|
PR ROUT FOOT CARE PER VISIT
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS S0390
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
|
|
PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB
|
Professional
|
Both
|
$4,028.00
|
|
|
Service Code
|
HCPCS 59610
|
| Min. Negotiated Rate |
$1,611.20 |
| Max. Negotiated Rate |
$3,540.57 |
| Rate for Payer: Aetna Commercial |
$3,294.70
|
| Rate for Payer: Aetna Medicare |
$2,458.73
|
| Rate for Payer: BCBS Complete |
$1,611.20
|
| Rate for Payer: BCBS MAPPO |
$2,458.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,458.73
|
| Rate for Payer: Cash Price |
$3,222.40
|
| Rate for Payer: Cash Price |
$3,222.40
|
| Rate for Payer: Cofinity Commercial |
$3,540.57
|
| Rate for Payer: Cofinity Commercial |
$3,294.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,458.73
|
| Rate for Payer: Healthscope Commercial |
$2,950.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,950.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,581.67
|
| Rate for Payer: Nomi Health Commercial |
$2,950.48
|
| Rate for Payer: PACE SWMI |
$2,458.73
|
| Rate for Payer: PHP Medicare Advantage |
$2,458.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,618.20
|
| Rate for Payer: Priority Health Medicare |
$2,458.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,458.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,458.73
|
| Rate for Payer: UHCCP DNSP |
$2,458.73
|
|
|
PR ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC
|
Professional
|
Both
|
$4,323.00
|
|
|
Service Code
|
HCPCS 59618
|
| Min. Negotiated Rate |
$1,729.20 |
| Max. Negotiated Rate |
$3,794.90 |
| Rate for Payer: Aetna Commercial |
$3,531.37
|
| Rate for Payer: Aetna Medicare |
$2,635.35
|
| Rate for Payer: BCBS Complete |
$1,729.20
|
| Rate for Payer: BCBS MAPPO |
$2,635.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,635.35
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Cofinity Commercial |
$3,794.90
|
| Rate for Payer: Cofinity Commercial |
$3,531.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,635.35
|
| Rate for Payer: Healthscope Commercial |
$3,162.42
|
| Rate for Payer: Healthscope Whirlpool |
$3,162.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,767.12
|
| Rate for Payer: Nomi Health Commercial |
$3,162.42
|
| Rate for Payer: PACE SWMI |
$2,635.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,635.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,809.95
|
| Rate for Payer: Priority Health Medicare |
$2,635.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,635.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,635.35
|
| Rate for Payer: UHCCP DNSP |
$2,635.35
|
|
|
PR RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST
|
Professional
|
Both
|
$2,539.00
|
|
|
Service Code
|
HCPCS 50840
|
| Min. Negotiated Rate |
$1,015.60 |
| Max. Negotiated Rate |
$1,691.38 |
| Rate for Payer: Aetna Commercial |
$1,573.92
|
| Rate for Payer: Aetna Medicare |
$1,174.57
|
| Rate for Payer: BCBS Complete |
$1,015.60
|
| Rate for Payer: BCBS MAPPO |
$1,174.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,174.57
|
| Rate for Payer: Cash Price |
$2,031.20
|
| Rate for Payer: Cash Price |
$2,031.20
|
| Rate for Payer: Cofinity Commercial |
$1,691.38
|
| Rate for Payer: Cofinity Commercial |
$1,573.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,174.57
|
| Rate for Payer: Healthscope Commercial |
$1,409.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,409.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,233.30
|
| Rate for Payer: Nomi Health Commercial |
$1,409.48
|
| Rate for Payer: PACE SWMI |
$1,174.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,174.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,650.35
|
| Rate for Payer: Priority Health Medicare |
$1,174.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,174.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,174.57
|
| Rate for Payer: UHCCP DNSP |
$1,174.57
|
|
|
PR RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS
|
Professional
|
Both
|
$9,690.00
|
|
|
Service Code
|
HCPCS 33411
|
| Min. Negotiated Rate |
$3,212.15 |
| Max. Negotiated Rate |
$6,298.50 |
| Rate for Payer: Aetna Commercial |
$4,304.28
|
| Rate for Payer: Aetna Medicare |
$3,212.15
|
| Rate for Payer: BCBS Complete |
$3,876.00
|
| Rate for Payer: BCBS MAPPO |
$3,212.15
|
| Rate for Payer: BCN Medicare Advantage |
$3,212.15
|
| Rate for Payer: Cash Price |
$7,752.00
|
| Rate for Payer: Cash Price |
