|
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 |
$93.51 |
| Max. Negotiated Rate |
$318.13 |
| Rate for Payer: Aetna Commercial |
$187.10
|
| Rate for Payer: Aetna Medicare |
$164.00
|
| Rate for Payer: BCBS Complete |
$98.19
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$318.13
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Meridian Medicaid |
$98.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.82
|
| Rate for Payer: Priority Health Narrow Network |
$218.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.39
|
| Rate for Payer: UHC Exchange |
$155.39
|
| Rate for Payer: UHCCP Medicaid |
$93.51
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 24200
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$318.13 |
| Rate for Payer: Aetna Commercial |
$187.10
|
| Rate for Payer: Aetna Medicare |
$164.00
|
| Rate for Payer: BCBS Complete |
$98.19
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$318.13
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Meridian Medicaid |
$98.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.82
|
| Rate for Payer: Priority Health Narrow Network |
$218.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.39
|
| Rate for Payer: UHC Exchange |
$155.39
|
| Rate for Payer: UHCCP Medicaid |
$93.51
|
|
|
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 |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: ASR Commercial |
$318.16
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$268.60
|
| Rate for Payer: BCN Commercial |
$254.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| 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 |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.70
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$615.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA
|
Professional
|
Both
|
$3,292.00
|
|
|
Service Code
|
HCPCS 27091
|
| Min. Negotiated Rate |
$538.87 |
| Max. Negotiated Rate |
$2,434.38 |
| Rate for Payer: Aetna Commercial |
$2,131.08
|
| Rate for Payer: Aetna Medicare |
$1,646.00
|
| Rate for Payer: BCBS Complete |
$1,078.66
|
| Rate for Payer: BCBS Trust/PPO |
$538.87
|
| Rate for Payer: BCN Commercial |
$2,324.64
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Meridian Medicaid |
$1,078.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,027.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,434.38
|
| Rate for Payer: Priority Health Narrow Network |
$2,434.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,859.96
|
| Rate for Payer: UHC Exchange |
$1,859.96
|
| Rate for Payer: UHCCP Medicaid |
$1,027.30
|
|
|
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 |
$446.66 |
| Max. Negotiated Rate |
$1,706.25 |
| Rate for Payer: Aetna Commercial |
$939.89
|
| Rate for Payer: Aetna Medicare |
$1,312.50
|
| Rate for Payer: BCBS Complete |
$468.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.81
|
| Rate for Payer: BCN Commercial |
$1,016.94
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Meridian Medicaid |
$468.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,706.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,113.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,113.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$934.36
|
| Rate for Payer: UHC Exchange |
$934.36
|
| Rate for Payer: UHCCP Medicaid |
$446.66
|
|
|
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 |
$234.73 |
| Max. Negotiated Rate |
$5,175.23 |
| Rate for Payer: Aetna Commercial |
$501.00
|
| Rate for Payer: Aetna Medicare |
$335.50
|
| Rate for Payer: BCBS Complete |
$246.47
|
| Rate for Payer: BCBS Trust/PPO |
$5,175.23
|
| Rate for Payer: BCN Commercial |
$539.50
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Meridian Medicaid |
$246.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$584.48
|
| Rate for Payer: Priority Health Narrow Network |
$584.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$501.89
|
| Rate for Payer: UHC Exchange |
$501.89
|
| Rate for Payer: UHCCP Medicaid |
$234.73
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 33263
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$6,021.04 |
| Rate for Payer: Aetna Commercial |
$521.20
|
| Rate for Payer: Aetna Medicare |
$393.50
|
| Rate for Payer: BCBS Complete |
$256.30
|
| Rate for Payer: BCBS Trust/PPO |
$6,021.04
|
| Rate for Payer: BCN Commercial |
