|
PR RMVL NFROS TUBE REQ FLUORO GUIDANCE
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 50389
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$196.30 |
| Rate for Payer: Aetna Commercial |
$68.11
|
| Rate for Payer: Aetna Medicare |
$50.83
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS MAPPO |
$50.83
|
| Rate for Payer: BCN Medicare Advantage |
$50.83
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$73.20
|
| Rate for Payer: Cofinity Commercial |
$68.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.83
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Healthscope Whirlpool |
$61.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.37
|
| Rate for Payer: Nomi Health Commercial |
$61.00
|
| Rate for Payer: PACE SWMI |
$50.83
|
| Rate for Payer: PHP Medicare Advantage |
$50.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health Medicare |
$50.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.83
|
| Rate for Payer: UHC Medicare Advantage |
$50.83
|
| Rate for Payer: UHCCP DNSP |
$50.83
|
|
|
PR RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 49623
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$284.64 |
| Rate for Payer: Aetna Commercial |
$264.88
|
| Rate for Payer: Aetna Medicare |
$197.67
|
| Rate for Payer: BCBS Complete |
$160.80
|
| Rate for Payer: BCBS MAPPO |
$197.67
|
| Rate for Payer: BCN Medicare Advantage |
$197.67
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$284.64
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.67
|
| Rate for Payer: Healthscope Commercial |
$237.20
|
| Rate for Payer: Healthscope Whirlpool |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.55
|
| Rate for Payer: Nomi Health Commercial |
$237.20
|
| Rate for Payer: PACE SWMI |
$197.67
|
| Rate for Payer: PHP Medicare Advantage |
$197.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health Medicare |
$197.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.67
|
| Rate for Payer: UHC Medicare Advantage |
$197.67
|
| Rate for Payer: UHCCP DNSP |
$197.67
|
|
|
PR RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT
|
Professional
|
Both
|
$1,084.00
|
|
|
Service Code
|
HCPCS 54415
|
| Min. Negotiated Rate |
$433.60 |
| Max. Negotiated Rate |
$732.20 |
| Rate for Payer: Aetna Commercial |
$681.35
|
| Rate for Payer: Aetna Medicare |
$508.47
|
| Rate for Payer: BCBS Complete |
$433.60
|
| Rate for Payer: BCBS MAPPO |
$508.47
|
| Rate for Payer: BCN Medicare Advantage |
$508.47
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Cofinity Commercial |
$732.20
|
| Rate for Payer: Cofinity Commercial |
$681.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.47
|
| Rate for Payer: Healthscope Commercial |
$610.16
|
| Rate for Payer: Healthscope Whirlpool |
$610.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$533.89
|
| Rate for Payer: Nomi Health Commercial |
$610.16
|
| Rate for Payer: PACE SWMI |
$508.47
|
| Rate for Payer: PHP Medicare Advantage |
$508.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.60
|
| Rate for Payer: Priority Health Medicare |
$508.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.47
|
| Rate for Payer: UHC Medicare Advantage |
$508.47
|
| Rate for Payer: UHCCP DNSP |
$508.47
|
|
|
PR RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 33272
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$476.37 |
| Rate for Payer: Aetna Commercial |
$443.29
|
| Rate for Payer: Aetna Medicare |
$330.81
|
| Rate for Payer: BCBS Complete |
$288.00
|
| Rate for Payer: BCBS MAPPO |
$330.81
|
| Rate for Payer: BCN Medicare Advantage |
$330.81
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$476.37
|
| Rate for Payer: Cofinity Commercial |
$443.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$330.81
|
| Rate for Payer: Healthscope Commercial |
$396.97
|
| Rate for Payer: Healthscope Whirlpool |
$396.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$347.35
|
| Rate for Payer: Nomi Health Commercial |
$396.97
|
| Rate for Payer: PACE SWMI |
$330.81
|
| Rate for Payer: PHP Medicare Advantage |
$330.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.00
|
| Rate for Payer: Priority Health Medicare |
$330.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$330.81
|
| Rate for Payer: UHC Medicare Advantage |
$330.81
|
| Rate for Payer: UHCCP DNSP |
$330.81
|
|
|
PR RMVL PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 49429
|
| Min. Negotiated Rate |
$445.65 |
| Max. Negotiated Rate |
$1,039.35 |
| Rate for Payer: Aetna Commercial |