$7,752.00
|
| Rate for Payer: Cofinity Commercial |
$4,625.50
|
| Rate for Payer: Cofinity Commercial |
$4,304.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,212.15
|
| Rate for Payer: Healthscope Commercial |
$3,854.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,854.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,372.76
|
| Rate for Payer: Nomi Health Commercial |
$3,854.58
|
| Rate for Payer: PACE SWMI |
$3,212.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,212.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,298.50
|
| Rate for Payer: Priority Health Medicare |
$3,212.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,212.15
|
| Rate for Payer: UHC Medicare Advantage |
$3,212.15
|
| Rate for Payer: UHCCP DNSP |
$3,212.15
|
|
|
PR RPLCMT AORTIC VALVE OPN ALLOGRAFT VALVE FREEHAND
|
Professional
|
Both
|
$6,847.00
|
|
|
Service Code
|
HCPCS 33406
|
| Min. Negotiated Rate |
$2,738.80 |
| Max. Negotiated Rate |
$4,450.55 |
| Rate for Payer: Aetna Commercial |
$3,707.27
|
| Rate for Payer: Aetna Medicare |
$2,766.62
|
| Rate for Payer: BCBS Complete |
$2,738.80
|
| Rate for Payer: BCBS MAPPO |
$2,766.62
|
| Rate for Payer: BCN Medicare Advantage |
$2,766.62
|
| Rate for Payer: Cash Price |
$5,477.60
|
| Rate for Payer: Cash Price |
$5,477.60
|
| Rate for Payer: Cofinity Commercial |
$3,983.93
|
| Rate for Payer: Cofinity Commercial |
$3,707.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,766.62
|
| Rate for Payer: Healthscope Commercial |
$3,319.94
|
| Rate for Payer: Healthscope Whirlpool |
$3,319.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,904.95
|
| Rate for Payer: Nomi Health Commercial |
$3,319.94
|
| Rate for Payer: PACE SWMI |
$2,766.62
|
| Rate for Payer: PHP Medicare Advantage |
$2,766.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,450.55
|
| Rate for Payer: Priority Health Medicare |
$2,766.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,766.62
|
| Rate for Payer: UHC Medicare Advantage |
$2,766.62
|
| Rate for Payer: UHCCP DNSP |
$2,766.62
|
|
|
PR RPLCMT AORTIC VALVE OPN W/STENTLESS TISSUE VALVE
|
Professional
|
Both
|
$8,127.00
|
|
|
Service Code
|
HCPCS 33410
|
| Min. Negotiated Rate |
$2,440.87 |
| Max. Negotiated Rate |
$5,282.55 |
| Rate for Payer: Aetna Commercial |
$3,270.77
|
| Rate for Payer: Aetna Medicare |
$2,440.87
|
| Rate for Payer: BCBS Complete |
$3,250.80
|
| Rate for Payer: BCBS MAPPO |
$2,440.87
|
| Rate for Payer: BCN Medicare Advantage |
$2,440.87
|
| Rate for Payer: Cash Price |
$6,501.60
|
| Rate for Payer: Cash Price |
$6,501.60
|
| Rate for Payer: Cofinity Commercial |
$3,514.85
|
| Rate for Payer: Cofinity Commercial |
$3,270.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,440.87
|
| Rate for Payer: Healthscope Commercial |
$2,929.04
|
| Rate for Payer: Healthscope Whirlpool |
$2,929.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,562.91
|
| Rate for Payer: Nomi Health Commercial |
$2,929.04
|
| Rate for Payer: PACE SWMI |
$2,440.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,440.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,282.55
|
| Rate for Payer: Priority Health Medicare |
$2,440.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,440.87
|
| Rate for Payer: UHC Medicare Advantage |
$2,440.87
|
| Rate for Payer: UHCCP DNSP |
$2,440.87
|
|
|
PR RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$5,033.00
|
|
|
Service Code
|
HCPCS 62143
|
| Min. Negotiated Rate |
$1,036.68 |
| Max. Negotiated Rate |
$3,271.45 |
| Rate for Payer: Aetna Commercial |
$1,389.15
|
| Rate for Payer: Aetna Medicare |
$1,036.68
|
| Rate for Payer: BCBS Complete |
$2,013.20
|
| Rate for Payer: BCBS MAPPO |
$1,036.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,036.68
|
| Rate for Payer: Cash Price |
$4,026.40
|
| Rate for Payer: Cash Price |
$4,026.40
|
| Rate for Payer: Cofinity Commercial |
$1,492.82
|
| Rate for Payer: Cofinity Commercial |
$1,389.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,036.68
|
| Rate for Payer: Healthscope Commercial |
$1,244.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,244.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,088.51
|
| Rate for Payer: Nomi Health Commercial |
$1,244.02
|
| Rate for Payer: PACE SWMI |
$1,036.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,036.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,271.45
|
| Rate for Payer: Priority Health Medicare |
$1,036.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,036.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,036.68