$560.02
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Meridian Medicaid |
$256.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$607.34
|
| Rate for Payer: Priority Health Narrow Network |
$607.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$521.76
|
| Rate for Payer: UHC Exchange |
$521.76
|
| Rate for Payer: UHCCP Medicaid |
$244.10
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 33264
|
| Min. Negotiated Rate |
$254.32 |
| Max. Negotiated Rate |
$2,214.63 |
| Rate for Payer: Aetna Commercial |
$544.48
|
| Rate for Payer: Aetna Medicare |
$411.00
|
| Rate for Payer: BCBS Complete |
$267.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.63
|
| Rate for Payer: BCN Commercial |
$583.97
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Meridian Medicaid |
$267.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.40
|
| Rate for Payer: Priority Health Narrow Network |
$633.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.64
|
| Rate for Payer: UHC Exchange |
$541.64
|
| Rate for Payer: UHCCP Medicaid |
$254.32
|
|
|
PR RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH
|
Professional
|
Both
|
$1,392.00
|
|
|
Service Code
|
HCPCS 54406
|
| Min. Negotiated Rate |
$469.24 |
| Max. Negotiated Rate |
$1,959.10 |
| Rate for Payer: Aetna Commercial |
$938.52
|
| Rate for Payer: Aetna Medicare |
$696.00
|
| Rate for Payer: BCBS Complete |
$492.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.10
|
| Rate for Payer: BCN Commercial |
$1,055.55
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Meridian Medicaid |
$492.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$469.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$904.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,165.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,165.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.91
|
| Rate for Payer: UHC Exchange |
$880.91
|
| Rate for Payer: UHCCP Medicaid |
$469.24
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY
|
Professional
|
Both
|
$3,691.00
|
|
|
Service Code
|
HCPCS 32484
|
| Min. Negotiated Rate |
$524.07 |
| Max. Negotiated Rate |
$2,399.15 |
| Rate for Payer: Aetna Commercial |
$1,853.16
|
| Rate for Payer: Aetna Medicare |
$1,845.50
|
| Rate for Payer: BCBS Complete |
$951.64
|
| Rate for Payer: BCBS Trust/PPO |
$524.07
|
| Rate for Payer: BCN Commercial |
$2,059.77
|
| Rate for Payer: Cash Price |
$2,952.80
|
| Rate for Payer: Cash Price |
$2,952.80
|
| Rate for Payer: Meridian Medicaid |
$951.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$906.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,399.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,962.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,962.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,713.22
|
| Rate for Payer: UHC Exchange |
$1,713.22
|
| Rate for Payer: UHCCP Medicaid |
$906.32
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC
|
Professional
|
Both
|
$5,362.00
|
|
|
Service Code
|
HCPCS 32482
|
| Min. Negotiated Rate |
$550.49 |
| Max. Negotiated Rate |
$3,485.30 |
| Rate for Payer: Aetna Commercial |
$2,045.67
|
| Rate for Payer: Aetna Medicare |
$2,681.00
|
| Rate for Payer: BCBS Complete |
$1,051.38
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$2,273.82
|
| Rate for Payer: Cash Price |
$4,289.60
|
| Rate for Payer: Cash Price |
$4,289.60
|
| Rate for Payer: Meridian Medicaid |
$1,051.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,001.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,485.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.70
|
| Rate for Payer: Priority Health Narrow Network |
$2,166.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,885.74
|
| Rate for Payer: UHC Exchange |
$1,885.74
|
| Rate for Payer: UHCCP Medicaid |
$1,001.31
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT
|
Professional
|
Both
|
$4,766.00
|
|
|
Service Code
|
HCPCS 32480
|
| Min. Negotiated Rate |
$546.26 |
| Max. Negotiated Rate |
$3,097.90 |
| Rate for Payer: Aetna Commercial |
$1,911.03
|
| Rate for Payer: Aetna Medicare |
$2,383.00
|
| Rate for Payer: BCBS Complete |
$982.28
|
| Rate for Payer: BCBS Trust/PPO |
$546.26
|
| Rate for Payer: BCN Commercial |
$2,127.70
|
| Rate for Payer: Cash Price |
$3,812.80
|
| Rate for Payer: Cash Price |
$3,812.80
|
| Rate for Payer: Meridian Medicaid |
