=======================================================66984 - Removal of Cataract with Insertion of Prosthetic Lens ======================================================= Setting: Outpatient Billing Code(s): HCPCS 66984 Number of Claims: 1575 Median Total Charges: $4,889.35 Median Allowed Amount: $2,234.61 Cash / Self-Pay Price: $3,449.28 De-identified Minimum Negotiated Rate: $1,202.65 De-identified Maximum Negotiated Rate: $3,549.71 Other billing codes included in charges (not separately allowed): 92015 (Determination of Refractive State) C1713 (Anchor/Screw for Opposing Bone-to-Bone or Soft Tissue-to-Bone) C1889 (Implantable/Insertable Device, Not Elsewhere Classified) V2630 (Anterior Chamber Intraocular Lens) V2632 (Posterior Chamber Intraocular Lens) V2788 (Presbyopia-Correcting Intraocular Lens) RC 0220 - Special Charges RC 0250 - Pharmacy RC 0270 - Medical/Surgical Supplies RC 0276 - Implants/Intraocular Lenses RC 0360 - Operating Room Services RC 0370 - Anesthesia Services not provided by this facility (may be billed separately): Surgeon Anesthesiologist / CRNA Payer-Specific Negotiated Rates: Medicare $2,299.52 Dual $1,839.62 BCBS - MedicarePlusBlueMedicareAdvantage $2,299.52 Aetna - Medicare $2,299.52 HAP - MedicareAdvantage $2,299.52 Wellcare - Medicare $2,299.52 Wellcare - MedicareMedicaidDual $1,839.62 Molina - MedicareMedicaidDual $1,839.62 Priority - MedicareAdvantage $2,299.52 UHC - MedicareCommunityPlan $2,299.52 McLaren - MedicareAdvantage $2,299.52 Humana - MedicareAdvantage $2,299.52 Medicaid $1,202.65 Aetna - Medicaid $1,202.65 Wellcare - Medicaid $1,202.65 Molina - Medicaid $1,202.65 Priority - MedicaidManagedCare $1,202.65 UHC - MedicaidCommunityPlan $1,202.65 McLaren - Medicaid $1,202.65 BCBS - Commercial $3,549.71 Aetna - Commercial 150% of Medicare allowed HAP - HMOPPO 60% of billed charges Priority - HMOPPO Algorithm: 87.38 conversion factor UHC - Commercial Algorithm: 115.00 conversion factor McLaren - Commercial 73.71% of billed chargesStraith Hospital for Special Surgery
Consumer-Friendly Display of Standard Charges for Shoppable Services
Hospital Address: 23901 Lahser Road, Southfield, MI 48033
Date Last Updated: April 1, 2026
NPI: 1548268436
How to Use This File
This file lists the standard charges for shoppable services provided by Straith Hospital for Special Surgery. A shoppable service is one that can be scheduled in advance. For each service, we provide:
- Median Total Charges — the median amount billed across all claims for this service, based on actual claims data from our patient population.
- Median Allowed Amount — the median amount that insurers have historically allowed (agreed to pay) for this service.
- Cash / Self-Pay Price — the discounted price available to patients who have no other means of payment. This is set at 150% of the Medicare allowed amount.
- De-identified Minimum and Maximum Negotiated Rates — the lowest and highest rates negotiated with any third-party payer for this service.
- Payer-Specific Negotiated Rates — the rate negotiated with each specific payer and plan. Rates shown as a percentage or algorithm indicate that the final dollar amount depends on the specific claim.
- Other Billing Codes — additional codes that may appear on your bill in connection with this service. These are included in the charges shown above and are not billed separately by the facility.
Important Notes:
- Charges shown are facility charges only. Your surgeon, anesthesiologist, and other physicians are not employed by Straith and will bill you separately.
- Your actual out-of-pocket cost will depend on your specific insurance plan, deductible, coinsurance, and out-of-pocket maximum.
- Median charges and allowed amounts are based on claims data from January 1, 2025 through March 6, 2026.
- This file is updated at least annually. For questions, contact Straith Hospital for Special Surgery at (248) 357-3360.
File Organization
- Section 1 — Outpatient Surgical Services (27 services)
- Section 2 — Inpatient Rehabilitation Services (6 DRGs)
- Section 3 — CMS-Specified Services Not Provided (services marked Not Applicable)
=======================================================
67042 - Vitrectomy with Removal of Internal Limiting Membrane
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 67042
Number of Claims: 211
Median Total Charges: $7,180.03
Median Allowed Amount: $3,941.52
Cash / Self-Pay Price: $6,177.83
De-identified Minimum Negotiated Rate: $2,154.00
De-identified Maximum Negotiated Rate: $4,266.09
Other billing codes included in charges (not separately allowed):
V2630 (Anterior Chamber Intraocular Lens)
RC 0250 - Pharmacy
RC 0258 - Pharmacy - IV Solutions
RC 0270 - Medical/Surgical Supplies
RC 0276 - Implants/Intraocular Lenses
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $4,118.55
Dual $3,294.84
BCBS - MedicarePlusBlueMedicareAdvantage $4,118.55
Aetna - Medicare $4,118.55
HAP - MedicareAdvantage $4,118.55
Wellcare - Medicare $4,118.55
Wellcare - MedicareMedicaidDual $3,294.84
Molina - MedicareMedicaidDual $3,294.84
Priority - MedicareAdvantage $4,118.55
UHC - MedicareCommunityPlan $4,118.55
McLaren - MedicareAdvantage $4,118.55
Humana - MedicareAdvantage $4,118.55
Medicaid $2,154.00
Aetna - Medicaid $2,154.00
Wellcare - Medicaid $2,154.00
Molina - Medicaid $2,154.00
Priority - MedicaidManagedCare $2,154.00
UHC - MedicaidCommunityPlan $2,154.00
McLaren - Medicaid $2,154.00
BCBS - Commercial $4,266.09
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
McLaren - Commercial 73.71% of billed charges
=======================================================
67108 - Repair of Retinal Detachment, Complex
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 67108
Number of Claims: 116
Median Total Charges: $9,607.33
Median Allowed Amount: $3,941.52
Cash / Self-Pay Price: $6,177.83
De-identified Minimum Negotiated Rate: $2,154.00
De-identified Maximum Negotiated Rate: $5,002.82
Other billing codes included in charges (not separately allowed):
00142
V2630 (Anterior Chamber Intraocular Lens)
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0276 - Implants/Intraocular Lenses
RC 0278 - Medical/Surgical Supplies - Other
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $4,118.55
Dual $3,294.84
BCBS - MedicarePlusBlueMedicareAdvantage $4,118.55
Aetna - Medicare $4,118.55
HAP - MedicareAdvantage $4,118.55
Wellcare - Medicare $4,118.55
Wellcare - MedicareMedicaidDual $3,294.84
Molina - MedicareMedicaidDual $3,294.84
Priority - MedicareAdvantage $4,118.55
UHC - MedicareCommunityPlan $4,118.55
McLaren - MedicareAdvantage $4,118.55
