|
PR INSERT TRAY W/O BAG/CATH
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$14.46
|
| Rate for Payer: Aetna Medicare |
$11.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$10.79
|
| Rate for Payer: BCN Medicare Advantage |
$10.79
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.79
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Nomi Health Commercial |
$12.95
|
| Rate for Payer: PACE SWMI |
$10.79
|
| Rate for Payer: PHP Medicare Advantage |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$10.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.79
|
| Rate for Payer: UHC Medicare Advantage |
$10.79
|
|
|
PR INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR
|
Professional
|
Both
|
$2,147.00
|
|
|
Service Code
|
HCPCS 36557
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$1,395.55 |
| Rate for Payer: Aetna Commercial |
$415.40
|
| Rate for Payer: Aetna Medicare |
$322.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.40
|
| Rate for Payer: BCBS Complete |
$858.80
|
| Rate for Payer: BCBS MAPPO |
$310.00
|
| Rate for Payer: BCN Medicare Advantage |
$310.00
|
| Rate for Payer: Cash Price |
$1,717.60
|
| Rate for Payer: Cash Price |
$1,717.60
|
| Rate for Payer: Cofinity Commercial |
$446.40
|
| Rate for Payer: Cofinity Commercial |
$415.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.00
|
| Rate for Payer: Healthscope Commercial |
$496.00
|
| Rate for Payer: Healthscope Commercial |
$573.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,395.55
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: PACE SWMI |
$310.00
|
| Rate for Payer: PHP Medicare Advantage |
$310.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.55
|
| Rate for Payer: Priority Health Medicare |
$310.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.00
|
| Rate for Payer: UHC Medicare Advantage |
$310.00
|
|
|
PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 37191
|
| Min. Negotiated Rate |
$208.54 |
| Max. Negotiated Rate |
$1,803.10 |
| Rate for Payer: Aetna Commercial |
$279.44
|
| Rate for Payer: Aetna Medicare |
$216.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.44
|
| Rate for Payer: BCBS Complete |
$1,109.60
|
| Rate for Payer: BCBS MAPPO |
$208.54
|
| Rate for Payer: BCN Medicare Advantage |
$208.54
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cofinity Commercial |
$300.30
|
| Rate for Payer: Cofinity Commercial |
$279.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.54
|
| Rate for Payer: Healthscope Commercial |
$385.80
|
| Rate for Payer: Healthscope Commercial |
$333.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$218.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,803.10
|
| Rate for Payer: Nomi Health Commercial |
$250.25
|
| Rate for Payer: PACE SWMI |
$208.54
|
| Rate for Payer: PHP Medicare Advantage |
$208.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health Medicare |
$208.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.54
|
| Rate for Payer: UHC Medicare Advantage |
$208.54
|
|
|
PR IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART
|
Professional
|
Both
|
$3,309.00
|
|
|
Service Code
|
HCPCS 35585
|
| Min. Negotiated Rate |
$1,323.60 |
| Max. Negotiated Rate |
$2,962.65 |
| Rate for Payer: Aetna Commercial |
$2,145.92
|
| Rate for Payer: Aetna Medicare |
$1,665.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,306.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,145.92
|
| Rate for Payer: BCBS Complete |
$1,323.60
|
| Rate for Payer: BCBS MAPPO |
$1,601.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,601.43
|
| Rate for Payer: Cash Price |
$2,647.20
|
| Rate for Payer: Cash Price |
$2,647.20
|
| Rate for Payer: Cofinity Commercial |
$2,306.06
|
| Rate for Payer: Cofinity Commercial |
$2,145.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,601.43
|
| Rate for Payer: Healthscope Commercial |
$2,562.29
|
| Rate for Payer: Healthscope Commercial |
$2,962.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,681.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,150.85
|
| Rate for Payer: Nomi Health Commercial |
$1,921.72
|
| Rate for Payer: PACE SWMI |
$1,601.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,601.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,150.85
|
| Rate for Payer: Priority Health Medicare |
$1,601.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,601.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,601.43
|
|
|
PR IN-SITU VEIN BYPASS FEMORAL-POPLITEAL
|
Professional
|
Both
|
$4,664.00
|
|
|
Service Code
|
HCPCS 35583
|
| Min. Negotiated Rate |
$1,382.11 |
| Max. Negotiated Rate |
$3,031.60 |
| Rate for Payer: Aetna Commercial |
$1,852.03
|
| Rate for Payer: Aetna Medicare |
$1,437.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,990.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,852.03
|
| Rate for Payer: BCBS Complete |
$1,865.60
|
| Rate for Payer: BCBS MAPPO |
$1,382.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,382.11
|
| Rate for Payer: Cash Price |
$3,731.20
|
| Rate for Payer: Cash Price |
$3,731.20
