|
PR RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER
|
Professional
|
Both
|
$3,367.00
|
|
|
Service Code
|
HCPCS 27488
|
| Min. Negotiated Rate |
$777.45 |
| Max. Negotiated Rate |
$2,188.55 |
| Rate for Payer: Aetna Commercial |
$1,603.73
|
| Rate for Payer: Aetna Medicare |
$1,683.50
|
| Rate for Payer: BCBS Complete |
$816.32
|
| Rate for Payer: BCBS Trust/PPO |
$995.85
|
| Rate for Payer: BCN Commercial |
$1,756.31
|
| Rate for Payer: Cash Price |
$2,693.60
|
| Rate for Payer: Cash Price |
$2,693.60
|
| Rate for Payer: Meridian Medicaid |
$816.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,188.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,842.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,842.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,390.88
|
| Rate for Payer: UHC Exchange |
$1,390.88
|
| Rate for Payer: UHCCP Medicaid |
$777.45
|
|
|
PR RMVL/REVJ SLING MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,587.00
|
|
|
Service Code
|
HCPCS 53442
|
| Min. Negotiated Rate |
$505.02 |
| Max. Negotiated Rate |
$1,276.37 |
| Rate for Payer: Aetna Commercial |
$1,005.18
|
| Rate for Payer: Aetna Medicare |
$793.50
|
| Rate for Payer: BCBS Complete |
$530.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,276.37
|
| Rate for Payer: BCN Commercial |
$1,134.22
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Meridian Medicaid |
$530.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,031.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,253.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,253.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$934.71
|
| Rate for Payer: UHC Exchange |
$934.71
|
| Rate for Payer: UHCCP Medicaid |
$505.02
|
|
|
PR RMVL/REVJ SLING STRESS INCONTINENCE
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
HCPCS 57287
|
| Min. Negotiated Rate |
$475.84 |
| Max. Negotiated Rate |
$2,457.12 |
| Rate for Payer: Aetna Commercial |
$871.45
|
| Rate for Payer: Aetna Medicare |
$617.00
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,457.12
|
| Rate for Payer: BCN Commercial |
$1,509.08
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,111.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,111.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$794.89
|
| Rate for Payer: UHC Exchange |
$794.89
|
| Rate for Payer: UHCCP Medicaid |
$475.84
|
|
|
PR RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Professional
|
Both
|
$1,673.00
|
|
|
Service Code
|
HCPCS 54410
|
| Min. Negotiated Rate |
$553.37 |
| Max. Negotiated Rate |
$2,612.13 |
| Rate for Payer: Aetna Commercial |
$1,106.42
|
| Rate for Payer: Aetna Medicare |
$836.50
|
| Rate for Payer: BCBS Complete |
$581.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,612.13
|
| Rate for Payer: BCN Commercial |
$1,244.66
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Meridian Medicaid |
$581.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,374.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,374.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,039.26
|
| Rate for Payer: UHC Exchange |
$1,039.26
|
| Rate for Payer: UHCCP Medicaid |
$553.37
|
|
|
PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 50382
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$4,259.15 |
| Rate for Payer: Aetna Commercial |
$326.82
|
| Rate for Payer: Aetna Medicare |
$1,075.00
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,259.15
|
| Rate for Payer: BCN Commercial |
$1,487.05
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.86
|
| Rate for Payer: Priority Health Narrow Network |
$389.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.34
|
| Rate for Payer: UHC Exchange |
$336.34
|
| Rate for Payer: UHCCP Medicaid |
$157.19
|
|
|
PR RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 53448
|
| Min. Negotiated Rate |
$807.77 |
| Max. Negotiated Rate |
$2,020.14 |
| Rate for Payer: Aetna Commercial |
$1,639.79
|
| Rate for Payer: Aetna Medicare |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$853.67
|
| Rate for Payer: BCBS Trust/PPO |
$807.77
|
| Rate for Payer: BCN Commercial |
$1,834.01
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Meridian Medicaid |
$853.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$813.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,020.14
|
| Rate for Payer: Priority Health Narrow Network |
$2,020.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,549.08
|
| Rate for Payer: UHC Exchange |
$1,549.08
|
| Rate for Payer: UHCCP Medicaid |
$813.02
|
|
|
PR RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL
|
Professional
|
Both
|
$2,131.00
|
|
|
Service Code
|
HCPCS 54411
|
| Min. Negotiated Rate |
$658.38 |
