|
PR INSERT GASTROSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 49440
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$364.66 |
| Rate for Payer: Aetna Commercial |
$237.29
|
| Rate for Payer: Aetna Medicare |
$184.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.00
|
| Rate for Payer: BCBS Complete |
$119.43
|
| Rate for Payer: BCBS MAPPO |
$177.08
|
| Rate for Payer: BCN Commercial |
$299.28
|
| Rate for Payer: BCN Medicare Advantage |
$177.08
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$255.00
|
| Rate for Payer: Cofinity Commercial |
$237.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$283.33
|
| Rate for Payer: Healthscope Commercial |
$327.60
|
| Rate for Payer: Mclaren Medicaid |
$113.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.93
|
| Rate for Payer: Meridian Medicaid |
$119.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.09
|
| Rate for Payer: Nomi Health Commercial |
$212.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.50
|
| Rate for Payer: PACE SWMI |
$177.08
|
| Rate for Payer: PHP Medicare Advantage |
$177.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$364.66
|
| Rate for Payer: Priority Health Medicare |
$177.08
|
| Rate for Payer: Priority Health SBD |
$364.66
|
| Rate for Payer: Priority Health Tiered Network |
$364.66
|
| Rate for Payer: Railroad Medicare Medicare |
$177.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.66
|
| Rate for Payer: UHC Core |
$363.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$177.08
|
| Rate for Payer: UHC Exchange |
$363.66
|
| Rate for Payer: UHC Medicaid |
$113.74
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
|
|
PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY
|
Professional
|
Both
|
$1,765.00
|
|
|
Service Code
|
HCPCS 19340
|
| Min. Negotiated Rate |
$447.09 |
| Max. Negotiated Rate |
$1,730.50 |
| Rate for Payer: Molina Medicare/Medicaid |
$752.72
|
| Rate for Payer: Aetna Commercial |
$916.95
|
| Rate for Payer: Aetna Medicare |
$711.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$985.38
|
| Rate for Payer: BCBS Complete |
$469.44
|
| Rate for Payer: BCBS MAPPO |
$684.29
|
| Rate for Payer: BCN Commercial |
$1,149.83
|
| Rate for Payer: BCN Medicare Advantage |
$684.29
|
| Rate for Payer: Cash Price |
$1,412.00
|
| Rate for Payer: Cash Price |
$1,412.00
|
| Rate for Payer: Cofinity Commercial |
$985.38
|
| Rate for Payer: Cofinity Commercial |
$916.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.29
|
| Rate for Payer: Healthscope Commercial |
$1,265.94
|
| Rate for Payer: Healthscope Commercial |
$1,094.86
|
| Rate for Payer: Mclaren Medicaid |
$447.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.50
|
| Rate for Payer: Meridian Medicaid |
$469.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,341.76
|
| Rate for Payer: Nomi Health Commercial |
$821.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,323.75
|
| Rate for Payer: PACE SWMI |
$684.29
|
| Rate for Payer: PHP Medicare Advantage |
$684.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,052.40
|
| Rate for Payer: Priority Health Medicare |
$684.29
|
| Rate for Payer: Priority Health SBD |
$1,052.40
|
| Rate for Payer: Priority Health Tiered Network |
$1,052.40
|
| Rate for Payer: Railroad Medicare Medicare |
$684.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,730.50
|
| Rate for Payer: UHC Core |
$1,730.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$684.29
|
| Rate for Payer: UHC Exchange |
$1,730.50
|
| Rate for Payer: UHC Medicaid |
$447.09
|
| Rate for Payer: UHCCP Medicaid |
$447.09
|
|
|
PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 59200
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.24
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$60.58
|
| Rate for Payer: BCN Commercial |
$100.60
|
| Rate for Payer: BCN Medicare Advantage |
$60.58
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$87.24
|
| Rate for Payer: Cofinity Commercial |
$81.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.58
|
| Rate for Payer: Healthscope Commercial |
$96.93
|
| Rate for Payer: Healthscope Commercial |
$112.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.85
|
| Rate for Payer: Nomi Health Commercial |
$72.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.25
|
| Rate for Payer: PACE SWMI |
$60.58
|
| Rate for Payer: PHP Medicare Advantage |
$60.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94.96
