|
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 |
$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
|
|
|
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 |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$169.75
|
| Rate for Payer: ASR Commercial |
$169.75
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$143.31
|
| Rate for Payer: BCN Commercial |
$135.68
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| 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 |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$175.00
|
| Rate for Payer: Healthscope Whirlpool |
$169.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$157.50
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: Nomi Health Commercial |
$143.50
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.34
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$122.67
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
PR RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 63662
|
| Min. Negotiated Rate |
$834.37 |
| Max. Negotiated Rate |
$2,562.30 |
| Rate for Payer: Aetna Commercial |
$1,118.06
|
| Rate for Payer: Aetna Medicare |
$834.37
|
| Rate for Payer: BCBS Complete |
$1,576.80
|
| Rate for Payer: BCBS MAPPO |
$834.37
|
| Rate for Payer: BCN Medicare Advantage |
$834.37
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cofinity Commercial |
$1,201.49
|
| Rate for Payer: Cofinity Commercial |
$1,118.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.37
|
| Rate for Payer: Healthscope Commercial |
$1,001.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,001.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$876.09
|
| Rate for Payer: Nomi Health Commercial |
$1,001.24
|
| Rate for Payer: PACE SWMI |
$834.37
|
| Rate for Payer: PHP Medicare Advantage |
$834.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,562.30
|
| Rate for Payer: Priority Health Medicare |
$834.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$834.37
|
| Rate for Payer: UHC Medicare Advantage |
$834.37
|
| Rate for Payer: UHCCP DNSP |
$834.37
|
|
|
PR RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR
|
Professional
|
Both
|
$1,821.00
|
|
|
Service Code
|
HCPCS 63661
|
| Min. Negotiated Rate |
$318.16 |
| Max. Negotiated Rate |
$1,183.65 |
| Rate for Payer: Aetna Commercial |
$426.33
|
| Rate for Payer: Aetna Medicare |
$318.16
|
| Rate for Payer: BCBS Complete |
$728.40
|
| Rate for Payer: BCBS MAPPO |
$318.16
|
| Rate for Payer: BCN Medicare Advantage |
$318.16
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cofinity Commercial |
$458.15
|
| Rate for Payer: Cofinity Commercial |
$426.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.16
|
| Rate for Payer: Healthscope Commercial |
$381.79
|
| Rate for Payer: Healthscope Whirlpool |
$381.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.07
|
| Rate for Payer: Nomi Health Commercial |
$381.79
|
| Rate for Payer: PACE SWMI |
$318.16
|
| Rate for Payer: PHP Medicare Advantage |
$318.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.65
|
| Rate for Payer: Priority Health Medicare |
$318.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.16
|
| Rate for Payer: UHC Medicare Advantage |
$318.16
|
| Rate for Payer: UHCCP DNSP |
$318.16
|
|
|
PR RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS 62365
|
| Min. Negotiated Rate |
$288.07 |
| Max. Negotiated Rate |
$985.40 |
| Rate for Payer: Aetna Commercial |
$386.01
|
| Rate for Payer: Aetna Medicare |
$288.07
|
| Rate for Payer: BCBS Complete |
$606.40
|
| Rate for Payer: BCBS MAPPO |
$288.07
|
| Rate for Payer: BCN Medicare Advantage |
$288.07
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cofinity Commercial |
$414.82
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.07
|
| Rate for Payer: Healthscope Commercial |
$345.68
|
| Rate for Payer: Healthscope Whirlpool |
$345.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.47
|
| Rate for Payer: Nomi Health Commercial |
$345.68
|
| Rate for Payer: PACE SWMI |
$288.07
|
| Rate for Payer: PHP Medicare Advantage |
$288.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.40
|
| Rate for Payer: Priority Health Medicare |
$288.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$288.07
|
| Rate for Payer: UHC Medicare Advantage |
$288.07
|
| Rate for Payer: UHCCP DNSP |
$288.07
|
|
|
PR RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD
|
Professional
|
Both
|
$1,628.00
|
|
|
Service Code
|
HCPCS 26392
|
| Min. Negotiated Rate |
$651.20 |
| Max. Negotiated Rate |
$1,351.99 |
| Rate for Payer: Aetna Commercial |
$1,258.10
|
| Rate for Payer: Aetna Medicare |
$938.88
|
| Rate for Payer: BCBS Complete |
$651.20
|