| Max. Negotiated Rate |
$3,265.16 |
| Rate for Payer: Aetna Commercial |
$1,326.02
|
| Rate for Payer: Aetna Medicare |
$1,065.50
|
| Rate for Payer: BCBS Complete |
$691.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,265.16
|
| Rate for Payer: BCN Commercial |
$1,484.61
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Meridian Medicaid |
$691.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$658.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,635.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,635.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,237.63
|
| Rate for Payer: UHC Exchange |
$1,237.63
|
| Rate for Payer: UHCCP Medicaid |
$658.38
|
|
|
PR RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC
|
Professional
|
Both
|
$2,515.00
|
|
|
Service Code
|
HCPCS 53447
|
| Min. Negotiated Rate |
$516.10 |
| Max. Negotiated Rate |
$1,634.75 |
| Rate for Payer: Aetna Commercial |
$1,035.47
|
| Rate for Payer: Aetna Medicare |
$1,257.50
|
| Rate for Payer: BCBS Complete |
$541.90
|
| Rate for Payer: BCBS Trust/PPO |
$790.34
|
| Rate for Payer: BCN Commercial |
$1,162.57
|
| Rate for Payer: Cash Price |
$2,012.00
|
| Rate for Payer: Cash Price |
$2,012.00
|
| Rate for Payer: Meridian Medicaid |
$541.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,634.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,282.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,282.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$978.35
|
| Rate for Payer: UHC Exchange |
$978.35
|
| Rate for Payer: UHCCP Medicaid |
$516.10
|
|
|
PR RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD
|
Professional
|
Both
|
$2,290.00
|
|
|
Service Code
|
HCPCS 54417
|
| Min. Negotiated Rate |
$575.74 |
| Max. Negotiated Rate |
$2,176.77 |
| Rate for Payer: Aetna Commercial |
$1,152.98
|
| Rate for Payer: Aetna Medicare |
$1,145.00
|
| Rate for Payer: BCBS Complete |
$604.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,176.77
|
| Rate for Payer: BCN Commercial |
$1,295.97
|
| Rate for Payer: Cash Price |
$1,832.00
|
| Rate for Payer: Cash Price |
$1,832.00
|
| Rate for Payer: Meridian Medicaid |
$604.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$575.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,488.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,429.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,429.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,083.89
|
| Rate for Payer: UHC Exchange |
$1,083.89
|
| Rate for Payer: UHCCP Medicaid |
$575.74
|
|
|
PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH
|
Professional
|
Both
|
$1,199.00
|
|
|
Service Code
|
HCPCS 50387
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$3,379.54 |
| Rate for Payer: Aetna Commercial |
$107.12
|
| Rate for Payer: Aetna Medicare |
$599.50
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,379.54
|
| Rate for Payer: BCN Commercial |
$822.45
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$779.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.90
|
| Rate for Payer: Priority Health Narrow Network |
$128.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.29
|
| Rate for Payer: UHC Exchange |
$122.29
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
|
|
PR RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 69711
|
| Min. Negotiated Rate |
$535.48 |
| Max. Negotiated Rate |
$3,026.10 |
| Rate for Payer: Aetna Commercial |
$960.92
|
| Rate for Payer: Aetna Medicare |
$849.00
|
| Rate for Payer: BCBS Complete |
$562.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,026.10
|
| Rate for Payer: BCN Commercial |
$1,238.80
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Meridian Medicaid |
$562.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,231.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,231.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$951.90
|
| Rate for Payer: UHC Exchange |
$951.90
|
| Rate for Payer: UHCCP Medicaid |
$535.48
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Facility
|
OP
|
$1,145.00
|
|
|
Service Code
|
CPT 19330
|
| Hospital Charge Code |
19330
|
| Min. Negotiated Rate |
$744.25 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$1,030.50
|
| Rate for Payer: Aetna Medicare |
$3,751.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: ASR ASR |
$1,110.65
|
| Rate for Payer: ASR Commercial |
$1,110.65
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$937.64
|
| Rate for Payer: BCN Commercial |
$887.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$1,076.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,145.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$1,030.50
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.25