Humana - MedicareAdvantage $4,118.55
Medicaid $2,154.00
Aetna - Medicaid $2,154.00
Wellcare - Medicaid $2,154.00
Molina - Medicaid $2,154.00
Priority - MedicaidManagedCare $2,154.00
UHC - MedicaidCommunityPlan $2,154.00
McLaren - Medicaid $2,154.00
BCBS - Commercial $5,002.82
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
McLaren - Commercial 73.71% of billed charges
=======================================================
67113 - Repair of Retinal Detachment, Extensive
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 67113
Number of Claims: 114
Median Total Charges: $11,281.36
Median Allowed Amount: $5,055.38
Cash / Self-Pay Price: $7,953.22
De-identified Minimum Negotiated Rate: $2,773.02
De-identified Maximum Negotiated Rate: $6,289.09
Other billing codes included in charges (not separately allowed):
C1713 (Anchor/Screw for Opposing Bone-to-Bone or Soft Tissue-to-Bone)
V2630 (Anterior Chamber Intraocular Lens)
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0276 - Implants/Intraocular Lenses
RC 0278 - Medical/Surgical Supplies - Other
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $5,302.15
Dual $4,241.72
BCBS - MedicarePlusBlueMedicareAdvantage $5,302.15
Aetna - Medicare $5,302.15
HAP - MedicareAdvantage $5,302.15
Wellcare - Medicare $5,302.15
Wellcare - MedicareMedicaidDual $4,241.72
Molina - MedicareMedicaidDual $4,241.72
Priority - MedicareAdvantage $5,302.15
UHC - MedicareCommunityPlan $5,302.15
McLaren - MedicareAdvantage $5,302.15
Humana - MedicareAdvantage $5,302.15
Medicaid $2,773.02
Aetna - Medicaid $2,773.02
Wellcare - Medicaid $2,773.02
Molina - Medicaid $2,773.02
Priority - MedicaidManagedCare $2,773.02
UHC - MedicaidCommunityPlan $2,773.02
McLaren - Medicaid $2,773.02
BCBS - Commercial $6,289.09
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
McLaren - Commercial 73.71% of billed charges
=======================================================
66982 - Complex Cataract Removal with Insertion of Prosthetic Lens
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 66982
Number of Claims: 93
Median Total Charges: $5,055.42
Median Allowed Amount: $2,085.80
Cash / Self-Pay Price: $3,449.28
De-identified Minimum Negotiated Rate: $1,202.65
De-identified Maximum Negotiated Rate: $5,048.20
Other billing codes included in charges (not separately allowed):
92015 (Determination of Refractive State)
C1889 (Implantable/Insertable Device, Not Elsewhere Classified)
V2630 (Anterior Chamber Intraocular Lens)
RC 0220 - Special Charges
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0276 - Implants/Intraocular Lenses
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $2,299.52
Dual $1,839.62
BCBS - MedicarePlusBlueMedicareAdvantage $2,299.52
Aetna - Medicare $2,299.52
HAP - MedicareAdvantage $2,299.52
Wellcare - Medicare $2,299.52
Wellcare - MedicareMedicaidDual $1,839.62
Molina - MedicareMedicaidDual $1,839.62
Priority - MedicareAdvantage $2,299.52
UHC - MedicareCommunityPlan $2,299.52
McLaren - MedicareAdvantage $2,299.52
Humana - MedicareAdvantage $2,299.52
Medicaid $1,202.65
Aetna - Medicaid $1,202.65
Wellcare - Medicaid $1,202.65
Molina - Medicaid $1,202.65
Priority - MedicaidManagedCare $1,202.65
UHC - MedicaidCommunityPlan $1,202.65
McLaren - Medicaid $1,202.65
BCBS - Commercial $5,048.20
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
McLaren - Commercial 73.71% of billed charges
=======================================================
67040 - Vitrectomy with Endolaser Panretinal Photocoagulation
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 67040
Number of Claims: 54
Median Total Charges: $8,807.65
Median Allowed Amount: $3,941.52
Cash / Self-Pay Price: $6,177.83
De-identified Minimum Negotiated Rate: $2,154.00
De-identified Maximum Negotiated Rate: $4,308.48
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $4,118.55
Dual $3,294.84
BCBS - MedicarePlusBlueMedicareAdvantage $4,118.55
Aetna - Medicare $4,118.55
HAP - MedicareAdvantage $4,118.55
Wellcare - Medicare $4,118.55
Wellcare - MedicareMedicaidDual $3,294.84
Molina - MedicareMedicaidDual $3,294.84
Priority - MedicareAdvantage $4,118.55
UHC - MedicareCommunityPlan $4,118.55
McLaren - MedicareAdvantage $4,118.55
Humana - MedicareAdvantage $4,118.55
Medicaid $2,154.00
Aetna - Medicaid $2,154.00
Wellcare - Medicaid $2,154.00
Molina - Medicaid $2,154.00
Priority - MedicaidManagedCare $2,154.00
UHC - MedicaidCommunityPlan $2,154.00
McLaren - Medicaid $2,154.00
BCBS - Commercial $4,308.48
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
McLaren - Commercial 73.71% of billed charges
=======================================================
67036 - Vitrectomy, Mechanical, Pars Plana Approach
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 67036
Number of Claims: 47
Median Total Charges: $6,346.94
Median Allowed Amount: $3,925.20
Cash / Self-Pay Price: $6,177.83
De-identified Minimum Negotiated Rate: $2,154.00
De-identified Maximum Negotiated Rate: $4,118.55
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $4,118.55
Dual $3,294.84
BCBS - MedicarePlusBlueMedicareAdvantage $4,118.55
Aetna - Medicare $4,118.55
HAP - MedicareAdvantage $4,118.55
Wellcare - Medicare $4,118.55
Wellcare - MedicareMedicaidDual $3,294.84
Molina - MedicareMedicaidDual $3,294.84
Priority - MedicareAdvantage $4,118.55
UHC - MedicareCommunityPlan $4,118.55
McLaren - MedicareAdvantage $4,118.55
Humana - MedicareAdvantage $4,118.55
Medicaid $2,154.00
Aetna - Medicaid $2,154.00
Wellcare - Medicaid $2,154.00
Molina - Medicaid $2,154.00
Priority - MedicaidManagedCare $2,154.00
UHC - MedicaidCommunityPlan $2,154.00
McLaren - Medicaid $2,154.00
BCBS - Commercial $3,925.20
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
McLaren - Commercial 73.71% of billed charges
=======================================================
66174 - Canaloplasty + 66984 - Removal of Cataract with Insertion of Prosthetic Lens
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 66174, HCPCS 66984
Number of Claims: 42
Median Total Charges: $7,787.16
Median Allowed Amount: $3,941.52
Cash / Self-Pay Price: $6,177.83
De-identified Minimum Negotiated Rate: $2,154.00
De-identified Maximum Negotiated Rate: $4,118.55
Other billing codes included in charges (not separately allowed):
92015 (Determination of Refractive State)
C1889 (Implantable/Insertable Device, Not Elsewhere Classified)
V2630 (Anterior Chamber Intraocular Lens)
RC 0220 - Special Charges
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0276 - Implants/Intraocular Lenses
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $4,118.55