$597.17
|
| Rate for Payer: Aetna Medicare |
$445.65
|
| Rate for Payer: BCBS Complete |
$639.60
|
| Rate for Payer: BCBS MAPPO |
$445.65
|
| Rate for Payer: BCN Medicare Advantage |
$445.65
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cofinity Commercial |
$641.74
|
| Rate for Payer: Cofinity Commercial |
$597.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.65
|
| Rate for Payer: Healthscope Commercial |
$534.78
|
| Rate for Payer: Healthscope Whirlpool |
$534.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.93
|
| Rate for Payer: Nomi Health Commercial |
$534.78
|
| Rate for Payer: PACE SWMI |
$445.65
|
| Rate for Payer: PHP Medicare Advantage |
$445.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.35
|
| Rate for Payer: Priority Health Medicare |
$445.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.65
|
| Rate for Payer: UHC Medicare Advantage |
$445.65
|
| Rate for Payer: UHCCP DNSP |
$445.65
|
|
|
PR RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH
|
Professional
|
Both
|
$2,296.00
|
|
|
Service Code
|
HCPCS 62355
|
| Min. Negotiated Rate |
$269.92 |
| Max. Negotiated Rate |
$1,492.40 |
| Rate for Payer: Aetna Commercial |
$361.69
|
| Rate for Payer: Aetna Medicare |
$269.92
|
| Rate for Payer: BCBS Complete |
$918.40
|
| Rate for Payer: BCBS MAPPO |
$269.92
|
| Rate for Payer: BCN Medicare Advantage |
$269.92
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Cofinity Commercial |
$388.68
|
| Rate for Payer: Cofinity Commercial |
$361.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$269.92
|
| Rate for Payer: Healthscope Commercial |
$323.90
|
| Rate for Payer: Healthscope Whirlpool |
$323.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$283.42
|
| Rate for Payer: Nomi Health Commercial |
$323.90
|
| Rate for Payer: PACE SWMI |
$269.92
|
| Rate for Payer: PHP Medicare Advantage |
$269.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,492.40
|
| Rate for Payer: Priority Health Medicare |
$269.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$269.92
|
| Rate for Payer: UHC Medicare Advantage |
$269.92
|
| Rate for Payer: UHCCP DNSP |
$269.92
|
|
|
PR RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY
|
Professional
|
Both
|
$2,640.00
|
|
|
Service Code
|
HCPCS 33237
|
| Min. Negotiated Rate |
$804.41 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,077.91
|
| Rate for Payer: Aetna Medicare |
$804.41
|
| Rate for Payer: BCBS Complete |
$1,056.00
|
| Rate for Payer: BCBS MAPPO |
$804.41
|
| Rate for Payer: BCN Medicare Advantage |
$804.41
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cofinity Commercial |
$1,158.35
|
| Rate for Payer: Cofinity Commercial |
$1,077.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.41
|
| Rate for Payer: Healthscope Commercial |
$965.29
|
| Rate for Payer: Healthscope Whirlpool |
$965.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$844.63
|
| Rate for Payer: Nomi Health Commercial |
$965.29
|
| Rate for Payer: PACE SWMI |
$804.41
|
| Rate for Payer: PHP Medicare Advantage |
$804.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.00
|
| Rate for Payer: Priority Health Medicare |
$804.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$804.41
|
| Rate for Payer: UHC Medicare Advantage |
$804.41
|
| Rate for Payer: UHCCP DNSP |
$804.41
|
|
|
PR RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 11008
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$353.49
|
| Rate for Payer: Aetna Medicare |
$263.80
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS MAPPO |
$263.80
|
| Rate for Payer: BCN Medicare Advantage |
$263.80
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$379.87
|
| Rate for Payer: Cofinity Commercial |
$353.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.80
|
| Rate for Payer: Healthscope Commercial |
$316.56
|
| Rate for Payer: Healthscope Whirlpool |
$316.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.99
|
| Rate for Payer: Nomi Health Commercial |
$316.56
|
| Rate for Payer: PACE SWMI |
$263.80
|
| Rate for Payer: PHP Medicare Advantage |
$263.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health Medicare |
$263.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.80
|
| Rate for Payer: UHC Medicare Advantage |
$263.80
|
| Rate for Payer: UHCCP DNSP |
$263.80
|
|
|
PR RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER
|
Professional
|
Both
|
$3,367.00
|
|
|
Service Code
|
HCPCS 27488
|
| Min. Negotiated Rate |
$1,156.49 |