|
| Rate for Payer: Priority Health Medicare |
$60.58
|
| Rate for Payer: Priority Health SBD |
$94.96
|
| Rate for Payer: Priority Health Tiered Network |
$94.96
|
| Rate for Payer: Railroad Medicare Medicare |
$60.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.02
|
| Rate for Payer: UHC Core |
$80.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60.58
|
| Rate for Payer: UHC Exchange |
$80.02
|
|
|
PR INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 11981
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Medicare |
$56.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.84
|
| Rate for Payer: BCBS Complete |
$36.68
|
| Rate for Payer: BCBS MAPPO |
$54.75
|
| Rate for Payer: BCN Commercial |
$94.12
|
| Rate for Payer: BCN Medicare Advantage |
$54.75
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$78.84
|
| Rate for Payer: Cofinity Commercial |
$73.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.75
|
| Rate for Payer: Healthscope Commercial |
$87.60
|
| Rate for Payer: Healthscope Commercial |
$101.29
|
| Rate for Payer: Mclaren Medicaid |
$34.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.49
|
| Rate for Payer: Meridian Medicaid |
$36.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.56
|
| Rate for Payer: Nomi Health Commercial |
$65.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.50
|
| Rate for Payer: PACE SWMI |
$54.75
|
| Rate for Payer: PHP Medicare Advantage |
$54.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$86.14
|
| Rate for Payer: Priority Health Medicare |
$54.75
|
| Rate for Payer: Priority Health SBD |
$86.14
|
| Rate for Payer: Priority Health Tiered Network |
$86.14
|
| Rate for Payer: Railroad Medicare Medicare |
$54.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.11
|
| Rate for Payer: UHC Core |
$114.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$54.75
|
| Rate for Payer: UHC Exchange |
$114.11
|
| Rate for Payer: UHC Medicaid |
$34.93
|
| Rate for Payer: UHCCP Medicaid |
$34.93
|
|
|
PR INSERTION EPICARDIAL ELECTRODE OPEN
|
Professional
|
Both
|
$2,443.00
|
|
|
Service Code
|
HCPCS 33202
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$1,832.25 |
| Rate for Payer: Aetna Commercial |
$987.51
|
| Rate for Payer: Aetna Medicare |
$766.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,061.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$987.51
|
| Rate for Payer: BCBS Complete |
$496.28
|
| Rate for Payer: BCBS MAPPO |
$736.95
|
| Rate for Payer: BCN Commercial |
$1,139.88
|
| Rate for Payer: BCN Medicare Advantage |
$736.95
|
| Rate for Payer: Cash Price |
$1,954.40
|
| Rate for Payer: Cash Price |
$1,954.40
|
| Rate for Payer: Cofinity Commercial |
$987.51
|
| Rate for Payer: Cofinity Commercial |
$1,061.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.95
|
| Rate for Payer: Healthscope Commercial |
$1,363.36
|
| Rate for Payer: Healthscope Commercial |
$1,179.12
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.80
|
| Rate for Payer: Meridian Medicaid |
$496.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.26
|
| Rate for Payer: Nomi Health Commercial |
$884.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,832.25
|
| Rate for Payer: PACE SWMI |
$736.95
|
| Rate for Payer: PHP Medicare Advantage |
$736.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,225.79
|
| Rate for Payer: Priority Health Medicare |
$736.95
|
| Rate for Payer: Priority Health SBD |
$1,225.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,225.79
|
| Rate for Payer: Railroad Medicare Medicare |
$736.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,366.46
|
| Rate for Payer: UHC Core |
$1,366.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.95
|
| Rate for Payer: UHC Exchange |
$1,366.46
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
|
|
PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 93503
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Aetna Commercial |
$109.04
|
| Rate for Payer: Aetna Medicare |
$84.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.17
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS MAPPO |
$81.37
|
| Rate for Payer: BCN Commercial |
$128.48
|
| Rate for Payer: BCN Medicare Advantage |
$81.37
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cofinity Commercial |
$117.17
|
| Rate for Payer: Cofinity Commercial |
$109.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.37
