for Payer: BCN Medicare Advantage |
$147.95
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$213.05
|
| Rate for Payer: Cofinity Commercial |
$198.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.95
|
| Rate for Payer: Healthscope Commercial |
$177.54
|
| Rate for Payer: Healthscope Whirlpool |
$177.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.35
|
| Rate for Payer: Nomi Health Commercial |
$177.54
|
| Rate for Payer: PACE SWMI |
$147.95
|
| Rate for Payer: PHP Medicare Advantage |
$147.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.90
|
| Rate for Payer: Priority Health Medicare |
$147.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.95
|
| Rate for Payer: UHC Medicare Advantage |
$147.95
|
| Rate for Payer: UHCCP DNSP |
$147.95
|
|