| Rate for Payer: BCBS MAPPO |
$938.88
|
| Rate for Payer: BCN Medicare Advantage |
$938.88
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Cofinity Commercial |
$1,351.99
|
| Rate for Payer: Cofinity Commercial |
$1,258.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$938.88
|
| Rate for Payer: Healthscope Commercial |
$1,126.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,126.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$985.82
|
| Rate for Payer: Nomi Health Commercial |
$1,126.66
|
| Rate for Payer: PACE SWMI |
$938.88
|
| Rate for Payer: PHP Medicare Advantage |
$938.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.20
|
| Rate for Payer: Priority Health Medicare |
$938.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$938.88
|
| Rate for Payer: UHC Medicare Advantage |
$938.88
|
| Rate for Payer: UHCCP DNSP |
$938.88
|
|
|
PR RMVL THIERSCH WIRE/SUTURE ANAL CANAL
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 46754
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$330.52 |
| Rate for Payer: Aetna Commercial |
$307.57
|
| Rate for Payer: Aetna Medicare |
$229.53
|
| Rate for Payer: BCBS Complete |
$188.80
|
| Rate for Payer: BCBS MAPPO |
$229.53
|
| Rate for Payer: BCN Medicare Advantage |
$229.53
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cofinity Commercial |
$330.52
|
| Rate for Payer: Cofinity Commercial |
$307.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.53
|
| Rate for Payer: Healthscope Commercial |
$275.44
|
| Rate for Payer: Healthscope Whirlpool |
$275.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.01
|
| Rate for Payer: Nomi Health Commercial |
$275.44
|
| Rate for Payer: PACE SWMI |
$229.53
|
| Rate for Payer: PHP Medicare Advantage |
$229.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.80
|
| Rate for Payer: Priority Health Medicare |
$229.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.53
|
| Rate for Payer: UHC Medicare Advantage |
$229.53
|
| Rate for Payer: UHCCP DNSP |
$229.53
|
|
|
PR RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR
|
Professional
|
Both
|
$1,678.00
|
|
|
Service Code
|
HCPCS 33234
|
| Min. Negotiated Rate |
$459.28 |
| Max. Negotiated Rate |
$1,090.70 |
| Rate for Payer: Aetna Commercial |
$615.44
|
| Rate for Payer: Aetna Medicare |
$459.28
|
| Rate for Payer: BCBS Complete |
$671.20
|
| Rate for Payer: BCBS MAPPO |
$459.28
|
| Rate for Payer: BCN Medicare Advantage |
$459.28
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cofinity Commercial |
$661.36
|
| Rate for Payer: Cofinity Commercial |
$615.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.28
|
| Rate for Payer: Healthscope Commercial |
$551.14
|
| Rate for Payer: Healthscope Whirlpool |
$551.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.24
|
| Rate for Payer: Nomi Health Commercial |
$551.14
|
| Rate for Payer: PACE SWMI |
$459.28
|
| Rate for Payer: PHP Medicare Advantage |
$459.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.70
|
| Rate for Payer: Priority Health Medicare |
$459.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.28
|
| Rate for Payer: UHC Medicare Advantage |
$459.28
|
| Rate for Payer: UHCCP DNSP |
$459.28
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 33235
|
| Min. Negotiated Rate |
$530.80 |
| Max. Negotiated Rate |
$867.82 |
| Rate for Payer: Aetna Commercial |
$807.55
|
| Rate for Payer: Aetna Medicare |
$602.65
|
| Rate for Payer: BCBS Complete |
$530.80
|
| Rate for Payer: BCBS MAPPO |
$602.65
|
| Rate for Payer: BCN Medicare Advantage |
$602.65
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cofinity Commercial |
$867.82
|
| Rate for Payer: Cofinity Commercial |
$807.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.65
|
| Rate for Payer: Healthscope Commercial |
$723.18
|
| Rate for Payer: Healthscope Whirlpool |
$723.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.78
|
| Rate for Payer: Nomi Health Commercial |
$723.18
|
| Rate for Payer: PACE SWMI |
$602.65
|
| Rate for Payer: PHP Medicare Advantage |
$602.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.55
|
| Rate for Payer: Priority Health Medicare |
$602.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.65
|
| Rate for Payer: UHC Medicare Advantage |
$602.65
|
| Rate for Payer: UHCCP DNSP |
$602.65
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
36590
|
| Min. Negotiated Rate |
$179.91 |
| Max. Negotiated Rate |
$465.40 |
| Rate for Payer: Aetna Commercial |
$241.08
|
| Rate for Payer: Aetna Medicare |
$179.91
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$179.91
|
| Rate for Payer: BCN Medicare Advantage |
$179.91
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$259.07