|
| Rate for Payer: Cofinity Commercial |
$1,990.24
|
| Rate for Payer: Cofinity Commercial |
$1,852.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,382.11
|
| Rate for Payer: Healthscope Commercial |
$2,556.90
|
| Rate for Payer: Healthscope Commercial |
$2,211.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,451.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,031.60
|
| Rate for Payer: Nomi Health Commercial |
$1,658.53
|
| Rate for Payer: PACE SWMI |
$1,382.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,382.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,031.60
|
| Rate for Payer: Priority Health Medicare |
$1,382.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,382.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,382.11
|
|
|
PR IN-SITU VEIN BYP POP-TIBL PRONEAL
|
Professional
|
Both
|
$2,851.00
|
|
|
Service Code
|
HCPCS 35587
|
| Min. Negotiated Rate |
$1,140.40 |
| Max. Negotiated Rate |
$2,374.60 |
| Rate for Payer: Aetna Commercial |
$1,719.98
|
| Rate for Payer: Aetna Medicare |
$1,334.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,848.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,719.98
|
| Rate for Payer: BCBS Complete |
$1,140.40
|
| Rate for Payer: BCBS MAPPO |
$1,283.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,283.57
|
| Rate for Payer: Cash Price |
$2,280.80
|
| Rate for Payer: Cash Price |
$2,280.80
|
| Rate for Payer: Cofinity Commercial |
$1,848.34
|
| Rate for Payer: Cofinity Commercial |
$1,719.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,283.57
|
| Rate for Payer: Healthscope Commercial |
$2,053.71
|
| Rate for Payer: Healthscope Commercial |
$2,374.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,347.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,853.15
|
| Rate for Payer: Nomi Health Commercial |
$1,540.28
|
| Rate for Payer: PACE SWMI |
$1,283.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,283.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.15
|
| Rate for Payer: Priority Health Medicare |
$1,283.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,283.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,283.57
|
|
|
PR INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS 33216
|
| Min. Negotiated Rate |
$351.59 |
| Max. Negotiated Rate |
$806.65 |
| Rate for Payer: Aetna Commercial |
$471.13
|
| Rate for Payer: Aetna Medicare |
$365.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.13
|
| Rate for Payer: BCBS Complete |
$496.40
|
| Rate for Payer: BCBS MAPPO |
$351.59
|
| Rate for Payer: BCN Medicare Advantage |
$351.59
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cofinity Commercial |
$506.29
|
| Rate for Payer: Cofinity Commercial |
$471.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.59
|
| Rate for Payer: Healthscope Commercial |
$650.44
|
| Rate for Payer: Healthscope Commercial |
$562.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.65
|
| Rate for Payer: Nomi Health Commercial |
$421.91
|
| Rate for Payer: PACE SWMI |
$351.59
|
| Rate for Payer: PHP Medicare Advantage |
$351.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.65
|
| Rate for Payer: Priority Health Medicare |
$351.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.59
|
| Rate for Payer: UHC Medicare Advantage |
$351.59
|
|
|
PR INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS 33217
|
| Min. Negotiated Rate |
$349.82 |
| Max. Negotiated Rate |
$806.65 |
| Rate for Payer: Aetna Commercial |
$468.76
|
| Rate for Payer: Aetna Medicare |
$363.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.76
|
| Rate for Payer: BCBS Complete |
$496.40
|
| Rate for Payer: BCBS MAPPO |
$349.82
|
| Rate for Payer: BCN Medicare Advantage |
$349.82
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cofinity Commercial |
$503.74
|
| Rate for Payer: Cofinity Commercial |
$468.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.82
|
| Rate for Payer: Healthscope Commercial |
$559.71
|
| Rate for Payer: Healthscope Commercial |
$647.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.65
|
| Rate for Payer: Nomi Health Commercial |
$419.78
|
| Rate for Payer: PACE SWMI |
$349.82
|
| Rate for Payer: PHP Medicare Advantage |
$349.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.65
|
| Rate for Payer: Priority Health Medicare |
$349.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.82
|
| Rate for Payer: UHC Medicare Advantage |
$349.82
|
|
|
PR INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 22853
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$465.59 |
| Rate for Payer: Aetna Commercial |
$337.24
|
| Rate for Payer: Aetna Medicare |
$261.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.24
|
| Rate for Payer: BCBS Complete |
$218.40
|
| Rate for Payer: BCBS MAPPO |
$251.67
|
| Rate for Payer: BCN Medicare Advantage |
$251.67
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$362.40
|
| Rate for Payer: Cofinity Commercial |
$337.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.67
|
| Rate for Payer: Healthscope Commercial |
$465.59