|
| Rate for Payer: UHCCP DNSP |
$1,036.68
|
|
|
PR RPLCMT CATH CTR VAD SUBQ PORT/PMP
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
HCPCS 36578
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$665.60 |
| Rate for Payer: Aetna Commercial |
$256.37
|
| Rate for Payer: Aetna Medicare |
$191.32
|
| Rate for Payer: BCBS Complete |
$409.60
|
| Rate for Payer: BCBS MAPPO |
$191.32
|
| Rate for Payer: BCN Medicare Advantage |
$191.32
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cofinity Commercial |
$275.50
|
| Rate for Payer: Cofinity Commercial |
$256.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.32
|
| Rate for Payer: Healthscope Commercial |
$229.58
|
| Rate for Payer: Healthscope Whirlpool |
$229.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.89
|
| Rate for Payer: Nomi Health Commercial |
$229.58
|
| Rate for Payer: PACE SWMI |
$191.32
|
| Rate for Payer: PHP Medicare Advantage |
$191.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.60
|
| Rate for Payer: Priority Health Medicare |
$191.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.32
|
| Rate for Payer: UHC Medicare Advantage |
$191.32
|
| Rate for Payer: UHCCP DNSP |
$191.32
|
|
|
PR RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$771.00
|
|
|
Service Code
|
HCPCS 36580
|
| Min. Negotiated Rate |
$61.41 |
| Max. Negotiated Rate |
$501.15 |
| Rate for Payer: Aetna Commercial |
$82.29
|
| Rate for Payer: Aetna Medicare |
$61.41
|
| Rate for Payer: BCBS Complete |
$308.40
|
| Rate for Payer: BCBS MAPPO |
$61.41
|
| Rate for Payer: BCN Medicare Advantage |
$61.41
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$82.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.41
|
| Rate for Payer: Healthscope Commercial |
$73.69
|
| Rate for Payer: Healthscope Whirlpool |
$73.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.48
|
| Rate for Payer: Nomi Health Commercial |
$73.69
|
| Rate for Payer: PACE SWMI |
$61.41
|
| Rate for Payer: PHP Medicare Advantage |
$61.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health Medicare |
$61.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.41
|
| Rate for Payer: UHC Medicare Advantage |
$61.41
|
| Rate for Payer: UHCCP DNSP |
$61.41
|
|
|
PR RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 36585
|
| Min. Negotiated Rate |
$293.26 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna Commercial |
$392.97
|
| Rate for Payer: Aetna Medicare |
$293.26
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: BCBS MAPPO |
$293.26
|
| Rate for Payer: BCN Medicare Advantage |
$293.26
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cofinity Commercial |
$422.29
|
| Rate for Payer: Cofinity Commercial |
$392.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.26
|
| Rate for Payer: Healthscope Commercial |
$351.91
|
| Rate for Payer: Healthscope Whirlpool |
$351.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.92
|
| Rate for Payer: Nomi Health Commercial |
$351.91
|
| Rate for Payer: PACE SWMI |
$293.26
|
| Rate for Payer: PHP Medicare Advantage |
$293.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
| Rate for Payer: Priority Health Medicare |
$293.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.26
|
| Rate for Payer: UHC Medicare Advantage |
$293.26
|
| Rate for Payer: UHCCP DNSP |
$293.26
|
|
|
PR RPLCMT COMPL TUN CTR VAD W/SUBQ PMP
|
Professional
|
Both
|
$1,945.00
|
|
|
Service Code
|
HCPCS 36583
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$1,264.25 |
| Rate for Payer: Aetna Commercial |
$425.80
|
| Rate for Payer: Aetna Medicare |
$317.76
|
| Rate for Payer: BCBS Complete |
$778.00
|
| Rate for Payer: BCBS MAPPO |
$317.76
|
| Rate for Payer: BCN Medicare Advantage |
$317.76
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cofinity Commercial |
$457.57
|
| Rate for Payer: Cofinity Commercial |
$425.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.76
|
| Rate for Payer: Healthscope Commercial |
$381.31
|
| Rate for Payer: Healthscope Whirlpool |
$381.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.65
|
| Rate for Payer: Nomi Health Commercial |
$381.31
|
| Rate for Payer: PACE SWMI |
$317.76
|
| Rate for Payer: PHP Medicare Advantage |
$317.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,264.25
|
| Rate for Payer: Priority Health Medicare |
$317.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.76
|
| Rate for Payer: UHC Medicare Advantage |
$317.76
|