|
| Rate for Payer: Healthscope Commercial |
$150.53
|
| Rate for Payer: Healthscope Commercial |
$130.19
|
| Rate for Payer: Mclaren Medicaid |
$51.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.44
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.04
|
| Rate for Payer: Nomi Health Commercial |
$97.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$659.25
|
| Rate for Payer: PACE SWMI |
$81.37
|
| Rate for Payer: PHP Medicare Advantage |
$81.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$122.11
|
| Rate for Payer: Priority Health Medicare |
$81.37
|
| Rate for Payer: Priority Health SBD |
$122.11
|
| Rate for Payer: Priority Health Tiered Network |
$122.11
|
| Rate for Payer: Railroad Medicare Medicare |
$81.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.33
|
| Rate for Payer: UHC Core |
$146.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$81.37
|
| Rate for Payer: UHC Exchange |
$146.33
|
| Rate for Payer: UHC Medicaid |
$51.97
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
|
|
PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER
|
Professional
|
Both
|
$2,009.00
|
|
|
Service Code
|
HCPCS 32550
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$1,506.75 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$187.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.73
|
| Rate for Payer: BCBS Complete |
$121.44
|
| Rate for Payer: BCBS MAPPO |
$180.37
|
| Rate for Payer: BCN Commercial |
$299.79
|
| Rate for Payer: BCN Medicare Advantage |
$180.37
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cofinity Commercial |
$259.73
|
| Rate for Payer: Cofinity Commercial |
$241.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.37
|
| Rate for Payer: Healthscope Commercial |
$333.68
|
| Rate for Payer: Healthscope Commercial |
$288.59
|
| Rate for Payer: Mclaren Medicaid |
$115.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.39
|
| Rate for Payer: Meridian Medicaid |
$121.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$198.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.13
|
| Rate for Payer: Nomi Health Commercial |
$216.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,506.75
|
| Rate for Payer: PACE SWMI |
$180.37
|
| Rate for Payer: PHP Medicare Advantage |
$180.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$282.31
|
| Rate for Payer: Priority Health Medicare |
$180.37
|
| Rate for Payer: Priority Health SBD |
$282.31
|
| Rate for Payer: Priority Health Tiered Network |
$282.31
|
| Rate for Payer: Railroad Medicare Medicare |
$180.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.74
|
| Rate for Payer: UHC Core |
$366.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$180.37
|
| Rate for Payer: UHC Exchange |
$366.74
|
| Rate for Payer: UHC Medicaid |
$115.66
|
| Rate for Payer: UHCCP Medicaid |
$115.66
|
|
|
PR INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 33967
|
| Min. Negotiated Rate |
$143.35 |
| Max. Negotiated Rate |
$580.50 |
| Rate for Payer: Aetna Commercial |
$303.93
|
| Rate for Payer: Aetna Medicare |
$235.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.61
|
| Rate for Payer: BCBS Complete |
$150.52
|
| Rate for Payer: BCBS MAPPO |
$226.81
|
| Rate for Payer: BCN Commercial |
$377.96
|
| Rate for Payer: BCN Medicare Advantage |
$226.81
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$326.61
|
| Rate for Payer: Cofinity Commercial |
$303.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.81
|
| Rate for Payer: Healthscope Commercial |
$419.60
|
| Rate for Payer: Healthscope Commercial |
$362.90
|
| Rate for Payer: Mclaren Medicaid |
$143.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.15
|
| Rate for Payer: Meridian Medicaid |
$150.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$249.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.36
|
| Rate for Payer: Nomi Health Commercial |
$272.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$580.50
|
| Rate for Payer: PACE SWMI |
$226.81
|
| Rate for Payer: PHP Medicare Advantage |
$226.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$406.46
|
| Rate for Payer: Priority Health Medicare |
$226.81
|
| Rate for Payer: Priority Health SBD |
$406.46
|
| Rate for Payer: Priority Health Tiered Network |
$406.46
|
| Rate for Payer: Railroad Medicare Medicare |
$226.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.89
|
| Rate for Payer: UHC Core |