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.91
|
| Rate for Payer: Healthscope Commercial |
$215.89
|
| Rate for Payer: Healthscope Whirlpool |
$215.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.91
|
| Rate for Payer: Nomi Health Commercial |
$215.89
|
| Rate for Payer: PACE SWMI |
$179.91
|
| Rate for Payer: PHP Medicare Advantage |
$179.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$179.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.91
|
| Rate for Payer: UHC Medicare Advantage |
$179.91
|
| Rate for Payer: UHCCP DNSP |
$179.91
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 36590
|
| Min. Negotiated Rate |
$179.91 |
| Max. Negotiated Rate |
$465.40 |
| Rate for Payer: Aetna Commercial |
$241.08
|
| Rate for Payer: Aetna Medicare |
$179.91
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$179.91
|
| Rate for Payer: BCN Medicare Advantage |
$179.91
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$259.07
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.91
|
| Rate for Payer: Healthscope Commercial |
$215.89
|
| Rate for Payer: Healthscope Whirlpool |
$215.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.91
|
| Rate for Payer: Nomi Health Commercial |
$215.89
|
| Rate for Payer: PACE SWMI |
$179.91
|
| Rate for Payer: PHP Medicare Advantage |
$179.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$179.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.91
|
| Rate for Payer: UHC Medicare Advantage |
$179.91
|
| Rate for Payer: UHCCP DNSP |
$179.91
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: ASR ASR |
$694.52
|
| Rate for Payer: ASR Commercial |
$694.52
|
| Rate for Payer: BCBS Trust/PPO |
$583.47
|
| Rate for Payer: BCN Commercial |
$555.11
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$673.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.80
|
| Rate for Payer: Healthscope Commercial |
$716.00
|
| Rate for Payer: Healthscope Whirlpool |
$694.52
|
| Rate for Payer: Mclaren Commercial |
$644.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$608.60
|
| Rate for Payer: Nomi Health Commercial |
$587.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$630.08
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,348.31 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: Aetna Medicare |
$1,515.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: ASR ASR |
$694.52
|
| Rate for Payer: ASR Commercial |
$694.52
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCBS Trust/PPO |
$586.33
|
| Rate for Payer: BCN Commercial |
$555.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$673.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Healthscope Commercial |
$716.00
|
| Rate for Payer: Healthscope Whirlpool |
$694.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,515.04
|
| Rate for Payer: Mclaren Commercial |
$644.40
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$608.60
|
| Rate for Payer: Nomi Health Commercial |
$587.12
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Commercial |
$1,666.54
|
| Rate for Payer: PHP Medicaid |
$812.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$627.36
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Priority Health Narrow Network |
$501.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$630.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Exchange |
$2,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP DNSP |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$812.06
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$278.85 |
| Max. Negotiated Rate |
$934.62 |
| Rate for Payer: Aetna Commercial |
$386.10
|
| Rate for Payer: Aetna Medicare |
$602.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: ASR ASR |
$416.13
|
| Rate for Payer: ASR Commercial |
$416.13
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCBS Trust/PPO |
$351.31
|
| Rate for Payer: BCN Commercial |
$332.60
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$403.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Healthscope Commercial |
$429.00
|
| Rate for Payer: Healthscope Whirlpool |
$416.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$602.98
|
| Rate for Payer: Mclaren Commercial |
$386.10
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.65
|
| Rate for Payer: Nomi Health Commercial |
$351.78
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Commercial |
$663.28
|
| Rate for Payer: PHP Medicaid |
$323.20
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.89
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Priority Health Narrow Network |
$300.73
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Exchange |