|
| Rate for Payer: Healthscope Commercial |
$402.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$264.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.90
|
| Rate for Payer: Nomi Health Commercial |
$302.00
|
| Rate for Payer: PACE SWMI |
$251.67
|
| Rate for Payer: PHP Medicare Advantage |
$251.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health Medicare |
$251.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.67
|
| Rate for Payer: UHC Medicare Advantage |
$251.67
|
|
|
PR INSJ BIOMCHN DEV NTRVRT DISC SPACE W/O ARTHRD
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 22859
|
| Min. Negotiated Rate |
$327.83 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$439.29
|
| Rate for Payer: Aetna Medicare |
$340.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.29
|
| Rate for Payer: BCBS Complete |
$914.80
|
| Rate for Payer: BCBS MAPPO |
$327.83
|
| Rate for Payer: BCN Medicare Advantage |
$327.83
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$472.08
|
| Rate for Payer: Cofinity Commercial |
$439.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.83
|
| Rate for Payer: Healthscope Commercial |
$524.53
|
| Rate for Payer: Healthscope Commercial |
$606.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,486.55
|
| Rate for Payer: Nomi Health Commercial |
$393.40
|
| Rate for Payer: PACE SWMI |
$327.83
|
| Rate for Payer: PHP Medicare Advantage |
$327.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health Medicare |
$327.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.83
|
| Rate for Payer: UHC Medicare Advantage |
$327.83
|
|
|
PR INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD
|
Professional
|
Both
|
$883.00
|
|
|
Service Code
|
HCPCS 22854
|
| Min. Negotiated Rate |
$328.21 |
| Max. Negotiated Rate |
$607.19 |
| Rate for Payer: Aetna Commercial |
$439.80
|
| Rate for Payer: Aetna Medicare |
$341.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.80
|
| Rate for Payer: BCBS Complete |
$353.20
|
| Rate for Payer: BCBS MAPPO |
$328.21
|
| Rate for Payer: BCN Medicare Advantage |
$328.21
|
| Rate for Payer: Cash Price |
$706.40
|
| Rate for Payer: Cash Price |
$706.40
|
| Rate for Payer: Cofinity Commercial |
$472.62
|
| Rate for Payer: Cofinity Commercial |
$439.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.21
|
| Rate for Payer: Healthscope Commercial |
$607.19
|
| Rate for Payer: Healthscope Commercial |
$525.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.95
|
| Rate for Payer: Nomi Health Commercial |
$393.85
|
| Rate for Payer: PACE SWMI |
$328.21
|
| Rate for Payer: PHP Medicare Advantage |
$328.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.95
|
| Rate for Payer: Priority Health Medicare |
$328.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.21
|
| Rate for Payer: UHC Medicare Advantage |
$328.21
|
|
|
PR INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL
|
Professional
|
Both
|
$1,483.00
|
|
|
Service Code
|
HCPCS 36810
|
| Min. Negotiated Rate |
$182.12 |
| Max. Negotiated Rate |
$963.95 |
| Rate for Payer: Aetna Commercial |
$244.04
|
| Rate for Payer: Aetna Medicare |
$189.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.04
|
| Rate for Payer: BCBS Complete |
$593.20
|
| Rate for Payer: BCBS MAPPO |
$182.12
|
| Rate for Payer: BCN Medicare Advantage |
$182.12
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$262.25
|
| Rate for Payer: Cofinity Commercial |
$244.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.12
|
| Rate for Payer: Healthscope Commercial |
$291.39
|
| Rate for Payer: Healthscope Commercial |
$336.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$963.95
|
| Rate for Payer: Nomi Health Commercial |
$218.54
|
| Rate for Payer: PACE SWMI |
$182.12
|
| Rate for Payer: PHP Medicare Advantage |
$182.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.95
|
| Rate for Payer: Priority Health Medicare |
$182.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.12
|
| Rate for Payer: UHC Medicare Advantage |
$182.12
|
|
|
PR INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 36800
|
| Min. Negotiated Rate |
$114.27 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Aetna Commercial |
$153.12
|
| Rate for Payer: Aetna Medicare |
$118.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.12
|
| Rate for Payer: BCBS Complete |
$266.00
|
| Rate for Payer: BCBS MAPPO |
$114.27
|
| Rate for Payer: BCN Medicare Advantage |
$114.27
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$164.55
|
| Rate for Payer: Cofinity Commercial |
$153.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.27
|
| Rate for Payer: Healthscope Commercial |
$211.40
|
| Rate for Payer: Healthscope Commercial |
$182.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.25
|
| Rate for Payer: Nomi Health Commercial |
$137.12
|
| Rate for Payer: PACE SWMI |
$114.27
|
| Rate for Payer: PHP Medicare Advantage |
$114.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health Medicare |
$114.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.27
|
| Rate for Payer: UHC Medicare Advantage |