Dual $3,294.84
BCBS - MedicarePlusBlueMedicareAdvantage $4,118.55
Aetna - Medicare $4,118.55
HAP - MedicareAdvantage $4,118.55
Wellcare - Medicare $4,118.55
Wellcare - MedicareMedicaidDual $3,294.84
Molina - MedicareMedicaidDual $3,294.84
Priority - MedicareAdvantage $4,118.55
UHC - MedicareCommunityPlan $4,118.55
McLaren - MedicareAdvantage $4,118.55
Humana - MedicareAdvantage $4,118.55
Medicaid $2,154.00
Aetna - Medicaid $2,154.00
Wellcare - Medicaid $2,154.00
Molina - Medicaid $2,154.00
Priority - MedicaidManagedCare $2,154.00
UHC - MedicaidCommunityPlan $2,154.00
McLaren - Medicaid $2,154.00
BCBS - Commercial $2,977.70
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
McLaren - Commercial 73.71% of billed charges
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
27130 - Total Hip Arthroplasty
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 27130
Number of Claims: 19
Median Total Charges: $15,713.16
Median Allowed Amount: $11,005.08
Cash / Self-Pay Price: $19,188.74
De-identified Minimum Negotiated Rate: $6,690.47
De-identified Maximum Negotiated Rate: $19,738.60
Other billing codes included in charges (not separately allowed):
C1713 (Anchor/Screw for Opposing Bone-to-Bone or Soft Tissue-to-Bone)
C1776 (Joint Device, Implantable)
RC 0250 - Pharmacy
RC 0258 - Pharmacy - IV Solutions
RC 0270 - Medical/Surgical Supplies
RC 0272 - Medical/Surgical Supplies - Sterile Supply
RC 0278 - Medical/Surgical Supplies - Other
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
RC 0420 - Physical Therapy
RC 0421 - Physical Therapy - Visit Charge
RC 0424 - Physical Therapy - Evaluation
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $12,792.49
Dual $10,233.99
BCBS - MedicarePlusBlueMedicareAdvantage $12,792.49
Aetna - Medicare $12,792.49
HAP - MedicareAdvantage $12,792.49
Wellcare - Medicare $12,792.49
Wellcare - MedicareMedicaidDual $10,233.99
Molina - MedicareMedicaidDual $10,233.99
Priority - MedicareAdvantage $12,792.49
UHC - MedicareCommunityPlan $12,792.49
McLaren - MedicareAdvantage $12,792.49
Humana - MedicareAdvantage $12,792.49
Medicaid $6,690.47
Aetna - Medicaid $6,690.47
Wellcare - Medicaid $6,690.47
Molina - Medicaid $6,690.47
Priority - MedicaidManagedCare $6,690.47
UHC - MedicaidCommunityPlan $6,690.47
McLaren - Medicaid $6,690.47
BCBS - Commercial $19,738.60
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
McLaren - Commercial 73.71% of billed charges
=======================================================
67041 - Vitrectomy with Removal of Preretinal Cellular Membrane
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 67041
Number of Claims: 19
Median Total Charges: $6,810.49
Median Allowed Amount: $3,941.52
Cash / Self-Pay Price: $6,177.83
De-identified Minimum Negotiated Rate: $2,154.00
De-identified Maximum Negotiated Rate: $4,301.10
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $4,118.55
Dual $3,294.84
BCBS - MedicarePlusBlueMedicareAdvantage $4,118.55
Aetna - Medicare $4,118.55
HAP - MedicareAdvantage $4,118.55
Wellcare - Medicare $4,118.55
Wellcare - MedicareMedicaidDual $3,294.84
Molina - MedicareMedicaidDual $3,294.84
Priority - MedicareAdvantage $4,118.55
UHC - MedicareCommunityPlan $4,118.55
McLaren - MedicareAdvantage $4,118.55
Humana - MedicareAdvantage $4,118.55
Medicaid $2,154.00
Aetna - Medicaid $2,154.00
Wellcare - Medicaid $2,154.00
Molina - Medicaid $2,154.00
Priority - MedicaidManagedCare $2,154.00
UHC - MedicaidCommunityPlan $2,154.00
McLaren - Medicaid $2,154.00
BCBS - Commercial $4,301.10
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
Aetna - Commercial 150% of Medicare allowed
McLaren - Commercial 73.71% of billed charges
=======================================================
15823 - Blepharoplasty, Upper Eyelid with Excess Skin
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 15823
Number of Claims: 17
Median Total Charges: $3,693.17
Median Allowed Amount: $2,309.22
Cash / Self-Pay Price: $3,083.77
De-identified Minimum Negotiated Rate: $1,075.21
De-identified Maximum Negotiated Rate: $2,055.85
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $2,055.85
Dual $1,644.68
BCBS - MedicarePlusBlueMedicareAdvantage $2,055.85
Aetna - Medicare $2,055.85
HAP - MedicareAdvantage $2,055.85
Wellcare - Medicare $2,055.85
Wellcare - MedicareMedicaidDual $1,644.68
Molina - MedicareMedicaidDual $1,644.68
Priority - MedicareAdvantage $2,055.85
UHC - MedicareCommunityPlan $2,055.85
McLaren - MedicareAdvantage $2,055.85
Humana - MedicareAdvantage $2,055.85
Medicaid $1,075.21
Aetna - Medicaid $1,075.21
Wellcare - Medicaid $1,075.21
Molina - Medicaid $1,075.21
Priority - MedicaidManagedCare $1,075.21
UHC - MedicaidCommunityPlan $1,075.21
McLaren - Medicaid $1,075.21
BCBS - Commercial $1,877.82
UHC - Commercial Algorithm: 115.00 conversion factor
McLaren - Commercial 73.71% of billed charges
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
=======================================================
66180 - Aqueous Shunt to Extraocular Reservoir
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 66180
Number of Claims: 15
Median Total Charges: $7,698.22
Median Allowed Amount: $5,055.38
Cash / Self-Pay Price: $7,953.22
De-identified Minimum Negotiated Rate: $2,773.02
De-identified Maximum Negotiated Rate: $7,002.02
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0278 - Medical/Surgical Supplies - Other
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $5,302.15
Dual $4,241.72
BCBS - MedicarePlusBlueMedicareAdvantage $5,302.15
Aetna - Medicare $5,302.15
HAP - MedicareAdvantage $5,302.15
Wellcare - Medicare $5,302.15
Wellcare - MedicareMedicaidDual $4,241.72
Molina - MedicareMedicaidDual $4,241.72
Priority - MedicareAdvantage $5,302.15
UHC - MedicareCommunityPlan $5,302.15
McLaren - MedicareAdvantage $5,302.15
Humana - MedicareAdvantage $5,302.15
Medicaid $2,773.02
Aetna - Medicaid $2,773.02
Wellcare - Medicaid $2,773.02
Molina - Medicaid $2,773.02
Priority - MedicaidManagedCare $2,773.02
UHC - MedicaidCommunityPlan $2,773.02
McLaren - Medicaid $2,773.02
BCBS - Commercial $7,002.02
Aetna - Commercial 150% of Medicare allowed
UHC - Commercial Algorithm: 115.00 conversion factor
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
=======================================================
29881 - Arthroscopic Meniscectomy, Knee
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 29881
Number of Claims: 14
Median Total Charges: $6,116.72
Median Allowed Amount: $3,179.00
Cash / Self-Pay Price: $4,890.35
De-identified Minimum Negotiated Rate: $1,705.10
De-identified Maximum Negotiated Rate: $3,497.88