| Rate for Payer: UHCCP DNSP |
$317.76
|
|
|
PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 36582
|
| Min. Negotiated Rate |
$225.60 |
| Max. Negotiated Rate |
$392.23 |
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: Aetna Medicare |
$272.38
|
| Rate for Payer: BCBS Complete |
$225.60
|
| Rate for Payer: BCBS MAPPO |
$272.38
|
| Rate for Payer: BCN Medicare Advantage |
$272.38
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cofinity Commercial |
$392.23
|
| Rate for Payer: Cofinity Commercial |
$364.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.38
|
| Rate for Payer: Healthscope Commercial |
$326.86
|
| Rate for Payer: Healthscope Whirlpool |
$326.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.00
|
| Rate for Payer: Nomi Health Commercial |
$326.86
|
| Rate for Payer: PACE SWMI |
$272.38
|
| Rate for Payer: PHP Medicare Advantage |
$272.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.60
|
| Rate for Payer: Priority Health Medicare |
$272.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.38
|
| Rate for Payer: UHC Medicare Advantage |
$272.38
|
| Rate for Payer: UHCCP DNSP |
$272.38
|
|
|
PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 36581
|
| Min. Negotiated Rate |
$172.66 |
| Max. Negotiated Rate |
$1,020.50 |
| Rate for Payer: Aetna Commercial |
$231.36
|
| Rate for Payer: Aetna Medicare |
$172.66
|
| Rate for Payer: BCBS Complete |
$628.00
|
| Rate for Payer: BCBS MAPPO |
$172.66
|
| Rate for Payer: BCN Medicare Advantage |
$172.66
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cofinity Commercial |
$248.63
|
| Rate for Payer: Cofinity Commercial |
$231.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.66
|
| Rate for Payer: Healthscope Commercial |
$207.19
|
| Rate for Payer: Healthscope Whirlpool |
$207.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.29
|
| Rate for Payer: Nomi Health Commercial |
$207.19
|
| Rate for Payer: PACE SWMI |
$172.66
|
| Rate for Payer: PHP Medicare Advantage |
$172.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.50
|
| Rate for Payer: Priority Health Medicare |
$172.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.66
|
| Rate for Payer: UHC Medicare Advantage |
$172.66
|
| Rate for Payer: UHCCP DNSP |
$172.66
|
|
|
PR RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 62194
|
| Min. Negotiated Rate |
$488.25 |
| Max. Negotiated Rate |
$1,218.10 |
| Rate for Payer: Aetna Commercial |
$654.25
|
| Rate for Payer: Aetna Medicare |
$488.25
|
| Rate for Payer: BCBS Complete |
$749.60
|
| Rate for Payer: BCBS MAPPO |
$488.25
|
| Rate for Payer: BCN Medicare Advantage |
$488.25
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cofinity Commercial |
$703.08
|
| Rate for Payer: Cofinity Commercial |
$654.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.25
|
| Rate for Payer: Healthscope Commercial |
$585.90
|
| Rate for Payer: Healthscope Whirlpool |
$585.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.66
|
| Rate for Payer: Nomi Health Commercial |
$585.90
|
| Rate for Payer: PACE SWMI |
$488.25
|
| Rate for Payer: PHP Medicare Advantage |
$488.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.10
|
| Rate for Payer: Priority Health Medicare |
$488.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$488.25
|
| Rate for Payer: UHC Medicare Advantage |
$488.25
|
| Rate for Payer: UHCCP DNSP |
$488.25
|
|
|
PR RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 63744
|
| Min. Negotiated Rate |
$705.13 |
| Max. Negotiated Rate |
$1,472.90 |
| Rate for Payer: Aetna Commercial |
$944.87
|
| Rate for Payer: Aetna Medicare |
$705.13
|
| Rate for Payer: BCBS Complete |
$906.40
|
| Rate for Payer: BCBS MAPPO |
$705.13
|
| Rate for Payer: BCN Medicare Advantage |
$705.13
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cofinity Commercial |
$944.87
|
| Rate for Payer: Cofinity Commercial |
$1,015.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.13
|
| Rate for Payer: Healthscope Commercial |
$846.16
|
| Rate for Payer: Healthscope Whirlpool |
$846.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.39
|
| Rate for Payer: Nomi Health Commercial |
$846.16
|
| Rate for Payer: PACE SWMI |
$705.13
|
| Rate for Payer: PHP Medicare Advantage |
$705.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.90
|
| Rate for Payer: Priority Health Medicare |
$705.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$705.13
|
| Rate for Payer: UHC Medicare Advantage |
$705.13
|
| Rate for Payer: UHCCP DNSP |