| Max. Negotiated Rate |
$2,188.55 |
| Rate for Payer: Aetna Commercial |
$1,549.70
|
| Rate for Payer: Aetna Medicare |
$1,156.49
|
| Rate for Payer: BCBS Complete |
$1,346.80
|
| Rate for Payer: BCBS MAPPO |
$1,156.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,156.49
|
| Rate for Payer: Cash Price |
$2,693.60
|
| Rate for Payer: Cash Price |
$2,693.60
|
| Rate for Payer: Cofinity Commercial |
$1,665.35
|
| Rate for Payer: Cofinity Commercial |
$1,549.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,156.49
|
| Rate for Payer: Healthscope Commercial |
$1,387.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,387.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,214.31
|
| Rate for Payer: Nomi Health Commercial |
$1,387.79
|
| Rate for Payer: PACE SWMI |
$1,156.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,156.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,188.55
|
| Rate for Payer: Priority Health Medicare |
$1,156.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,156.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,156.49
|
| Rate for Payer: UHCCP DNSP |
$1,156.49
|
|
|
PR RMVL/REVJ SLING MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,587.00
|
|
|
Service Code
|
HCPCS 53442
|
| Min. Negotiated Rate |
$634.80 |
| Max. Negotiated Rate |
$1,082.03 |
| Rate for Payer: Aetna Commercial |
$1,006.89
|
| Rate for Payer: Aetna Medicare |
$751.41
|
| Rate for Payer: BCBS Complete |
$634.80
|
| Rate for Payer: BCBS MAPPO |
$751.41
|
| Rate for Payer: BCN Medicare Advantage |
$751.41
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cofinity Commercial |
$1,082.03
|
| Rate for Payer: Cofinity Commercial |
$1,006.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.41
|
| Rate for Payer: Healthscope Commercial |
$901.69
|
| Rate for Payer: Healthscope Whirlpool |
$901.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.98
|
| Rate for Payer: Nomi Health Commercial |
$901.69
|
| Rate for Payer: PACE SWMI |
$751.41
|
| Rate for Payer: PHP Medicare Advantage |
$751.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,031.55
|
| Rate for Payer: Priority Health Medicare |
$751.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.41
|
| Rate for Payer: UHC Medicare Advantage |
$751.41
|
| Rate for Payer: UHCCP DNSP |
$751.41
|
|
|
PR RMVL/REVJ SLING STRESS INCONTINENCE
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
HCPCS 57287
|
| Min. Negotiated Rate |
$493.60 |
| Max. Negotiated Rate |
$1,014.57 |
| Rate for Payer: Aetna Commercial |
$944.11
|
| Rate for Payer: Aetna Medicare |
$704.56
|
| Rate for Payer: BCBS Complete |
$493.60
|
| Rate for Payer: BCBS MAPPO |
$704.56
|
| Rate for Payer: BCN Medicare Advantage |
$704.56
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cofinity Commercial |
$944.11
|
| Rate for Payer: Cofinity Commercial |
$1,014.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$704.56
|
| Rate for Payer: Healthscope Commercial |
$845.47
|
| Rate for Payer: Healthscope Whirlpool |
$845.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$739.79
|
| Rate for Payer: Nomi Health Commercial |
$845.47
|
| Rate for Payer: PACE SWMI |
$704.56
|
| Rate for Payer: PHP Medicare Advantage |
$704.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.10
|
| Rate for Payer: Priority Health Medicare |
$704.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$704.56
|
| Rate for Payer: UHC Medicare Advantage |
$704.56
|
| Rate for Payer: UHCCP DNSP |
$704.56
|
|
|
PR RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Professional
|
Both
|
$1,673.00
|
|
|
Service Code
|
HCPCS 54410
|
| Min. Negotiated Rate |
$669.20 |
| Max. Negotiated Rate |
$1,187.80 |
| Rate for Payer: Aetna Commercial |
$1,105.31
|
| Rate for Payer: Aetna Medicare |
$824.86
|
| Rate for Payer: BCBS Complete |
$669.20
|
| Rate for Payer: BCBS MAPPO |
$824.86
|
| Rate for Payer: BCN Medicare Advantage |
$824.86
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cofinity Commercial |
$1,187.80
|
| Rate for Payer: Cofinity Commercial |
$1,105.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$824.86
|
| Rate for Payer: Healthscope Commercial |
$989.83
|
| Rate for Payer: Healthscope Whirlpool |
$989.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$866.10
|
| Rate for Payer: Nomi Health Commercial |
$989.83
|
| Rate for Payer: PACE SWMI |
$824.86
|
| Rate for Payer: PHP Medicare Advantage |
$824.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.45
|
| Rate for Payer: Priority Health Medicare |