Other billing codes included in charges (not separately allowed):
C1776 (Joint Device, Implantable)
RC 0250 - Pharmacy
RC 0258 - Pharmacy - IV Solutions
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $3,260.23
Dual $2,608.18
BCBS - MedicarePlusBlueMedicareAdvantage $3,260.23
Aetna - Medicare $3,260.23
HAP - MedicareAdvantage $3,260.23
Wellcare - Medicare $3,260.23
Wellcare - MedicareMedicaidDual $2,608.18
Molina - MedicareMedicaidDual $2,608.18
Priority - MedicareAdvantage $3,260.23
UHC - MedicareCommunityPlan $3,260.23
McLaren - MedicareAdvantage $3,260.23
Humana - MedicareAdvantage $3,260.23
Medicaid $1,705.10
Aetna - Medicaid $1,705.10
Wellcare - Medicaid $1,705.10
Molina - Medicaid $1,705.10
Priority - MedicaidManagedCare $1,705.10
UHC - MedicaidCommunityPlan $1,705.10
McLaren - Medicaid $1,705.10
BCBS - Commercial $3,497.88
Aetna - Commercial 150% of Medicare allowed
McLaren - Commercial 73.71% of billed charges
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
67904 - Repair of Blepharoptosis, Levator Resection
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 67904
Number of Claims: 14
Median Total Charges: $3,609.65
Median Allowed Amount: $1,828.63
Cash / Self-Pay Price: $3,553.39
De-identified Minimum Negotiated Rate: $1,238.95
De-identified Maximum Negotiated Rate: $2,368.93
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $2,368.93
Dual $1,895.14
BCBS - MedicarePlusBlueMedicareAdvantage $2,368.93
Aetna - Medicare $2,368.93
HAP - MedicareAdvantage $2,368.93
Wellcare - Medicare $2,368.93
Wellcare - MedicareMedicaidDual $1,895.14
Molina - MedicareMedicaidDual $1,895.14
Priority - MedicareAdvantage $2,368.93
UHC - MedicareCommunityPlan $2,368.93
McLaren - MedicareAdvantage $2,368.93
Humana - MedicareAdvantage $2,368.93
Medicaid $1,238.95
Aetna - Medicaid $1,238.95
Wellcare - Medicaid $1,238.95
Molina - Medicaid $1,238.95
Priority - MedicaidManagedCare $1,238.95
UHC - MedicaidCommunityPlan $1,238.95
McLaren - Medicaid $1,238.95
BCBS - Commercial $1,741.40
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
66170 - Fistulization of Sclera for Glaucoma
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 66170
Number of Claims: 11
Median Total Charges: $5,293.92
Median Allowed Amount: $2,234.61
Cash / Self-Pay Price: $3,449.28
De-identified Minimum Negotiated Rate: $1,202.65
De-identified Maximum Negotiated Rate: $2,299.52
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $2,299.52
Dual $1,839.62
BCBS - MedicarePlusBlueMedicareAdvantage $2,299.52
Aetna - Medicare $2,299.52
HAP - MedicareAdvantage $2,299.52
Wellcare - Medicare $2,299.52
Wellcare - MedicareMedicaidDual $1,839.62
Molina - MedicareMedicaidDual $1,839.62
Priority - MedicareAdvantage $2,299.52
UHC - MedicareCommunityPlan $2,299.52
McLaren - MedicareAdvantage $2,299.52
Humana - MedicareAdvantage $2,299.52
Medicaid $1,202.65
Aetna - Medicaid $1,202.65
Wellcare - Medicaid $1,202.65
Molina - Medicaid $1,202.65
Priority - MedicaidManagedCare $1,202.65
UHC - MedicaidCommunityPlan $1,202.65
McLaren - Medicaid $1,202.65
BCBS - Commercial $2,219.27
Aetna - Commercial 150% of Medicare allowed
Priority - HMOPPO Algorithm: 87.38 conversion factor
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
67039 - Vitrectomy with Focal Endolaser Photocoagulation
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 67039
Number of Claims: 11
Median Total Charges: $8,713.66
Median Allowed Amount: $3,598.05
Cash / Self-Pay Price: $6,177.83
De-identified Minimum Negotiated Rate: $2,154.00
De-identified Maximum Negotiated Rate: $4,118.55
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $4,118.55
Dual $3,294.84
BCBS - MedicarePlusBlueMedicareAdvantage $4,118.55
Aetna - Medicare $4,118.55
HAP - MedicareAdvantage $4,118.55
Wellcare - Medicare $4,118.55
Wellcare - MedicareMedicaidDual $3,294.84
Molina - MedicareMedicaidDual $3,294.84
Priority - MedicareAdvantage $4,118.55
UHC - MedicareCommunityPlan $4,118.55
McLaren - MedicareAdvantage $4,118.55
Humana - MedicareAdvantage $4,118.55
Medicaid $2,154.00
Aetna - Medicaid $2,154.00
Wellcare - Medicaid $2,154.00
Molina - Medicaid $2,154.00
Priority - MedicaidManagedCare $2,154.00
UHC - MedicaidCommunityPlan $2,154.00
McLaren - Medicaid $2,154.00
BCBS - Commercial $3,598.05
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
66250 - Revision or Repair of Operative Wound, Anterior Segment
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 66250
Number of Claims: 10
Median Total Charges: $5,162.55
Median Allowed Amount: $2,285.79
Cash / Self-Pay Price: $3,553.39
De-identified Minimum Negotiated Rate: $1,238.95
De-identified Maximum Negotiated Rate: $2,368.93
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $2,368.93
Dual $1,895.14
BCBS - MedicarePlusBlueMedicareAdvantage $2,368.93
Aetna - Medicare $2,368.93
HAP - MedicareAdvantage $2,368.93
Wellcare - Medicare $2,368.93
Wellcare - MedicareMedicaidDual $1,895.14
Molina - MedicareMedicaidDual $1,895.14
Priority - MedicareAdvantage $2,368.93
UHC - MedicareCommunityPlan $2,368.93
McLaren - MedicareAdvantage $2,368.93
Humana - MedicareAdvantage $2,368.93
Medicaid $1,238.95
Aetna - Medicaid $1,238.95
Wellcare - Medicaid $1,238.95
Molina - Medicaid $1,238.95
Priority - MedicaidManagedCare $1,238.95
UHC - MedicaidCommunityPlan $1,238.95
McLaren - Medicaid $1,238.95
BCBS - Commercial $1,572.86
Priority - HMOPPO Algorithm: 87.38 conversion factor
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
66172 - Fistulization of Sclera for Glaucoma, Complex
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 66172
Number of Claims: 9
Median Total Charges: $5,547.93
Median Allowed Amount: $2,234.61
Cash / Self-Pay Price: $3,449.28
De-identified Minimum Negotiated Rate: $1,202.65
De-identified Maximum Negotiated Rate: $2,299.52
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $2,299.52
Dual $1,839.62
BCBS - MedicarePlusBlueMedicareAdvantage $2,299.52
Aetna - Medicare $2,299.52
HAP - MedicareAdvantage $2,299.52
Wellcare - Medicare $2,299.52
Wellcare - MedicareMedicaidDual $1,839.62
Molina - MedicareMedicaidDual $1,839.62
Priority - MedicareAdvantage $2,299.52
UHC - MedicareCommunityPlan $2,299.52
McLaren - MedicareAdvantage $2,299.52
Humana - MedicareAdvantage $2,299.52
Medicaid $1,202.65
Aetna - Medicaid $1,202.65
Wellcare - Medicaid $1,202.65
Molina - Medicaid $1,202.65
Priority - MedicaidManagedCare $1,202.65
UHC - MedicaidCommunityPlan $1,202.65
McLaren - Medicaid $1,202.65
BCBS - Commercial $2,219.27
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
66183 - Insertion of Aqueous Drainage Device