|
| Rate for Payer: Nomi Health Commercial |
$938.90
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$4,127.04
|
| Rate for Payer: PHP Medicaid |
$2,010.99
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,003.25
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$802.64
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$5,815.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP DNSP |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
19330
|
| Min. Negotiated Rate |
$418.55 |
| Max. Negotiated Rate |
$947.54 |
| Rate for Payer: Aetna Commercial |
$698.31
|
| Rate for Payer: Aetna Medicare |
$572.50
|
| Rate for Payer: BCBS Complete |
$439.48
|
| Rate for Payer: BCBS Trust/PPO |
$476.13
|
| Rate for Payer: BCN Commercial |
$947.54
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Meridian Medicaid |
$439.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.65
|
| Rate for Payer: Priority Health Narrow Network |
$878.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.67
|
| Rate for Payer: UHC Exchange |
$658.67
|
| Rate for Payer: UHCCP Medicaid |
$418.55
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Facility
|
IP
|
$1,145.00
|
|
|
Service Code
|
CPT 19330
|
| Hospital Charge Code |
19330
|
| Min. Negotiated Rate |
$744.25 |
| Max. Negotiated Rate |
$1,145.00 |
| Rate for Payer: Aetna Commercial |
$1,030.50
|
| Rate for Payer: ASR ASR |
$1,110.65
|
| Rate for Payer: ASR Commercial |
$1,110.65
|
| Rate for Payer: BCBS Trust/PPO |
$933.06
|
| Rate for Payer: BCN Commercial |
$887.72
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$1,076.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.00
|
| Rate for Payer: Healthscope Commercial |
$1,145.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.65
|
| Rate for Payer: Mclaren Commercial |
$1,030.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.25
|
| Rate for Payer: Nomi Health Commercial |
$938.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.60
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 19330
|
| Min. Negotiated Rate |
$418.55 |
| Max. Negotiated Rate |
$947.54 |
| Rate for Payer: Aetna Commercial |
$698.31
|
| Rate for Payer: Aetna Medicare |
$572.50
|
| Rate for Payer: BCBS Complete |
$439.48
|
| Rate for Payer: BCBS Trust/PPO |
$476.13
|
| Rate for Payer: BCN Commercial |
$947.54
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Meridian Medicaid |
$439.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.65
|
| Rate for Payer: Priority Health Narrow Network |
$878.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.67
|
| Rate for Payer: UHC Exchange |
$658.67
|
| Rate for Payer: UHCCP Medicaid |
$418.55
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 11201
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$106.97 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$10.73
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Meridian Medicaid |
$10.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.68
|
| Rate for Payer: Priority Health Narrow Network |
$21.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.15
|
| Rate for Payer: UHC Exchange |
$18.15
|
| Rate for Payer: UHCCP Medicaid |
$10.22
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
11200
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$1,422.75 |
| Rate for Payer: Aetna Commercial |
$79.26
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: BCBS Complete |
$52.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.75
|
| Rate for Payer: BCN Commercial |
$107.59
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Meridian Medicaid |
$52.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.29
|
| Rate for Payer: Priority Health Narrow Network |
$104.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.67
|
| Rate for Payer: UHC Exchange |
$72.67
|
| Rate for Payer: UHCCP Medicaid |
$49.63
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
11200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$169.75
|
| Rate for Payer: ASR Commercial |
$169.75
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$143.31
|
| Rate for Payer: BCN Commercial |
$135.68
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$175.00
|
| Rate for Payer: Healthscope Whirlpool |
$169.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$157.50
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: Nomi Health Commercial |
$143.50
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.84
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$141.47
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
11200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: ASR ASR |
$169.75
|
| Rate for Payer: ASR Commercial |