$934.62
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP DNSP |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$323.20
|
| Rate for Payer: VA VA |
$602.98
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$278.85 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$386.10
|
| Rate for Payer: ASR ASR |
$416.13
|
| Rate for Payer: ASR Commercial |
$416.13
|
| Rate for Payer: BCBS Trust/PPO |
$349.59
|
| Rate for Payer: BCN Commercial |
$332.60
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$403.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.20
|
| Rate for Payer: Healthscope Commercial |
$429.00
|
| Rate for Payer: Healthscope Whirlpool |
$416.13
|
| Rate for Payer: Mclaren Commercial |
$386.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.65
|
| Rate for Payer: Nomi Health Commercial |
$351.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.52
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 36589
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$278.85 |
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Aetna Medicare |
$129.08
|
| Rate for Payer: BCBS Complete |
$171.60
|
| Rate for Payer: BCBS MAPPO |
$129.08
|
| Rate for Payer: BCN Medicare Advantage |
$129.08
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$172.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.08
|
| Rate for Payer: Healthscope Commercial |
$154.90
|
| Rate for Payer: Healthscope Whirlpool |
$154.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.53
|
| Rate for Payer: Nomi Health Commercial |
$154.90
|
| Rate for Payer: PACE SWMI |
$129.08
|
| Rate for Payer: PHP Medicare Advantage |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health Medicare |
$129.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.08
|
| Rate for Payer: UHC Medicare Advantage |
$129.08
|
| Rate for Payer: UHCCP DNSP |
$129.08
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$278.85 |
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Aetna Medicare |
$129.08
|
| Rate for Payer: BCBS Complete |
$171.60
|
| Rate for Payer: BCBS MAPPO |
$129.08
|
| Rate for Payer: BCN Medicare Advantage |
$129.08
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$172.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.08
|
| Rate for Payer: Healthscope Commercial |
$154.90
|
| Rate for Payer: Healthscope Whirlpool |
$154.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.53
|
| Rate for Payer: Nomi Health Commercial |
$154.90
|
| Rate for Payer: PACE SWMI |
$129.08
|
| Rate for Payer: PHP Medicare Advantage |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health Medicare |
$129.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.08
|
| Rate for Payer: UHC Medicare Advantage |
$129.08
|
| Rate for Payer: UHCCP DNSP |
$129.08
|
|
|
PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 11983
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$261.30 |
| Rate for Payer: Aetna Commercial |
$133.64
|
| Rate for Payer: Aetna Medicare |
$99.73
|
| Rate for Payer: BCBS Complete |
$160.80
|
| Rate for Payer: BCBS MAPPO |
$99.73
|
| Rate for Payer: BCN Medicare Advantage |
$99.73
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$143.61
|
| Rate for Payer: Cofinity Commercial |
$133.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.73
|
| Rate for Payer: Healthscope Commercial |
$119.68
|
| Rate for Payer: Healthscope Whirlpool |
$119.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.72
|
| Rate for Payer: Nomi Health Commercial |
$119.68
|
| Rate for Payer: PACE SWMI |
$99.73
|
| Rate for Payer: PHP Medicare Advantage |
$99.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health Medicare |
$99.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.73
|
| Rate for Payer: UHC Medicare Advantage |
$99.73
|
| Rate for Payer: UHCCP DNSP |
$99.73
|
|
|
PR RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
HCPCS 50575
|
| Min. Negotiated Rate |
$554.40 |
| Max. Negotiated Rate |
$974.39 |
| Rate for Payer: Aetna Commercial |
$906.72
|
| Rate for Payer: Aetna Medicare |
$676.66
|
| Rate for Payer: BCBS Complete |
$554.40
|
| Rate for Payer: BCBS MAPPO |
$676.66
|
| Rate for Payer: BCN Medicare Advantage |
$676.66
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cofinity Commercial |
$974.39
|
| Rate for Payer: Cofinity Commercial |
$906.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.66
|
| Rate for Payer: Healthscope Commercial |
$811.99
|
| Rate for Payer: Healthscope Whirlpool |
$811.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.49
|
| Rate for Payer: Nomi Health Commercial |
$811.99
|
| Rate for Payer: PACE SWMI |
$676.66
|
| Rate for Payer: PHP Medicare Advantage |