$982.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$935.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,097.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,027.21
|
| Rate for Payer: Priority Health Narrow Network |
$2,027.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,765.08
|
| Rate for Payer: UHC Exchange |
$1,765.08
|
| Rate for Payer: UHCCP Medicaid |
$935.50
|
|
|
PR RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC
|
Professional
|
Both
|
$4,483.00
|
|
|
Service Code
|
HCPCS 32488
|
| Min. Negotiated Rate |
$873.28 |
| Max. Negotiated Rate |
$3,431.00 |
| Rate for Payer: Aetna Commercial |
$3,091.30
|
| Rate for Payer: Aetna Medicare |
$2,241.50
|
| Rate for Payer: BCBS Complete |
$1,581.43
|
| Rate for Payer: BCBS Trust/PPO |
$873.28
|
| Rate for Payer: BCN Commercial |
$3,431.00
|
| Rate for Payer: Cash Price |
$3,586.40
|
| Rate for Payer: Cash Price |
$3,586.40
|
| Rate for Payer: Meridian Medicaid |
$1,581.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,506.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,913.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,268.36
|
| Rate for Payer: Priority Health Narrow Network |
$3,268.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,830.70
|
| Rate for Payer: UHC Exchange |
$2,830.70
|
| Rate for Payer: UHCCP Medicaid |
$1,506.12
|
|
|
PR RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY
|
Professional
|
Both
|
$4,436.00
|
|
|
Service Code
|
HCPCS 32486
|
| Min. Negotiated Rate |
$663.54 |
| Max. Negotiated Rate |
$3,356.72 |
| Rate for Payer: Aetna Commercial |
$3,031.83
|
| Rate for Payer: Aetna Medicare |
$2,218.00
|
| Rate for Payer: BCBS Complete |
$1,545.20
|
| Rate for Payer: BCBS Trust/PPO |
$663.54
|
| Rate for Payer: BCN Commercial |
$3,356.72
|
| Rate for Payer: Cash Price |
$3,548.80
|
| Rate for Payer: Cash Price |
$3,548.80
|
| Rate for Payer: Meridian Medicaid |
$1,545.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,471.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,883.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,195.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,195.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,799.22
|
| Rate for Payer: UHC Exchange |
$2,799.22
|
| Rate for Payer: UHCCP Medicaid |
$1,471.62
|
|
|
PR RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 32552
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$887.54 |
| Rate for Payer: Aetna Commercial |
$202.65
|
| Rate for Payer: Aetna Medicare |
$173.00
|
| Rate for Payer: BCBS Complete |
$104.44
|
| Rate for Payer: BCBS Trust/PPO |
$887.54
|
| Rate for Payer: BCN Commercial |
$265.85
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Meridian Medicaid |
$104.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.98
|
| Rate for Payer: Priority Health Narrow Network |
$215.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.27
|
| Rate for Payer: UHC Exchange |
$188.27
|
| Rate for Payer: UHCCP Medicaid |
$99.47
|
|
|
PR RMVL NFROS TUBE REQ FLUORO GUIDANCE
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 50389
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$3,593.50 |
| Rate for Payer: Aetna Commercial |
$68.80
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$3,593.50
|
| Rate for Payer: BCN Commercial |
$615.25
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.09
|
| Rate for Payer: Priority Health Narrow Network |
$83.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.59
|
| Rate for Payer: UHC Exchange |
$66.59
|
| Rate for Payer: UHCCP Medicaid |
$33.65
|
|
|
PR RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 49623
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$3,514.78 |
| Rate for Payer: Aetna Commercial |
$266.29
|
| Rate for Payer: Aetna Medicare |
$201.00
|
| Rate for Payer: BCBS Complete |
$135.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,514.78
|
| Rate for Payer: BCN Commercial |
$287.34
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Meridian Medicaid |
$135.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.80
|
| Rate for Payer: Priority Health Narrow Network |
$350.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.69
|
| Rate for Payer: UHC Exchange |
$271.69
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
|
|
PR RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT
|
Professional