$462.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$226.81
|
| Rate for Payer: UHC Exchange |
$462.89
|
| Rate for Payer: UHC Medicaid |
$143.35
|
| Rate for Payer: UHCCP Medicaid |
$143.35
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 58300
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Aetna Commercial |
$60.86
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.86
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCN Commercial |
$59.30
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Mclaren Medicaid |
$27.90
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$76.15
|
| Rate for Payer: Priority Health SBD |
$76.15
|
| Rate for Payer: Priority Health Tiered Network |
$76.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.47
|
| Rate for Payer: UHC Core |
$91.47
|
| Rate for Payer: UHC Exchange |
$91.47
|
| Rate for Payer: UHC Medicaid |
$27.90
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$192.15 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Advantage |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.75
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$117.08 |
| Max. Negotiated Rate |
$557.28 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS Trust/PPO |
$557.28
|
| Rate for Payer: BCN Commercial |
$557.28
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Advantage |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.75
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$146.35
|
| Rate for Payer: Priority Health SBD |
$192.15
|
| Rate for Payer: Priority Health Tiered Network |
$117.08
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
58300
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Aetna Commercial |
$60.86
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.86
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCN Commercial |
$59.30
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Mclaren Medicaid |
$27.90
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$76.15
|
| Rate for Payer: Priority Health SBD |
$76.15
|
| Rate for Payer: Priority Health Tiered Network |
$76.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.47
|
| Rate for Payer: UHC Core |
$91.47
|
| Rate for Payer: UHC Exchange |
$91.47
|
| Rate for Payer: UHC Medicaid |
$27.90
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
|
PR INSERTION PICC W/O IMG GDN < 5 YR
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 36568
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$166.36 |
| Rate for Payer: Aetna Commercial |
$113.10
|
| Rate for Payer: Aetna Medicare |
$87.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.10
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$84.40
|
| Rate for Payer: BCN Commercial |
$136.44
|
| Rate for Payer: BCN Medicare Advantage |
$84.40
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cofinity Commercial |
$121.54
|
| Rate for Payer: Cofinity Commercial |
$113.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.40
|
| Rate for Payer: Healthscope Commercial |
$156.14
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Mclaren Medicaid |
$53.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.62
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.56
|
| Rate for Payer: Nomi Health Commercial |
$101.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.25
|
| Rate for Payer: PACE SWMI |
$84.40
|
| Rate for Payer: PHP Medicare Advantage |
$84.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$146.73
|
| Rate for Payer: Priority Health Medicare |
$84.40
|
| Rate for Payer: Priority Health SBD |
$146.73
|
| Rate for Payer: Priority Health Tiered Network |
$146.73
|
| Rate for Payer: Railroad Medicare Medicare |
$84.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.36
|
| Rate for Payer: UHC Core |
$166.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$84.40
|
| Rate for Payer: UHC Exchange |
$166.36
|
| Rate for Payer: UHC Medicaid |
$53.46
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
|
|
PR INSERTION PICC W/O IMG GDN 5 YR/>
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 36569
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$378.75 |
| Rate for Payer: Aetna Commercial |
$115.82
|
| Rate for Payer: Aetna Medicare |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.46
|
| Rate for Payer: BCBS Complete |
$57.70
|
| Rate for Payer: BCBS MAPPO |
$86.43
|
| Rate for Payer: BCN Commercial |