$824.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$824.86
|
| Rate for Payer: UHC Medicare Advantage |
$824.86
|
| Rate for Payer: UHCCP DNSP |
$824.86
|
|
|
PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 50382
|
| Min. Negotiated Rate |
$237.33 |
| Max. Negotiated Rate |
$1,397.50 |
| Rate for Payer: Aetna Commercial |
$318.02
|
| Rate for Payer: Aetna Medicare |
$237.33
|
| Rate for Payer: BCBS Complete |
$860.00
|
| Rate for Payer: BCBS MAPPO |
$237.33
|
| Rate for Payer: BCN Medicare Advantage |
$237.33
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cofinity Commercial |
$341.76
|
| Rate for Payer: Cofinity Commercial |
$318.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.33
|
| Rate for Payer: Healthscope Commercial |
$284.80
|
| Rate for Payer: Healthscope Whirlpool |
$284.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.20
|
| Rate for Payer: Nomi Health Commercial |
$284.80
|
| Rate for Payer: PACE SWMI |
$237.33
|
| Rate for Payer: PHP Medicare Advantage |
$237.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health Medicare |
$237.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.33
|
| Rate for Payer: UHC Medicare Advantage |
$237.33
|
| Rate for Payer: UHCCP DNSP |
$237.33
|
|
|
PR RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 53448
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,751.27 |
| Rate for Payer: Aetna Commercial |
$1,629.65
|
| Rate for Payer: Aetna Medicare |
$1,216.16
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$1,216.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,216.16
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,751.27
|
| Rate for Payer: Cofinity Commercial |
$1,629.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,216.16
|
| Rate for Payer: Healthscope Commercial |
$1,459.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,459.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,276.97
|
| Rate for Payer: Nomi Health Commercial |
$1,459.39
|
| Rate for Payer: PACE SWMI |
$1,216.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,216.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$1,216.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,216.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,216.16
|
| Rate for Payer: UHCCP DNSP |
$1,216.16
|
|
|
PR RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL
|
Professional
|
Both
|
$2,131.00
|
|
|
Service Code
|
HCPCS 54411
|
| Min. Negotiated Rate |
$852.40 |
| Max. Negotiated Rate |
$1,414.79 |
| Rate for Payer: Aetna Commercial |
$1,316.54
|
| Rate for Payer: Aetna Medicare |
$982.49
|
| Rate for Payer: BCBS Complete |
$852.40
|
| Rate for Payer: BCBS MAPPO |
$982.49
|
| Rate for Payer: BCN Medicare Advantage |
$982.49
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cofinity Commercial |
$1,414.79
|
| Rate for Payer: Cofinity Commercial |
$1,316.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$982.49
|
| Rate for Payer: Healthscope Commercial |
$1,178.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,178.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,031.61
|
| Rate for Payer: Nomi Health Commercial |
$1,178.99
|
| Rate for Payer: PACE SWMI |
$982.49
|
| Rate for Payer: PHP Medicare Advantage |
$982.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.15
|
| Rate for Payer: Priority Health Medicare |
$982.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$982.49
|
| Rate for Payer: UHC Medicare Advantage |
$982.49
|
| Rate for Payer: UHCCP DNSP |
$982.49
|
|
|
PR RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC
|
Professional
|
Both
|
$2,515.00
|
|
|
Service Code
|
HCPCS 53447
|
| Min. Negotiated Rate |
$769.69 |
| Max. Negotiated Rate |
$1,634.75 |
| Rate for Payer: Aetna Commercial |
$1,031.38
|
| Rate for Payer: Aetna Medicare |
$769.69
|
| Rate for Payer: BCBS Complete |
$1,006.00
|
| Rate for Payer: BCBS MAPPO |
$769.69
|
| Rate for Payer: BCN Medicare Advantage |
$769.69
|
| Rate for Payer: Cash Price |
$2,012.00
|
| Rate for Payer: Cash Price |
$2,012.00
|
| Rate for Payer: Cofinity Commercial |
$1,108.35
|
| Rate for Payer: Cofinity Commercial |
$1,031.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$769.69
|
| Rate for Payer: Healthscope Commercial |
$923.63
|
| Rate for Payer: Healthscope Whirlpool |
$923.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$808.17
|
| Rate for Payer: Nomi Health Commercial |
$923.63
|
| Rate for Payer: PACE SWMI |
$769.69
|
| Rate for Payer: PHP Medicare Advantage |