|
Both
|
$1,084.00
|
|
|
Service Code
|
HCPCS 54415
|
| Min. Negotiated Rate |
$342.50 |
| Max. Negotiated Rate |
$1,959.10 |
| Rate for Payer: Aetna Commercial |
$679.13
|
| Rate for Payer: Aetna Medicare |
$542.00
|
| Rate for Payer: BCBS Complete |
$359.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.10
|
| Rate for Payer: BCN Commercial |
$768.69
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Meridian Medicaid |
$359.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$852.16
|
| Rate for Payer: Priority Health Narrow Network |
$852.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.51
|
| Rate for Payer: UHC Exchange |
$633.51
|
| Rate for Payer: UHCCP Medicaid |
$342.50
|
|
|
PR RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 33272
|
| Min. Negotiated Rate |
$220.24 |
| Max. Negotiated Rate |
$2,196.14 |
| Rate for Payer: Aetna Commercial |
$464.31
|
| Rate for Payer: Aetna Medicare |
$360.00
|
| Rate for Payer: BCBS Complete |
$231.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,196.14
|
| Rate for Payer: BCN Commercial |
$501.39
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Meridian Medicaid |
$231.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.65
|
| Rate for Payer: Priority Health Narrow Network |
$545.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.69
|
| Rate for Payer: UHC Exchange |
$484.69
|
| Rate for Payer: UHCCP Medicaid |
$220.24
|
|
|
PR RMVL PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 49429
|
| Min. Negotiated Rate |
$295.01 |
| Max. Negotiated Rate |
$1,039.35 |
| Rate for Payer: Aetna Commercial |
$619.78
|
| Rate for Payer: Aetna Medicare |
$799.50
|
| Rate for Payer: BCBS Complete |
$309.76
|
| Rate for Payer: BCN Commercial |
$670.47
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Meridian Medicaid |
$309.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$820.31
|
| Rate for Payer: Priority Health Narrow Network |
$820.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.19
|
| Rate for Payer: UHC Exchange |
$551.19
|
| Rate for Payer: UHCCP Medicaid |
$295.01
|
|
|
PR RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH
|
Professional
|
Both
|
$2,296.00
|
|
|
Service Code
|
HCPCS 62355
|
| Min. Negotiated Rate |
$182.33 |
| Max. Negotiated Rate |
$1,492.40 |
| Rate for Payer: Aetna Commercial |
$348.09
|
| Rate for Payer: Aetna Medicare |
$1,148.00
|
| Rate for Payer: BCBS Complete |
$191.45
|
| Rate for Payer: BCBS Trust/PPO |
$187.02
|
| Rate for Payer: BCN Commercial |
$403.65
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Meridian Medicaid |
$191.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,492.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.58
|
| Rate for Payer: Priority Health Narrow Network |
$476.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.54
|
| Rate for Payer: UHC Exchange |
$337.54
|
| Rate for Payer: UHCCP Medicaid |
$182.33
|
|
|
PR RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY
|
Professional
|
Both
|
$2,640.00
|
|
|
Service Code
|
HCPCS 33237
|
| Min. Negotiated Rate |
$533.35 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,121.51
|
| Rate for Payer: Aetna Medicare |
$1,320.00
|
| Rate for Payer: BCBS Complete |
$560.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.34
|
| Rate for Payer: BCN Commercial |
$1,211.44
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Meridian Medicaid |
$560.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$533.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,323.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,323.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,099.89
|
| Rate for Payer: UHC Exchange |
$1,099.89
|
| Rate for Payer: UHCCP Medicaid |
$533.35
|
|
|
PR RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 11008
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$300.89
|
| Rate for Payer: Aetna Medicare |
$412.50
|
| Rate for Payer: BCBS Complete |
$181.38
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$394.85
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Meridian Medicaid |
$181.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.82
|
| Rate for Payer: Priority Health Narrow Network |
$364.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.40
|
| Rate for Payer: UHC Exchange |
$301.40
|
| Rate for Payer: UHCCP Medicaid |
$172.74
|
|