$139.93
|
| Rate for Payer: BCN Medicare Advantage |
$86.43
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cofinity Commercial |
$124.46
|
| Rate for Payer: Cofinity Commercial |
$115.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.43
|
| Rate for Payer: Healthscope Commercial |
$159.90
|
| Rate for Payer: Healthscope Commercial |
$138.29
|
| Rate for Payer: Mclaren Medicaid |
$54.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.75
|
| Rate for Payer: Meridian Medicaid |
$57.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.74
|
| Rate for Payer: Nomi Health Commercial |
$103.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.75
|
| Rate for Payer: PACE SWMI |
$86.43
|
| Rate for Payer: PHP Medicare Advantage |
$86.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.47
|
| Rate for Payer: Priority Health Medicare |
$86.43
|
| Rate for Payer: Priority Health SBD |
$150.47
|
| Rate for Payer: Priority Health Tiered Network |
$150.47
|
| Rate for Payer: Railroad Medicare Medicare |
$86.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.94
|
| Rate for Payer: UHC Core |
$167.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.43
|
| Rate for Payer: UHC Exchange |
$167.94
|
| Rate for Payer: UHC Medicaid |
$54.95
|
| Rate for Payer: UHCCP Medicaid |
$54.95
|
|
|
PR INSERTION PICC W/RS&I < 5 YR
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 36572
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$651.75 |
| Rate for Payer: Aetna Commercial |
$98.92
|
| Rate for Payer: Aetna Medicare |
$76.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.92
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$73.82
|
| Rate for Payer: BCN Commercial |
$119.51
|
| Rate for Payer: BCN Medicare Advantage |
$73.82
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cofinity Commercial |
$98.92
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.82
|
| Rate for Payer: Healthscope Commercial |
$136.57
|
| Rate for Payer: Healthscope Commercial |
$118.11
|
| Rate for Payer: Mclaren Medicaid |
$46.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.51
|
| Rate for Payer: Meridian Medicaid |
$49.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.34
|
| Rate for Payer: Nomi Health Commercial |
$88.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$651.75
|
| Rate for Payer: PACE SWMI |
$73.82
|
| Rate for Payer: PHP Medicare Advantage |
$73.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$128.52
|
| Rate for Payer: Priority Health Medicare |
$73.82
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: Priority Health Tiered Network |
$128.52
|
| Rate for Payer: Railroad Medicare Medicare |
$73.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.05
|
| Rate for Payer: UHC Core |
$161.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.82
|
| Rate for Payer: UHC Exchange |
$161.05
|
| Rate for Payer: UHC Medicaid |
$46.86
|
| Rate for Payer: UHCCP Medicaid |
$46.86
|
|
|
PR INSERTION PICC W/RS&I 5 YR/>
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 36573
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$599.25 |
| Rate for Payer: Aetna Commercial |
$96.47
|
| Rate for Payer: Aetna Medicare |
$74.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.47
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS MAPPO |
$71.99
|
| Rate for Payer: BCN Commercial |
$122.50
|
| Rate for Payer: BCN Medicare Advantage |
$71.99
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Cofinity Commercial |
$96.47
|
| Rate for Payer: Cofinity Commercial |
$103.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.99
|
| Rate for Payer: Healthscope Commercial |
$133.18
|
| Rate for Payer: Healthscope Commercial |
$115.18
|
| Rate for Payer: Mclaren Medicaid |
$46.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.59
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.30
|
| Rate for Payer: Nomi Health Commercial |
$86.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$599.25
|
| Rate for Payer: PACE SWMI |
$71.99
|
| Rate for Payer: PHP Medicare Advantage |
$71.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$131.73
|
| Rate for Payer: Priority Health Medicare |
$71.99
|
| Rate for Payer: Priority Health SBD |
$131.73
|
| Rate for Payer: Priority Health Tiered Network |
$131.73
|
| Rate for Payer: Railroad Medicare Medicare |
$71.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.84
|