$769.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,634.75
|
| Rate for Payer: Priority Health Medicare |
$769.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$769.69
|
| Rate for Payer: UHC Medicare Advantage |
$769.69
|
| Rate for Payer: UHCCP DNSP |
$769.69
|
|
|
PR RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD
|
Professional
|
Both
|
$2,290.00
|
|
|
Service Code
|
HCPCS 54417
|
| Min. Negotiated Rate |
$859.39 |
| Max. Negotiated Rate |
$1,488.50 |
| Rate for Payer: Aetna Commercial |
$1,151.58
|
| Rate for Payer: Aetna Medicare |
$859.39
|
| Rate for Payer: BCBS Complete |
$916.00
|
| Rate for Payer: BCBS MAPPO |
$859.39
|
| Rate for Payer: BCN Medicare Advantage |
$859.39
|
| Rate for Payer: Cash Price |
$1,832.00
|
| Rate for Payer: Cash Price |
$1,832.00
|
| Rate for Payer: Cofinity Commercial |
$1,237.52
|
| Rate for Payer: Cofinity Commercial |
$1,151.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$859.39
|
| Rate for Payer: Healthscope Commercial |
$1,031.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,031.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$902.36
|
| Rate for Payer: Nomi Health Commercial |
$1,031.27
|
| Rate for Payer: PACE SWMI |
$859.39
|
| Rate for Payer: PHP Medicare Advantage |
$859.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,488.50
|
| Rate for Payer: Priority Health Medicare |
$859.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$859.39
|
| Rate for Payer: UHC Medicare Advantage |
$859.39
|
| Rate for Payer: UHCCP DNSP |
$859.39
|
|
|
PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH
|
Professional
|
Both
|
$1,199.00
|
|
|
Service Code
|
HCPCS 50387
|
| Min. Negotiated Rate |
$78.46 |
| Max. Negotiated Rate |
$779.35 |
| Rate for Payer: Aetna Commercial |
$105.14
|
| Rate for Payer: Aetna Medicare |
$78.46
|
| Rate for Payer: BCBS Complete |
$479.60
|
| Rate for Payer: BCBS MAPPO |
$78.46
|
| Rate for Payer: BCN Medicare Advantage |
$78.46
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cofinity Commercial |
$112.98
|
| Rate for Payer: Cofinity Commercial |
$105.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.46
|
| Rate for Payer: Healthscope Commercial |
$94.15
|
| Rate for Payer: Healthscope Whirlpool |
$94.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.38
|
| Rate for Payer: Nomi Health Commercial |
$94.15
|
| Rate for Payer: PACE SWMI |
$78.46
|
| Rate for Payer: PHP Medicare Advantage |
$78.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$779.35
|
| Rate for Payer: Priority Health Medicare |
$78.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.46
|
| Rate for Payer: UHC Medicare Advantage |
$78.46
|
| Rate for Payer: UHCCP DNSP |
$78.46
|
|
|
PR RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 69711
|
| Min. Negotiated Rate |
$679.20 |
| Max. Negotiated Rate |
$1,129.59 |
| Rate for Payer: Aetna Commercial |
$1,051.15
|
| Rate for Payer: Aetna Medicare |
$784.44
|
| Rate for Payer: BCBS Complete |
$679.20
|
| Rate for Payer: BCBS MAPPO |
$784.44
|
| Rate for Payer: BCN Medicare Advantage |
$784.44
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cofinity Commercial |
$1,129.59
|
| Rate for Payer: Cofinity Commercial |
$1,051.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$784.44
|
| Rate for Payer: Healthscope Commercial |
$941.33
|
| Rate for Payer: Healthscope Whirlpool |
$941.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$823.66
|
| Rate for Payer: Nomi Health Commercial |
$941.33
|
| Rate for Payer: PACE SWMI |
$784.44
|
| Rate for Payer: PHP Medicare Advantage |
$784.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.70
|
| Rate for Payer: Priority Health Medicare |
$784.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$784.44
|
| Rate for Payer: UHC Medicare Advantage |
$784.44
|
| Rate for Payer: UHCCP DNSP |
$784.44
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 19330
|
| Min. Negotiated Rate |
$458.00 |
| Max. Negotiated Rate |
$891.88 |
| Rate for Payer: Aetna Commercial |
$829.94
|
| Rate for Payer: Aetna Medicare |
$619.36
|
| Rate for Payer: BCBS Complete |
$458.00
|
| Rate for Payer: BCBS MAPPO |
$619.36
|
| Rate for Payer: BCN Medicare Advantage |
$619.36
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$891.88
|
| Rate for Payer: Cofinity Commercial |
$829.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$619.36
|
| Rate for Payer: Healthscope Commercial |
$743.23
|
| Rate for Payer: Healthscope Whirlpool |