$705.13
|
|
|
PR RPLCMT/IRRIGATION VENTRICULAR CATHETER
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 62225
|
| Min. Negotiated Rate |
$530.02 |
| Max. Negotiated Rate |
$1,771.25 |
| Rate for Payer: Aetna Commercial |
$710.23
|
| Rate for Payer: Aetna Medicare |
$530.02
|
| Rate for Payer: BCBS Complete |
$1,090.00
|
| Rate for Payer: BCBS MAPPO |
$530.02
|
| Rate for Payer: BCN Medicare Advantage |
$530.02
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$763.23
|
| Rate for Payer: Cofinity Commercial |
$710.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.02
|
| Rate for Payer: Healthscope Commercial |
$636.02
|
| Rate for Payer: Healthscope Whirlpool |
$636.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.52
|
| Rate for Payer: Nomi Health Commercial |
$636.02
|
| Rate for Payer: PACE SWMI |
$530.02
|
| Rate for Payer: PHP Medicare Advantage |
$530.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health Medicare |
$530.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.02
|
| Rate for Payer: UHC Medicare Advantage |
$530.02
|
| Rate for Payer: UHCCP DNSP |
$530.02
|
|
|
PR RPLCMT OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 69717
|
| Min. Negotiated Rate |
$530.52 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Aetna Commercial |
$710.90
|
| Rate for Payer: Aetna Medicare |
$530.52
|
| Rate for Payer: BCBS Complete |
$904.40
|
| Rate for Payer: BCBS MAPPO |
$530.52
|
| Rate for Payer: BCN Medicare Advantage |
$530.52
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cofinity Commercial |
$763.95
|
| Rate for Payer: Cofinity Commercial |
$710.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.52
|
| Rate for Payer: Healthscope Commercial |
$636.62
|
| Rate for Payer: Healthscope Whirlpool |
$636.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.05
|
| Rate for Payer: Nomi Health Commercial |
$636.62
|
| Rate for Payer: PACE SWMI |
$530.52
|
| Rate for Payer: PHP Medicare Advantage |
$530.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health Medicare |
$530.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.52
|
| Rate for Payer: UHC Medicare Advantage |
$530.52
|
| Rate for Payer: UHCCP DNSP |
$530.52
|
|
|
PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT
|
Professional
|
Both
|
$4,753.00
|
|
|
Service Code
|
HCPCS 33405
|
| Min. Negotiated Rate |
$1,901.20 |
| Max. Negotiated Rate |
$3,132.84 |
| Rate for Payer: Aetna Commercial |
$2,915.28
|
| Rate for Payer: Aetna Medicare |
$2,175.58
|
| Rate for Payer: BCBS Complete |
$1,901.20
|
| Rate for Payer: BCBS MAPPO |
$2,175.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,175.58
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cofinity Commercial |
$3,132.84
|
| Rate for Payer: Cofinity Commercial |
$2,915.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,175.58
|
| Rate for Payer: Healthscope Commercial |
$2,610.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,610.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,284.36
|
| Rate for Payer: Nomi Health Commercial |
$2,610.70
|
| Rate for Payer: PACE SWMI |
$2,175.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,175.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,089.45
|
| Rate for Payer: Priority Health Medicare |
$2,175.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,175.58
|
| Rate for Payer: UHC Medicare Advantage |
$2,175.58
|
| Rate for Payer: UHCCP DNSP |
$2,175.58
|
|
|
PR RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS
|
Professional
|
Both
|
$3,555.00
|
|
|
Service Code
|
HCPCS 62230
|
| Min. Negotiated Rate |
$830.75 |
| Max. Negotiated Rate |
$2,310.75 |
| Rate for Payer: Aetna Commercial |
$1,113.20
|
| Rate for Payer: Aetna Medicare |
$830.75
|
| Rate for Payer: BCBS Complete |
$1,422.00
|
| Rate for Payer: BCBS MAPPO |
$830.75
|
| Rate for Payer: BCN Medicare Advantage |
$830.75
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,196.28
|
| Rate for Payer: Cofinity Commercial |
$1,113.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.75
|
| Rate for Payer: Healthscope Commercial |
$996.90
|
| Rate for Payer: Healthscope Whirlpool |
$996.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.29
|
| Rate for Payer: Nomi Health Commercial |
$996.90
|
| Rate for Payer: PACE SWMI |
$830.75
|
| Rate for Payer: PHP Medicare Advantage |
$830.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,310.75
|
| Rate for Payer: Priority Health Medicare |
$830.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.75