| Rate for Payer: UHC Core |
$150.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.99
|
| Rate for Payer: UHC Exchange |
$150.84
|
| Rate for Payer: UHC Medicaid |
$46.01
|
| Rate for Payer: UHCCP Medicaid |
$46.01
|
|
|
PR INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS 33285
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Priority Health SBD |
$138.16
|
| Rate for Payer: Aetna Commercial |
$102.04
|
| Rate for Payer: Aetna Medicare |
$79.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.66
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS MAPPO |
$76.15
|
| Rate for Payer: BCN Commercial |
$128.48
|
| Rate for Payer: BCN Medicare Advantage |
$76.15
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$109.66
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$140.88
|
| Rate for Payer: Healthscope Commercial |
$121.84
|
| Rate for Payer: Mclaren Medicaid |
$48.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.96
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.75
|
| Rate for Payer: Nomi Health Commercial |
$91.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE SWMI |
$76.15
|
| Rate for Payer: PHP Medicare Advantage |
$76.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$138.16
|
| Rate for Payer: Priority Health Medicare |
$76.15
|
| Rate for Payer: Priority Health Tiered Network |
$138.16
|
| Rate for Payer: Railroad Medicare Medicare |
$76.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.63
|
| Rate for Payer: UHC Core |
$157.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.15
|
| Rate for Payer: UHC Exchange |
$157.63
|
| Rate for Payer: UHC Medicaid |
$48.35
|
| Rate for Payer: UHCCP Medicaid |
$48.35
|
|
|
PR INSERTION TANDEM CUFF
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 53444
|
| Min. Negotiated Rate |
$457.10 |
| Max. Negotiated Rate |
$1,401.27 |
| Rate for Payer: Aetna Commercial |
$947.93
|
| Rate for Payer: Aetna Medicare |
$735.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,018.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.93
|
| Rate for Payer: BCBS Complete |
$479.95
|
| Rate for Payer: BCBS MAPPO |
$707.41
|
| Rate for Payer: BCN Commercial |
$1,188.18
|
| Rate for Payer: BCN Medicare Advantage |
$707.41
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Cofinity Commercial |
$947.93
|
| Rate for Payer: Cofinity Commercial |
$1,018.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.41
|
| Rate for Payer: Healthscope Commercial |
$1,308.71
|
| Rate for Payer: Healthscope Commercial |
$1,131.86
|
| Rate for Payer: Mclaren Medicaid |
$457.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$742.78
|
| Rate for Payer: Meridian Medicaid |
$479.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$778.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.58
|
| Rate for Payer: Nomi Health Commercial |
$848.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,172.25
|
| Rate for Payer: PACE SWMI |
$707.41
|
| Rate for Payer: PHP Medicare Advantage |
$707.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,294.32
|
| Rate for Payer: Priority Health Medicare |
$707.41
|
| Rate for Payer: Priority Health SBD |
$1,294.32
|
| Rate for Payer: Priority Health Tiered Network |
$1,294.32
|
| Rate for Payer: Railroad Medicare Medicare |
$707.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,401.27
|
| Rate for Payer: UHC Core |
$1,401.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$707.41
|
| Rate for Payer: UHC Exchange |
$1,401.27
|
| Rate for Payer: UHC Medicaid |
$457.10
|
| Rate for Payer: UHCCP Medicaid |
$457.10
|
|
|
PR INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN
|
Professional
|
Both
|
$1,347.00
|
|
|
Service Code
|
HCPCS 49421
|
| Min. Negotiated Rate |
$131.85 |
| Max. Negotiated Rate |
$1,010.25 |
| Rate for Payer: Aetna Commercial |
$278.87
|
| Rate for Payer: Aetna Medicare |
$216.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.68
|
| Rate for Payer: BCBS Complete |
$138.44
|
| Rate for Payer: BCBS MAPPO |
$208.11
|
| Rate for Payer: BCN Commercial |
$336.64
|
| Rate for Payer: BCN Medicare Advantage |
$208.11
|
| Rate for Payer: Cash Price |
$1,077.60
|
| Rate for Payer: Cash Price |
$1,077.60
|
| Rate for Payer: Cofinity Commercial |
$299.68
|
| Rate for Payer: Cofinity Commercial |
$278.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.11
|
| Rate for Payer: Healthscope Commercial |
$385.00
|