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 66183
Number of Claims: 8
Median Total Charges: $8,756.18
Median Allowed Amount: $3,941.52
Cash / Self-Pay Price: $6,177.83
De-identified Minimum Negotiated Rate: $2,154.00
De-identified Maximum Negotiated Rate: $4,118.55
Other billing codes included in charges (not separately allowed):
C1783
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $4,118.55
Dual $3,294.84
BCBS - MedicarePlusBlueMedicareAdvantage $4,118.55
Aetna - Medicare $4,118.55
HAP - MedicareAdvantage $4,118.55
Wellcare - Medicare $4,118.55
Wellcare - MedicareMedicaidDual $3,294.84
Molina - MedicareMedicaidDual $3,294.84
Priority - MedicareAdvantage $4,118.55
UHC - MedicareCommunityPlan $4,118.55
McLaren - MedicareAdvantage $4,118.55
Humana - MedicareAdvantage $4,118.55
Medicaid $2,154.00
Aetna - Medicaid $2,154.00
Wellcare - Medicaid $2,154.00
Molina - Medicaid $2,154.00
Priority - MedicaidManagedCare $2,154.00
UHC - MedicaidCommunityPlan $2,154.00
McLaren - Medicaid $2,154.00
BCBS - Commercial $3,473.98
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
15823 - Blepharoplasty, Upper Eyelid with Excess Skin + 67904 - Repair of Blepharoptosis, Levator Resection
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 15823, HCPCS 67904
Number of Claims: 7
Median Total Charges: $4,554.98
Median Allowed Amount: $2,285.79
Cash / Self-Pay Price: $3,083.77
De-identified Minimum Negotiated Rate: $1,075.21
De-identified Maximum Negotiated Rate: $2,055.85
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
--- Rates for 15823 - Blepharoplasty, Upper Eyelid with Excess Skin ---
Medicare $2,055.85
Dual $1,644.68
BCBS - MedicarePlusBlueMedicareAdvantage $2,055.85
Aetna - Medicare $2,055.85
HAP - MedicareAdvantage $2,055.85
Wellcare - Medicare $2,055.85
Wellcare - MedicareMedicaidDual $1,644.68
Molina - MedicareMedicaidDual $1,644.68
Priority - MedicareAdvantage $2,055.85
UHC - MedicareCommunityPlan $2,055.85
McLaren - MedicareAdvantage $2,055.85
Humana - MedicareAdvantage $2,055.85
Medicaid $1,075.21
Aetna - Medicaid $1,075.21
Wellcare - Medicaid $1,075.21
Molina - Medicaid $1,075.21
Priority - MedicaidManagedCare $1,075.21
UHC - MedicaidCommunityPlan $1,075.21
McLaren - Medicaid $1,075.21
BCBS - Commercial $1,877.82
UHC - Commercial Algorithm: 115.00 conversion factor
McLaren - Commercial 73.71% of billed charges
--- Rates for 67904 - Repair of Blepharoptosis, Levator Resection ---
Medicare $2,368.93
Dual $1,895.14
BCBS - MedicarePlusBlueMedicareAdvantage $2,368.93
Aetna - Medicare $2,368.93
HAP - MedicareAdvantage $2,368.93
Wellcare - Medicare $2,368.93
Wellcare - MedicareMedicaidDual $1,895.14
Molina - MedicareMedicaidDual $1,895.14
Priority - MedicareAdvantage $2,368.93
UHC - MedicareCommunityPlan $2,368.93
McLaren - MedicareAdvantage $2,368.93
Humana - MedicareAdvantage $2,368.93
Medicaid $1,238.95
Aetna - Medicaid $1,238.95
Wellcare - Medicaid $1,238.95
Molina - Medicaid $1,238.95
Priority - MedicaidManagedCare $1,238.95
UHC - MedicaidCommunityPlan $1,238.95
McLaren - Medicaid $1,238.95
BCBS - Commercial $1,741.40
=======================================================
27447 - Total Knee Arthroplasty
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 27447
Number of Claims: 7
Median Total Charges: $20,903.51
Median Allowed Amount: $10,164.06
Cash / Self-Pay Price: $19,188.74
De-identified Minimum Negotiated Rate: $6,690.47
De-identified Maximum Negotiated Rate: $19,248.20
Other billing codes included in charges (not separately allowed):
C1713 (Anchor/Screw for Opposing Bone-to-Bone or Soft Tissue-to-Bone)
C1776 (Joint Device, Implantable)
RC 0250 - Pharmacy
RC 0258 - Pharmacy - IV Solutions
RC 0270 - Medical/Surgical Supplies
RC 0278 - Medical/Surgical Supplies - Other
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
RC 0420 - Physical Therapy
RC 0421 - Physical Therapy - Visit Charge
RC 0424 - Physical Therapy - Evaluation
RC 0430 - Occupational Therapy - General
RC 0431 - Occupational Therapy
RC 0434 - Occupational Therapy - Evaluation
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $12,792.49
Dual $10,233.99
BCBS - MedicarePlusBlueMedicareAdvantage $12,792.49
Aetna - Medicare $12,792.49
HAP - MedicareAdvantage $12,792.49
Wellcare - Medicare $12,792.49
Wellcare - MedicareMedicaidDual $10,233.99
Molina - MedicareMedicaidDual $10,233.99
Priority - MedicareAdvantage $12,792.49
UHC - MedicareCommunityPlan $12,792.49
McLaren - MedicareAdvantage $12,792.49
Humana - MedicareAdvantage $12,792.49
Medicaid $6,690.47
Aetna - Medicaid $6,690.47
Wellcare - Medicaid $6,690.47
Molina - Medicaid $6,690.47
Priority - MedicaidManagedCare $6,690.47
UHC - MedicaidCommunityPlan $6,690.47
McLaren - Medicaid $6,690.47
BCBS - Commercial $19,248.20
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
McLaren - Commercial 73.71% of billed charges
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
66174 - Canaloplasty
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 66174
Number of Claims: 7
Median Total Charges: $6,482.78
Median Allowed Amount: $3,941.52
Cash / Self-Pay Price: $6,177.83
De-identified Minimum Negotiated Rate: $2,154.00
De-identified Maximum Negotiated Rate: $4,118.55
Other billing codes included in charges (not separately allowed):
C1889 (Implantable/Insertable Device, Not Elsewhere Classified)
V2630 (Anterior Chamber Intraocular Lens)
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0276 - Implants/Intraocular Lenses
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $4,118.55
Dual $3,294.84
BCBS - MedicarePlusBlueMedicareAdvantage $4,118.55
Aetna - Medicare $4,118.55
HAP - MedicareAdvantage $4,118.55
Wellcare - Medicare $4,118.55
Wellcare - MedicareMedicaidDual $3,294.84
Molina - MedicareMedicaidDual $3,294.84
Priority - MedicareAdvantage $4,118.55
UHC - MedicareCommunityPlan $4,118.55
McLaren - MedicareAdvantage $4,118.55
Humana - MedicareAdvantage $4,118.55
Medicaid $2,154.00
Aetna - Medicaid $2,154.00
Wellcare - Medicaid $2,154.00
Molina - Medicaid $2,154.00
Priority - MedicaidManagedCare $2,154.00
UHC - MedicaidCommunityPlan $2,154.00
McLaren - Medicaid $2,154.00
BCBS - Commercial $2,977.70
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
McLaren - Commercial 73.71% of billed charges
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
67808 - Excision of Chalazion, Multiple, General Anesthesia
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 67808
Number of Claims: 7
Median Total Charges: $3,591.49
Median Allowed Amount: $1,276.13
Cash / Self-Pay Price: $3,553.39
De-identified Minimum Negotiated Rate: $1,238.95