|
| Rate for Payer: UHC Medicare Advantage |
$830.75
|
| Rate for Payer: UHCCP DNSP |
$830.75
|
|
|
PR RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP
|
Professional
|
Both
|
$3,924.00
|
|
|
Service Code
|
HCPCS 20822
|
| Min. Negotiated Rate |
$1,569.60 |
| Max. Negotiated Rate |
$2,550.60 |
| Rate for Payer: Aetna Commercial |
$2,281.78
|
| Rate for Payer: Aetna Medicare |
$1,702.82
|
| Rate for Payer: BCBS Complete |
$1,569.60
|
| Rate for Payer: BCBS MAPPO |
$1,702.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,702.82
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cofinity Commercial |
$2,452.06
|
| Rate for Payer: Cofinity Commercial |
$2,281.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,702.82
|
| Rate for Payer: Healthscope Commercial |
$2,043.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,043.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,787.96
|
| Rate for Payer: Nomi Health Commercial |
$2,043.38
|
| Rate for Payer: PACE SWMI |
$1,702.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,702.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,550.60
|
| Rate for Payer: Priority Health Medicare |
$1,702.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,702.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,702.82
|
| Rate for Payer: UHCCP DNSP |
$1,702.82
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$733.85 |
| Max. Negotiated Rate |
$5,334.82 |
| Rate for Payer: Aetna Commercial |
$1,016.10
|
| Rate for Payer: Aetna Medicare |
$3,441.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: ASR ASR |
$1,095.13
|
| Rate for Payer: ASR Commercial |
$1,095.13
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCBS Trust/PPO |
$924.54
|
| Rate for Payer: BCN Commercial |
$875.31
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$1,061.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$1,129.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,095.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,441.82
|
| Rate for Payer: Mclaren Commercial |
$1,016.10
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: Nomi Health Commercial |
$925.78
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$3,786.00
|
| Rate for Payer: PHP Medicaid |
$1,844.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$989.23
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health Narrow Network |
$791.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$993.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Exchange |
$5,334.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP DNSP |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,844.82
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Min. Negotiated Rate |
$451.60 |
| Max. Negotiated Rate |
$887.44 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$616.28
|
| Rate for Payer: BCBS Complete |
$451.60
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Healthscope Commercial |
$739.54
|
| Rate for Payer: Healthscope Whirlpool |
$739.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health Medicare |
$616.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
| Rate for Payer: UHCCP DNSP |
$616.28
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Hospital Charge Code |
49553
|
| Min. Negotiated Rate |
$451.60 |
| Max. Negotiated Rate |
$887.44 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$616.28
|
| Rate for Payer: BCBS Complete |
$451.60
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Healthscope Commercial |
$739.54
|
| Rate for Payer: Healthscope Whirlpool |
$739.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health Medicare |
$616.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
| Rate for Payer: UHCCP DNSP |
$616.28
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$733.85 |
| Max. Negotiated Rate |
$1,129.00 |
| Rate for Payer: Aetna Commercial |
$1,016.10
|
| Rate for Payer: ASR ASR |
$1,095.13
|
| Rate for Payer: ASR Commercial |
$1,095.13
|
| Rate for Payer: BCBS Trust/PPO |
$920.02
|
| Rate for Payer: BCN Commercial |
$875.31
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$1,061.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Healthscope Commercial |
$1,129.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,095.13
|
| Rate for Payer: Mclaren Commercial |
$1,016.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: Nomi Health Commercial |
$925.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$993.52
|
|