$743.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$650.33
|
| Rate for Payer: Nomi Health Commercial |
$743.23
|
| Rate for Payer: PACE SWMI |
$619.36
|
| Rate for Payer: PHP Medicare Advantage |
$619.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health Medicare |
$619.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$619.36
|
| Rate for Payer: UHC Medicare Advantage |
$619.36
|
| Rate for Payer: UHCCP DNSP |
$619.36
|
|
|
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 |
$5,788.66 |
| Rate for Payer: Aetna Commercial |
$1,030.50
|
| Rate for Payer: Aetna Medicare |
$3,734.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: ASR ASR |
$1,110.65
|
| Rate for Payer: ASR Commercial |
$1,110.65
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCBS Trust/PPO |
$937.64
|
| Rate for Payer: BCN Commercial |
$887.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| 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 |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$1,145.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,734.62
|
| Rate for Payer: Mclaren Commercial |
$1,030.50
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.25
|
| Rate for Payer: Nomi Health Commercial |
$938.90
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$4,108.08
|
| Rate for Payer: PHP Medicaid |
$2,001.76
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| 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 |
$3,734.62
|
| Rate for Payer: Priority Health Narrow Network |
$802.64
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$5,788.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP DNSP |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
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
|
| Hospital Charge Code |
19330
|
| Min. Negotiated Rate |
$458.00 |
| Max. Negotiated Rate |
$891.88 |
| Rate for Payer: Aetna Commercial |
$829.94
|
| Rate for Payer: Aetna Medicare |
$619.36
|
| Rate for Payer: BCBS Complete |
$458.00
|
| Rate for Payer: BCBS MAPPO |
$619.36
|
| Rate for Payer: BCN Medicare Advantage |
$619.36
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$891.88
|
| Rate for Payer: Cofinity Commercial |
$829.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$619.36
|
| Rate for Payer: Healthscope Commercial |
$743.23
|
| Rate for Payer: Healthscope Whirlpool |
$743.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$650.33
|
| Rate for Payer: Nomi Health Commercial |
$743.23
|
| Rate for Payer: PACE SWMI |
$619.36
|
| Rate for Payer: PHP Medicare Advantage |
$619.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health Medicare |
$619.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$619.36
|
| Rate for Payer: UHC Medicare Advantage |
$619.36
|
| Rate for Payer: UHCCP DNSP |
$619.36
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 11201
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Medicare |
$15.23
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$15.23
|
| Rate for Payer: BCN Medicare Advantage |
$15.23
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$18.28
|
| Rate for Payer: Healthscope Whirlpool |
$18.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.99
|
| Rate for Payer: Nomi Health Commercial |
$18.28
|
| Rate for Payer: PACE SWMI |
$15.23
|
| Rate for Payer: PHP Medicare Advantage |
$15.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$15.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.23
|
| Rate for Payer: UHC Medicare Advantage |
$15.23
|
| Rate for Payer: UHCCP DNSP |
$15.23
|
|
|
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 |
$70.00 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Aetna Commercial |
$96.08
|
| Rate for Payer: Aetna Medicare |
$71.70
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$71.70
|
| Rate for Payer: BCN Medicare Advantage |
$71.70
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Cofinity Commercial |
$103.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.70
|
| Rate for Payer: Healthscope Commercial |
$86.04
|
| Rate for Payer: Healthscope Whirlpool |
$86.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.28
|
| Rate for Payer: Nomi Health Commercial |
$86.04
|
| Rate for Payer: PACE SWMI |
$71.70
|
| Rate for Payer: PHP Medicare Advantage |
$71.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Medicare |
$71.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.70
|
| Rate for Payer: UHC Medicare Advantage |
$71.70
|
| Rate for Payer: UHCCP DNSP |
$71.70
|
|