| Rate for Payer: Healthscope Commercial |
$332.98
|
| Rate for Payer: Mclaren Medicaid |
$131.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$218.52
|
| Rate for Payer: Meridian Medicaid |
$138.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$228.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.02
|
| Rate for Payer: Nomi Health Commercial |
$249.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,010.25
|
| Rate for Payer: PACE SWMI |
$208.11
|
| Rate for Payer: PHP Medicare Advantage |
$208.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$410.16
|
| Rate for Payer: Priority Health Medicare |
$208.11
|
| Rate for Payer: Priority Health SBD |
$410.16
|
| Rate for Payer: Priority Health Tiered Network |
$410.16
|
| Rate for Payer: Railroad Medicare Medicare |
$208.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.58
|
| Rate for Payer: UHC Core |
$409.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$208.11
|
| Rate for Payer: UHC Exchange |
$409.58
|
| Rate for Payer: UHC Medicaid |
$131.85
|
| Rate for Payer: UHCCP Medicaid |
$131.85
|
|
|
PR INSERTION VAGINAL RADIATION DEVICE
|
Professional
|
Both
|
$403.00
|
|
|
Service Code
|
HCPCS 57156
|
| Min. Negotiated Rate |
$80.94 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$167.51
|
| Rate for Payer: Aetna Medicare |
$130.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.01
|
| Rate for Payer: BCBS Complete |
$84.99
|
| Rate for Payer: BCBS MAPPO |
$125.01
|
| Rate for Payer: BCN Commercial |
$228.57
|
| Rate for Payer: BCN Medicare Advantage |
$125.01
|
| Rate for Payer: Cash Price |
$322.40
|
| Rate for Payer: Cash Price |
$322.40
|
| Rate for Payer: Cofinity Commercial |
$180.01
|
| Rate for Payer: Cofinity Commercial |
$167.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.01
|
| Rate for Payer: Healthscope Commercial |
$231.27
|
| Rate for Payer: Healthscope Commercial |
$200.02
|
| Rate for Payer: Mclaren Medicaid |
$80.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.26
|
| Rate for Payer: Meridian Medicaid |
$84.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$137.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.43
|
| Rate for Payer: Nomi Health Commercial |
$150.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.25
|
| Rate for Payer: PACE SWMI |
$125.01
|
| Rate for Payer: PHP Medicare Advantage |
$125.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$231.49
|
| Rate for Payer: Priority Health Medicare |
$125.01
|
| Rate for Payer: Priority Health SBD |
$231.49
|
| Rate for Payer: Priority Health Tiered Network |
$231.49
|
| Rate for Payer: Railroad Medicare Medicare |
$125.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.43
|
| Rate for Payer: UHC Core |
$262.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.01
|
| Rate for Payer: UHC Exchange |
$262.43
|
| Rate for Payer: UHC Medicaid |
$80.94
|
| Rate for Payer: UHCCP Medicaid |
$80.94
|
|
|
PR INSERTION VASCULAR PEDICLE CARPAL BONE
|
Professional
|
Both
|
$1,272.00
|
|
|
Service Code
|
HCPCS 25430
|
| Min. Negotiated Rate |
$443.47 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna Commercial |
$907.18
|
| Rate for Payer: Aetna Medicare |
$704.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.88
|
| Rate for Payer: BCBS Complete |
$465.64
|
| Rate for Payer: BCBS MAPPO |
$677.00
|
| Rate for Payer: BCN Commercial |
$1,121.95
|
| Rate for Payer: BCN Medicare Advantage |
$677.00
|
| Rate for Payer: Cash Price |
$1,017.60
|
| Rate for Payer: Cash Price |
$1,017.60
|
| Rate for Payer: Cofinity Commercial |
$974.88
|
| Rate for Payer: Cofinity Commercial |
$907.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.00
|
| Rate for Payer: Healthscope Commercial |
$1,252.45
|
| Rate for Payer: Healthscope Commercial |
$1,083.20
|
| Rate for Payer: Mclaren Medicaid |
$443.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.85
|
| Rate for Payer: Meridian Medicaid |
$465.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$744.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.50
|
| Rate for Payer: Nomi Health Commercial |
$812.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.00
|
| Rate for Payer: PACE SWMI |
$677.00
|
| Rate for Payer: PHP Medicare Advantage |
$677.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,199.34
|
| Rate for Payer: Priority Health Medicare |
$677.00
|
| Rate for Payer: Priority Health SBD |
$1,199.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,199.34