De-identified Maximum Negotiated Rate: $2,368.93
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $2,368.93
Dual $1,895.14
BCBS - MedicarePlusBlueMedicareAdvantage $2,368.93
Aetna - Medicare $2,368.93
HAP - MedicareAdvantage $2,368.93
Wellcare - Medicare $2,368.93
Wellcare - MedicareMedicaidDual $1,895.14
Molina - MedicareMedicaidDual $1,895.14
Priority - MedicareAdvantage $2,368.93
UHC - MedicareCommunityPlan $2,368.93
McLaren - MedicareAdvantage $2,368.93
Humana - MedicareAdvantage $2,368.93
Medicaid $1,238.95
Aetna - Medicaid $1,238.95
Wellcare - Medicaid $1,238.95
Molina - Medicaid $1,238.95
Priority - MedicaidManagedCare $1,238.95
UHC - MedicaidCommunityPlan $1,238.95
McLaren - Medicaid $1,238.95
BCBS - Commercial $1,572.86
Aetna - Commercial 150% of Medicare allowed
UHC - Commercial Algorithm: 115.00 conversion factor
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
=======================================================
62323 - Injection, Epidural, Lumbar/Sacral
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 62323
Number of Claims: 6
Median Total Charges: $3,006.70
Median Allowed Amount: $662.25
Cash / Self-Pay Price: $1,055.01
De-identified Minimum Negotiated Rate: $367.85
De-identified Maximum Negotiated Rate: $703.34
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $703.34
Dual $562.67
BCBS - MedicarePlusBlueMedicareAdvantage $703.34
Aetna - Medicare $703.34
HAP - MedicareAdvantage $703.34
Wellcare - Medicare $703.34
Wellcare - MedicareMedicaidDual $562.67
Molina - MedicareMedicaidDual $562.67
Priority - MedicareAdvantage $703.34
UHC - MedicareCommunityPlan $703.34
McLaren - MedicareAdvantage $703.34
Humana - MedicareAdvantage $703.34
Medicaid $367.85
Aetna - Medicaid $367.85
Wellcare - Medicaid $367.85
Molina - Medicaid $367.85
Priority - MedicaidManagedCare $367.85
UHC - MedicaidCommunityPlan $367.85
McLaren - Medicaid $367.85
BCBS - Commercial $645.97
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
14060 - Adjacent Tissue Transfer or Rearrangement, Eyelids
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 14060
Number of Claims: 5
Median Total Charges: $3,352.43
Median Allowed Amount: $635.27
Cash / Self-Pay Price: $3,083.77
De-identified Minimum Negotiated Rate: $1,075.21
De-identified Maximum Negotiated Rate: $2,055.85
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $2,055.85
Dual $1,644.68
BCBS - MedicarePlusBlueMedicareAdvantage $2,055.85
Aetna - Medicare $2,055.85
HAP - MedicareAdvantage $2,055.85
Wellcare - Medicare $2,055.85
Wellcare - MedicareMedicaidDual $1,644.68
Molina - MedicareMedicaidDual $1,644.68
Priority - MedicareAdvantage $2,055.85
UHC - MedicareCommunityPlan $2,055.85
McLaren - MedicareAdvantage $2,055.85
Humana - MedicareAdvantage $2,055.85
Medicaid $1,075.21
Aetna - Medicaid $1,075.21
Wellcare - Medicaid $1,075.21
Molina - Medicaid $1,075.21
Priority - MedicaidManagedCare $1,075.21
UHC - MedicaidCommunityPlan $1,075.21
McLaren - Medicaid $1,075.21
BCBS - Commercial $1,561.54
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
29880 - Arthroscopic Meniscectomy, Knee, Medial and Lateral
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 29880
Number of Claims: 5
Median Total Charges: $6,127.87
Median Allowed Amount: $3,179.00
Cash / Self-Pay Price: $4,890.35
De-identified Minimum Negotiated Rate: $1,705.10
De-identified Maximum Negotiated Rate: $3,763.59
Other billing codes included in charges (not separately allowed):
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $3,260.23
Dual $2,608.18
BCBS - MedicarePlusBlueMedicareAdvantage $3,260.23
Aetna - Medicare $3,260.23
HAP - MedicareAdvantage $3,260.23
Wellcare - Medicare $3,260.23
Wellcare - MedicareMedicaidDual $2,608.18
Molina - MedicareMedicaidDual $2,608.18
Priority - MedicareAdvantage $3,260.23
UHC - MedicareCommunityPlan $3,260.23
McLaren - MedicareAdvantage $3,260.23
Humana - MedicareAdvantage $3,260.23
Medicaid $1,705.10
Aetna - Medicaid $1,705.10
Wellcare - Medicaid $1,705.10
Molina - Medicaid $1,705.10
Priority - MedicaidManagedCare $1,705.10
UHC - MedicaidCommunityPlan $1,705.10
McLaren - Medicaid $1,705.10
BCBS - Commercial $3,763.59
Aetna - Commercial 150% of Medicare allowed
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
Priority - HMOPPO Algorithm: 87.38 conversion factor
UHC - Commercial Algorithm: 115.00 conversion factor
=======================================================
66170 - Fistulization of Sclera for Glaucoma + 66984 - Removal of Cataract with Insertion of Prosthetic Lens
=======================================================
Setting: Outpatient
Billing Code(s): HCPCS 66170, HCPCS 66984
Number of Claims: 5
Median Total Charges: $6,508.01
Median Allowed Amount: $2,234.61
Cash / Self-Pay Price: $3,449.28
De-identified Minimum Negotiated Rate: $1,202.65
De-identified Maximum Negotiated Rate: $2,299.52
Other billing codes included in charges (not separately allowed):
V2630 (Anterior Chamber Intraocular Lens)
RC 0250 - Pharmacy
RC 0270 - Medical/Surgical Supplies
RC 0276 - Implants/Intraocular Lenses
RC 0360 - Operating Room Services
RC 0370 - Anesthesia
Services not provided by this facility (may be billed separately):
Surgeon
Anesthesiologist / CRNA
Payer-Specific Negotiated Rates:
Medicare $2,299.52
Dual $1,839.62
BCBS - MedicarePlusBlueMedicareAdvantage $2,299.52
Aetna - Medicare $2,299.52
HAP - MedicareAdvantage $2,299.52
Wellcare - Medicare $2,299.52
Wellcare - MedicareMedicaidDual $1,839.62
Molina - MedicareMedicaidDual $1,839.62
Priority - MedicareAdvantage $2,299.52
UHC - MedicareCommunityPlan $2,299.52
McLaren - MedicareAdvantage $2,299.52
Humana - MedicareAdvantage $2,299.52
Medicaid $1,202.65
Aetna - Medicaid $1,202.65
Wellcare - Medicaid $1,202.65
Molina - Medicaid $1,202.65
Priority - MedicaidManagedCare $1,202.65
UHC - MedicaidCommunityPlan $1,202.65
McLaren - Medicaid $1,202.65
BCBS - Commercial $2,219.27
Aetna - Commercial 150% of Medicare allowed
Priority - HMOPPO Algorithm: 87.38 conversion factor
HAP - HMOPPO 60% of billed charges
McLaren - Commercial 73.71% of billed charges
UHC - Commercial Algorithm: 115.00 conversion factor
Rehabilitation without Major Comorbid Conditions or Complications (MS-DRG 945)
What is a DRG? A Diagnosis Related Group (DRG) is a fixed payment rate that covers all facility services during your inpatient stay, including room and board, nursing care, therapy services, medications, and routine supplies. You will receive one all-inclusive bill from the hospital for your stay. Your physician and other professional providers may bill separately.