$169.75
|
| Rate for Payer: BCBS Trust/PPO |
$142.61
|
| Rate for Payer: BCN Commercial |
$135.68
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$175.00
|
| Rate for Payer: Healthscope Whirlpool |
$169.75
|
| Rate for Payer: Mclaren Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: Nomi Health Commercial |
$143.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.00
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 11200
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$1,422.75 |
| Rate for Payer: Aetna Commercial |
$79.26
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: BCBS Complete |
$52.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.75
|
| Rate for Payer: BCN Commercial |
$107.59
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Meridian Medicaid |
$52.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.29
|
| Rate for Payer: Priority Health Narrow Network |
$104.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.67
|
| Rate for Payer: UHC Exchange |
$72.67
|
| Rate for Payer: UHCCP Medicaid |
$49.63
|
|
|
PR RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 63662
|
| Min. Negotiated Rate |
$556.57 |
| Max. Negotiated Rate |
$2,562.30 |
| Rate for Payer: Aetna Commercial |
$1,089.28
|
| Rate for Payer: Aetna Medicare |
$1,971.00
|
| Rate for Payer: BCBS Complete |
$584.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.15
|
| Rate for Payer: BCN Commercial |
$1,251.99
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Meridian Medicaid |
$584.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$556.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,562.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,478.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,478.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$835.91
|
| Rate for Payer: UHC Exchange |
$835.91
|
| Rate for Payer: UHCCP Medicaid |
$556.57
|
|
|
PR RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR
|
Professional
|
Both
|
$1,821.00
|
|
|
Service Code
|
HCPCS 63661
|
| Min. Negotiated Rate |
$213.21 |
| Max. Negotiated Rate |
$1,183.65 |
| Rate for Payer: Aetna Commercial |
$419.58
|
| Rate for Payer: Aetna Medicare |
$910.50
|
| Rate for Payer: BCBS Complete |
$223.87
|
| Rate for Payer: BCBS Trust/PPO |
$409.43
|
| Rate for Payer: BCN Commercial |
$1,003.26
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Meridian Medicaid |
$223.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.87
|
| Rate for Payer: Priority Health Narrow Network |
$565.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.06
|
| Rate for Payer: UHC Exchange |
$385.06
|
| Rate for Payer: UHCCP Medicaid |
$213.21
|
|
|
PR RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS 62365
|
| Min. Negotiated Rate |
$178.57 |
| Max. Negotiated Rate |
$985.40 |
| Rate for Payer: Aetna Commercial |
$379.91
|
| Rate for Payer: Aetna Medicare |
$758.00
|
| Rate for Payer: BCBS Complete |
$203.74
|
| Rate for Payer: BCBS Trust/PPO |
$178.57
|
| Rate for Payer: BCN Commercial |
$434.93
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Meridian Medicaid |
$203.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$515.25
|
| Rate for Payer: Priority Health Narrow Network |
$515.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.41
|
| Rate for Payer: UHC Exchange |
$371.41
|
| Rate for Payer: UHCCP Medicaid |
$194.04
|
|
|
PR RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD
|
Professional
|
Both
|
$1,628.00
|
|
|
Service Code
|
HCPCS 26392
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$1,544.90 |
| Rate for Payer: Aetna Commercial |
$1,339.43
|
| Rate for Payer: Aetna Medicare |
$814.00
|
| Rate for Payer: BCBS Complete |
$675.87
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$1,485.09
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Meridian Medicaid |
$675.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,544.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,081.43
|
| Rate for Payer: UHC Exchange |
$1,081.43
|
| Rate for Payer: UHCCP Medicaid |
$643.69
|
|
|
PR RMVL THIERSCH WIRE/SUTURE ANAL CANAL
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 46754
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$512.14 |
| Rate for Payer: Aetna Commercial |
$312.54
|
| Rate for Payer: Aetna Medicare |
$236.00
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCBS Trust/PPO |
$396.75
|
| Rate for Payer: BCN Commercial |
$512.14
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.31
|
| Rate for Payer: Priority Health Narrow Network |
$437.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.96
|
| Rate for Payer: UHC Exchange |
$257.96
|
| Rate for Payer: UHCCP Medicaid |
$157.19
|
|