|
| Rate for Payer: Railroad Medicare Medicare |
$677.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,272.60
|
| Rate for Payer: UHC Core |
$1,272.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$677.00
|
| Rate for Payer: UHC Exchange |
$1,272.60
|
| Rate for Payer: UHC Medicaid |
$443.47
|
| Rate for Payer: UHCCP Medicaid |
$443.47
|
|
|
PR INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 20650
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna Commercial |
$208.05
|
| Rate for Payer: Aetna Medicare |
$161.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.57
|
| Rate for Payer: BCBS Complete |
$107.13
|
| Rate for Payer: BCBS MAPPO |
$155.26
|
| Rate for Payer: BCN Commercial |
$255.97
|
| Rate for Payer: BCN Medicare Advantage |
$155.26
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$223.57
|
| Rate for Payer: Cofinity Commercial |
$208.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.26
|
| Rate for Payer: Healthscope Commercial |
$287.23
|
| Rate for Payer: Healthscope Commercial |
$248.42
|
| Rate for Payer: Mclaren Medicaid |
$102.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.02
|
| Rate for Payer: Meridian Medicaid |
$107.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$170.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.18
|
| Rate for Payer: Nomi Health Commercial |
$186.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.00
|
| Rate for Payer: PACE SWMI |
$155.26
|
| Rate for Payer: PHP Medicare Advantage |
$155.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$273.61
|
| Rate for Payer: Priority Health Medicare |
$155.26
|
| Rate for Payer: Priority Health SBD |
$273.61
|
| Rate for Payer: Priority Health Tiered Network |
$273.61
|
| Rate for Payer: Railroad Medicare Medicare |
$155.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.71
|
| Rate for Payer: UHC Core |
$274.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.26
|
| Rate for Payer: UHC Exchange |
$274.71
|
| Rate for Payer: UHC Medicaid |
$102.03
|
| Rate for Payer: UHCCP Medicaid |
$102.03
|
|
|
PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, EA ADD
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 0172T
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$408.75 |
| Rate for Payer: Aetna Medicare |
$272.50
|
| Rate for Payer: BCBS Complete |
$218.00
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.75
|
|
|
PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, SINGLE
|
Professional
|
Both
|
$2,816.00
|
|
|
Service Code
|
HCPCS 0171T
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Medicare |
$1,408.00
|
| Rate for Payer: BCBS Complete |
$1,126.40
|
| Rate for Payer: Cash Price |
$2,252.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,112.00
|
|
|
PR INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 53855
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$902.25 |
| Rate for Payer: Aetna Commercial |
$96.12
|
| Rate for Payer: Aetna Medicare |
$74.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.12
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS MAPPO |
$71.73
|
| Rate for Payer: BCN Commercial |
$121.01
|
| Rate for Payer: BCN Medicare Advantage |
$71.73
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$96.12
|
| Rate for Payer: Cofinity Commercial |
$103.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.73
|
| Rate for Payer: Healthscope Commercial |
$132.70
|
| Rate for Payer: Healthscope Commercial |
$114.77
|
| Rate for Payer: Mclaren Medicaid |
$45.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.32
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.18
|
| Rate for Payer: Nomi Health Commercial |
$86.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$902.25
|
| Rate for Payer: PACE SWMI |
$71.73
|
| Rate for Payer: PHP Medicare Advantage |
$71.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$131.82
|
| Rate for Payer: Priority Health Medicare |
$71.73
|
| Rate for Payer: Priority Health SBD |
$131.82
|
| Rate for Payer: Priority Health Tiered Network |
$131.82
|
| Rate for Payer: Railroad Medicare Medicare |
$71.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.08
|
| Rate for Payer: UHC Core |
$147.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.73
|
| Rate for Payer: UHC Exchange |
$147.08
|
| Rate for Payer: UHC Medicaid |
$45.80
|
| Rate for Payer: UHCCP Medicaid |
$45.80
|
|