Setting: Inpatient Billing Code: 945
Number of Claims: 214 Median Total Charges: $23,078.03 Median Allowed Amount: $12,857.33 Cash / Self-Pay Price: $16,467.92 De-identified Minimum: $10,978.61 De-identified Maximum: $10,978.61
Median Charges and Allowed Amounts by Service Category:
All services below are included in the DRG package rate.
Service Category Median Charge Median Allowed RC 0120 - Room and Board $14,000.00 $8,025.91 RC 0250 - Pharmacy $612.33 $338.50 RC 0270 - Medical/Surgical Supplies $82.71 $41.78 RC 0320 - Radiology $125.00 $67.16 RC 0370 - Anesthesia $3.00 $1.68 RC 0420 - Physical Therapy $1,885.00 $1,042.40 RC 0421 - Physical Therapy - Visit Charge $2,015.00 $999.55 RC 0424 - Physical Therapy - Evaluation $130.00 $73.26 RC 0430 - Occupational Therapy $1,820.00 $998.53 RC 0431 - Occupational Therapy - Visit Charge $1,820.00 $969.84 RC 0434 - Occupational Therapy - Evaluation $130.00 $73.16 RC 0440 - Speech-Language Pathology $195.00 $92.86 RC 0444 - Speech-Language Pathology - Evaluation $260.00 $132.71
Payer-Specific Negotiated Rates:
Payer / Plan Negotiated Rate Medicare $10,978.61 BCBS - MedicarePlusBlueMedicareAdvantage $10,978.61 Aetna - Medicare $10,978.61 HAP - MedicareAdvantage $10,978.61 Wellcare - Medicare $10,978.61 Priority - MedicareAdvantage $10,978.61 UHC - MedicareCommunityPlan $10,978.61 McLaren - MedicareAdvantage $10,978.61 Humana - MedicareAdvantage $10,978.61
Rehabilitation with Major Comorbid Conditions or Complications (MS-DRG 946)
What is a DRG? A Diagnosis Related Group (DRG) is a fixed payment rate that covers all facility services during your inpatient stay, including room and board, nursing care, therapy services, medications, and routine supplies. You will receive one all-inclusive bill from the hospital for your stay. Your physician and other professional providers may bill separately.
Setting: Inpatient Billing Code: 946
Number of Claims: 280 Median Total Charges: $22,897.46 Median Allowed Amount: $7,927.78 Cash / Self-Pay Price: $12,195.15 De-identified Minimum: $8,130.10 De-identified Maximum: $8,130.10
Median Charges and Allowed Amounts by Service Category:
All services below are included in the DRG package rate.
Service Category Median Charge Median Allowed RC 0120 - Room and Board $14,000.00 $5,881.10 RC 0250 - Pharmacy $591.46 $233.05 RC 0270 - Medical/Surgical Supplies $85.50 $32.66 RC 0320 - Radiology $125.00 $59.28 RC 0370 - Anesthesia $3.00 $2.00 RC 0420 - Physical Therapy $1,820.00 $749.71 RC 0421 - Physical Therapy - Visit Charge $1,885.00 $0.00 RC 0424 - Physical Therapy - Evaluation $130.00 $53.69 RC 0430 - Occupational Therapy $1,820.00 $729.42 RC 0431 - Occupational Therapy - Visit Charge $1,950.00 $0.00 RC 0434 - Occupational Therapy - Evaluation $130.00 $53.66 RC 0440 - Speech-Language Pathology $97.50 $26.73 RC 0444 - Speech-Language Pathology - Evaluation $260.00 $106.47
Payer-Specific Negotiated Rates:
Payer / Plan Negotiated Rate Medicare $8,130.10 BCBS - MedicarePlusBlueMedicareAdvantage $8,130.10 Aetna - Medicare $8,130.10 HAP - MedicareAdvantage $8,130.10 Wellcare - Medicare $8,130.10 Priority - MedicareAdvantage $8,130.10 UHC - MedicareCommunityPlan $8,130.10 McLaren - MedicareAdvantage $8,130.10 Humana - MedicareAdvantage $8,130.10
Rehabilitation, Minor Severity (APR-DRG 8601)
What is a DRG? A Diagnosis Related Group (DRG) is a fixed payment rate that covers all facility services during your inpatient stay, including room and board, nursing care, therapy services, medications, and routine supplies. You will receive one all-inclusive bill from the hospital for your stay. Your physician and other professional providers may bill separately.
Setting: Inpatient Billing Code: 8601
Insufficient claims data to report median charges and allowed amounts.
Cash / Self-Pay Price: $13,828.59 De-identified Minimum: $9,219.06 De-identified Maximum: $9,219.06
All services are included in the DRG package rate. Patients receive one all-inclusive bill for the inpatient stay.
Payer-Specific Negotiated Rates:
Payer / Plan Negotiated Rate Medicaid $9,219.06 Wellcare - Medicaid $9,219.06 Molina - Medicaid $9,219.06 Priority - MedicaidManagedCare $9,219.06 UHC - MedicaidCommunityPlan $9,219.06 McLaren - Medicaid $9,219.06
Rehabilitation, Moderate Severity (APR-DRG 8602)
What is a DRG? A Diagnosis Related Group (DRG) is a fixed payment rate that covers all facility services during your inpatient stay, including room and board, nursing care, therapy services, medications, and routine supplies. You will receive one all-inclusive bill from the hospital for your stay. Your physician and other professional providers may bill separately.
Setting: Inpatient Billing Code: 8602
Insufficient claims data to report median charges and allowed amounts.
Cash / Self-Pay Price: $17,473.41 De-identified Minimum: $11,648.94 De-identified Maximum: $11,648.94
All services are included in the DRG package rate. Patients receive one all-inclusive bill for the inpatient stay.
Payer-Specific Negotiated Rates:
Payer / Plan Negotiated Rate Medicaid $11,648.94 Wellcare - Medicaid $11,648.94 Molina - Medicaid $11,648.94 Priority - MedicaidManagedCare $11,648.94 UHC - MedicaidCommunityPlan $11,648.94 McLaren - Medicaid $11,648.94
Rehabilitation, Major Severity (APR-DRG 8603)
What is a DRG? A Diagnosis Related Group (DRG) is a fixed payment rate that covers all facility services during your inpatient stay, including room and board, nursing care, therapy services, medications, and routine supplies. You will receive one all-inclusive bill from the hospital for your stay. Your physician and other professional providers may bill separately.