$676.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.90
|
| Rate for Payer: Priority Health Medicare |
$676.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.66
|
| Rate for Payer: UHC Medicare Advantage |
$676.66
|
| Rate for Payer: UHCCP DNSP |
$676.66
|
|
|
PR ROBOTIC SURGICAL SYSTEM
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS S2900
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 95852
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$7.25
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS MAPPO |
$5.41
|
| Rate for Payer: BCN Medicare Advantage |
$5.41
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$7.79
|
| Rate for Payer: Cofinity Commercial |
$7.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.41
|
| Rate for Payer: Healthscope Commercial |
$6.49
|
| Rate for Payer: Healthscope Whirlpool |
$6.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.68
|
| Rate for Payer: Nomi Health Commercial |
$6.49
|
| Rate for Payer: PACE SWMI |
$5.41
|
| Rate for Payer: PHP Medicare Advantage |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.00
|
| Rate for Payer: Priority Health Medicare |
$5.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.41
|
| Rate for Payer: UHC Medicare Advantage |
$5.41
|
| Rate for Payer: UHCCP DNSP |
$5.41
|
|
|
PR ROPRTJ > 1 MO AFTER ORIGINAL OPRATION
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 35700
|
| Min. Negotiated Rate |
$145.85 |
| Max. Negotiated Rate |
$375.70 |
| Rate for Payer: Aetna Commercial |
$195.44
|
| Rate for Payer: Aetna Medicare |
$145.85
|
| Rate for Payer: BCBS Complete |
$231.20
|
| Rate for Payer: BCBS MAPPO |
$145.85
|
| Rate for Payer: BCN Medicare Advantage |
$145.85
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cofinity Commercial |
$210.02
|
| Rate for Payer: Cofinity Commercial |
$195.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.85
|
| Rate for Payer: Healthscope Commercial |
$175.02
|
| Rate for Payer: Healthscope Whirlpool |
$175.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.14
|
| Rate for Payer: Nomi Health Commercial |
$175.02
|
| Rate for Payer: PACE SWMI |
$145.85
|
| Rate for Payer: PHP Medicare Advantage |
$145.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.70
|
| Rate for Payer: Priority Health Medicare |
$145.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.85
|
| Rate for Payer: UHC Medicare Advantage |
$145.85
|
| Rate for Payer: UHCCP DNSP |
$145.85
|
|
|
PR ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ
|
Professional
|
Both
|
$1,703.00
|
|
|
Service Code
|
HCPCS 33530
|
| Min. Negotiated Rate |
$502.04 |
| Max. Negotiated Rate |
$1,106.95 |
| Rate for Payer: Aetna Commercial |
$672.73
|
| Rate for Payer: Aetna Medicare |
$502.04
|
| Rate for Payer: BCBS Complete |
$681.20
|
| Rate for Payer: BCBS MAPPO |
$502.04
|
| Rate for Payer: BCN Medicare Advantage |
$502.04
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cofinity Commercial |
$722.94
|
| Rate for Payer: Cofinity Commercial |
$672.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.04
|
| Rate for Payer: Healthscope Commercial |
$602.45
|
| Rate for Payer: Healthscope Whirlpool |
$602.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$527.14
|
| Rate for Payer: Nomi Health Commercial |
$602.45
|
| Rate for Payer: PACE SWMI |
$502.04
|
| Rate for Payer: PHP Medicare Advantage |
$502.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,106.95
|
| Rate for Payer: Priority Health Medicare |
$502.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.04
|
| Rate for Payer: UHC Medicare Advantage |
$502.04
|
| Rate for Payer: UHCCP DNSP |
$502.04
|
|
|
PR ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 35390
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$220.61 |
| Rate for Payer: Aetna Commercial |
$205.29
|
| Rate for Payer: Aetna Medicare |
$153.20
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$153.20
|
| Rate for Payer: BCN Medicare Advantage |
$153.20
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$220.61
|
| Rate for Payer: Cofinity Commercial |
$205.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.20
|
| Rate for Payer: Healthscope Commercial |
$183.84
|
| Rate for Payer: Healthscope Whirlpool |
$183.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.86
|
| Rate for Payer: Nomi Health Commercial |
$183.84
|
| Rate for Payer: PACE SWMI |
$153.20
|
| Rate for Payer: PHP Medicare Advantage |
$153.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$153.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.20
|
| Rate for Payer: UHC Medicare Advantage |
$153.20
|
| Rate for Payer: UHCCP DNSP |
$153.20
|
|