Setting: Inpatient Billing Code: 8603
Insufficient claims data to report median charges and allowed amounts.
Cash / Self-Pay Price: $17,545.59 De-identified Minimum: $11,697.06 De-identified Maximum: $11,697.06
All services are included in the DRG package rate. Patients receive one all-inclusive bill for the inpatient stay.
Payer-Specific Negotiated Rates:
Payer / Plan Negotiated Rate Medicaid $11,697.06 Wellcare - Medicaid $11,697.06 Molina - Medicaid $11,697.06 Priority - MedicaidManagedCare $11,697.06 UHC - MedicaidCommunityPlan $11,697.06 McLaren - Medicaid $11,697.06
Rehabilitation, Extreme Severity (APR-DRG 8604)
What is a DRG? A Diagnosis Related Group (DRG) is a fixed payment rate that covers all facility services during your inpatient stay, including room and board, nursing care, therapy services, medications, and routine supplies. You will receive one all-inclusive bill from the hospital for your stay. Your physician and other professional providers may bill separately.
Setting: Inpatient Billing Code: 8604
Insufficient claims data to report median charges and allowed amounts.
Cash / Self-Pay Price: $20,608.94 De-identified Minimum: $13,739.29 De-identified Maximum: $13,739.29
All services are included in the DRG package rate. Patients receive one all-inclusive bill for the inpatient stay.
Payer-Specific Negotiated Rates:
Payer / Plan Negotiated Rate Medicaid $13,739.29 Wellcare - Medicaid $13,739.29 Molina - Medicaid $13,739.29 Priority - MedicaidManagedCare $13,739.29 UHC - MedicaidCommunityPlan $13,739.29 McLaren - Medicaid $13,739.29
Section 3: CMS-Specified Shoppable Services Not Provided by This Facility
The following services are among the 70 shoppable services specified by the Centers for Medicare and Medicaid Services (CMS). Straith Hospital for Special Surgery does not provide these services. In accordance with 45 CFR §180.60(b)(2), we are required to indicate services from the CMS-specified list that we do not offer.
Billing Code Service Description Status 19120 Removal of Breast Growth Not provided by this facility 216 Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization Not provided by this facility 42820 Removal of Tonsils and Adenoids, Patient Younger than 12 Not provided by this facility 43235 Diagnostic Examination of Esophagus, Stomach and/or Upper Small Bowel (Endoscope) Not provided by this facility 43239 Biopsy of Esophagus, Stomach and/or Upper Small Bowel (Endoscope) Not provided by this facility 45378 Diagnostic Examination of Large Bowel (Endoscope) Not provided by this facility 45380 Biopsy of Large Bowel (Endoscope) Not provided by this facility 45385 Removal of Polyps or Growths of Large Bowel (Endoscope) Not provided by this facility 45391 Ultrasound of Large Bowel (Endoscope) Not provided by this facility 460 Spinal Fusion Except Cervical Without Major Comorbid Conditions or Complications Not provided by this facility 470 Major Joint Replacement or Reattachment of Lower Extremity Without Major Comorbid Conditions or Complications Not provided by this facility 473 Cervical Spinal Fusion Without Comorbid Conditions or Complications Not provided by this facility 47562 Removal of Gallbladder (Endoscope) Not provided by this facility 49505 Repair of Groin Hernia, Patient Age 5 Years and Older Not provided by this facility 55700 Biopsy of Prostate Gland Not provided by this facility 55866 Surgical Removal of Prostate (Endoscope) Not provided by this facility 59400 Routine Obstetric Care Including Antepartum Care, Vaginal Delivery and Postpartum Care Not provided by this facility 59510 Routine Obstetric Care Including Antepartum Care, Cesarean Delivery and Postpartum Care Not provided by this facility 59610 Routine Obstetric Care Including Antepartum Care, Vaginal Delivery After Prior Cesarean Delivery and Postpartum Care Not provided by this facility 62322 Injection of Substance into Spinal Canal of Lower Back or Sacrum Not provided by this facility 66821 Removal of Recurring Cataract in Lens Capsule Using Laser Not provided by this facility 70450 CT Scan of Head or Brain without Contrast Not provided by this facility 70553 MRI Scan of Brain Before and After Contrast Not provided by this facility 72148 MRI Scan of Lower Spinal Canal Not provided by this facility 72193 CT Scan of Pelvis with Contrast Not provided by this facility 73721 MRI of Leg Joint Not provided by this facility 74177 CT Scan of Abdomen and Pelvis with Contrast Not provided by this facility 743 Uterine and Adnexa Procedures for Non-Malignancy Without Comorbid Conditions or Complications Not provided by this facility 76700 Ultrasound of Abdomen Not provided by this facility 76805 Ultrasound of Pregnant Uterus Not provided by this facility 76830 Ultrasound of Pelvis Through Vagina Not provided by this facility 77065 Diagnostic Mammography, One Breast Not provided by this facility 77066 Diagnostic Mammography, Both Breasts Not provided by this facility 77067 Screening Mammography, Both Breasts Not provided by this facility 80048 Basic Metabolic Panel Not provided by this facility 80053 Comprehensive Metabolic Panel Not provided by this facility 80055 Obstetric Blood Test Panel Not provided by this facility 80061 Lipid Panel Not provided by this facility 80069 Kidney Function Panel Not provided by this facility 80076 Liver Function Panel Not provided by this facility 81000 Manual Urinalysis with Microscope Examination Not provided by this facility 81001 Manual Urinalysis with Microscope Examination (Alternate) Not provided by this facility 81002 Automated Urinalysis without Microscope Not provided by this facility 81003 Automated Urinalysis without Microscope (Alternate) Not provided by this facility 84153 Prostate Specific Antigen (PSA) Not provided by this facility 84154 Prostate Specific Antigen (PSA) (Alternate) Not provided by this facility 84443 Thyroid Stimulating Hormone (TSH) Not provided by this facility 85025 Complete Blood Count with Differential Not provided by this facility 85027 Complete Blood Count, Automated Not provided by this facility 85610 Prothrombin Time Not provided by this facility 85730 Coagulation Assessment Not provided by this facility 90832 Psychotherapy, 30 Minutes Not provided by this facility 90834 Psychotherapy, 45 Minutes Not provided by this facility 90837 Psychotherapy, 60 Minutes Not provided by this facility 90846 Family Psychotherapy Not Including Patient, 50 Minutes Not provided by this facility 90847 Family Psychotherapy Including Patient, 50 Minutes Not provided by this facility 90853 Group Psychotherapy Not provided by this facility 93000 Electrocardiogram, Routine Not provided by this facility 93452 Insertion of Catheter into Left Heart for Diagnosis Not provided by this facility 95810 Sleep Study Not provided by this facility 97110 Physical Therapy, Therapeutic Exercise Not provided by this facility 99203 New Patient Office or Other Outpatient Visit, 30 Minutes Not provided by this facility 99204 New Patient Office or Other Outpatient Visit, 45 Minutes Not provided by this facility 99205 New Patient Office or Other Outpatient Visit, 60 Minutes Not provided by this facility 99243 Patient Office Consultation, 40 Minutes Not provided by this facility 99244 Patient Office Consultation, 60 Minutes Not provided by this facility 99385 Initial Preventive Medicine Evaluation, Age 18-39 Not provided by this facility 99386 Initial Preventive Medicine Evaluation, Age 40-64 Not provided by this facility