$114.27
|
|
|
PR INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN
|
Professional
|
Both
|
$1,619.00
|
|
|
Service Code
|
HCPCS 33224
|
| Min. Negotiated Rate |
$486.34 |
| Max. Negotiated Rate |
$1,052.35 |
| Rate for Payer: Aetna Commercial |
$651.70
|
| Rate for Payer: Aetna Medicare |
$505.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.70
|
| Rate for Payer: BCBS Complete |
$647.60
|
| Rate for Payer: BCBS MAPPO |
$486.34
|
| Rate for Payer: BCN Medicare Advantage |
$486.34
|
| Rate for Payer: Cash Price |
$1,295.20
|
| Rate for Payer: Cash Price |
$1,295.20
|
| Rate for Payer: Cofinity Commercial |
$700.33
|
| Rate for Payer: Cofinity Commercial |
$651.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.34
|
| Rate for Payer: Healthscope Commercial |
$778.14
|
| Rate for Payer: Healthscope Commercial |
$899.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$510.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.35
|
| Rate for Payer: Nomi Health Commercial |
$583.61
|
| Rate for Payer: PACE SWMI |
$486.34
|
| Rate for Payer: PHP Medicare Advantage |
$486.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,052.35
|
| Rate for Payer: Priority Health Medicare |
$486.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.34
|
| Rate for Payer: UHC Medicare Advantage |
$486.34
|
|
|
PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 33225
|
| Min. Negotiated Rate |
$394.40 |
| Max. Negotiated Rate |
$813.22 |
| Rate for Payer: Aetna Commercial |
$589.04
|
| Rate for Payer: Aetna Medicare |
$457.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.04
|
| Rate for Payer: BCBS Complete |
$394.40
|
| Rate for Payer: BCBS MAPPO |
$439.58
|
| Rate for Payer: BCN Medicare Advantage |
$439.58
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$633.00
|
| Rate for Payer: Cofinity Commercial |
$589.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.58
|
| Rate for Payer: Healthscope Commercial |
$813.22
|
| Rate for Payer: Healthscope Commercial |
$703.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.90
|
| Rate for Payer: Nomi Health Commercial |
$527.50
|
| Rate for Payer: PACE SWMI |
$439.58
|
| Rate for Payer: PHP Medicare Advantage |
$439.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health Medicare |
$439.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.58
|
| Rate for Payer: UHC Medicare Advantage |
$439.58
|
|
|
PR INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS
|
Professional
|
Both
|
$8,205.00
|
|
|
Service Code
|
HCPCS 33335
|
| Min. Negotiated Rate |
$1,785.29 |
| Max. Negotiated Rate |
$5,333.25 |
| Rate for Payer: Aetna Commercial |
$2,392.29
|
| Rate for Payer: Aetna Medicare |
$1,856.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,570.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,392.29
|
| Rate for Payer: BCBS Complete |
$3,282.00
|
| Rate for Payer: BCBS MAPPO |
$1,785.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,785.29
|
| Rate for Payer: Cash Price |
$6,564.00
|
| Rate for Payer: Cash Price |
$6,564.00
|
| Rate for Payer: Cofinity Commercial |
$2,570.82
|
| Rate for Payer: Cofinity Commercial |
$2,392.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,785.29
|
| Rate for Payer: Healthscope Commercial |
$2,856.46
|
| Rate for Payer: Healthscope Commercial |
$3,302.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,874.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,333.25
|
| Rate for Payer: Nomi Health Commercial |
$2,142.35
|
| Rate for Payer: PACE SWMI |
$1,785.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,785.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,333.25
|
| Rate for Payer: Priority Health Medicare |
$1,785.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,785.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,785.29
|
|
|
PR INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$3,117.00
|
|
|
Service Code
|
HCPCS 53445
|
| Min. Negotiated Rate |
$722.89 |
| Max. Negotiated Rate |
$2,026.05 |
| Rate for Payer: Aetna Commercial |
$968.67
|
| Rate for Payer: Aetna Medicare |
$751.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.96
|
| Rate for Payer: BCBS Complete |
$1,246.80
|
| Rate for Payer: BCBS MAPPO |
$722.89
|
| Rate for Payer: BCN Medicare Advantage |
$722.89
|
| Rate for Payer: Cash Price |
$2,493.60
|
| Rate for Payer: Cash Price |
$2,493.60
|
| Rate for Payer: Cofinity Commercial |
$968.67
|
| Rate for Payer: Cofinity Commercial |
$1,040.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.89
|
| Rate for Payer: Healthscope Commercial |
$1,337.35
|
| Rate for Payer: Healthscope Commercial |
$1,156.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$759.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,026.05
|
| Rate for Payer: Nomi Health Commercial |
$867.47
|
| Rate for Payer: PACE SWMI |
$722.89
|
| Rate for Payer: PHP Medicare Advantage |
$722.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,026.05
|
| Rate for Payer: Priority Health Medicare |
$722.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.89
|
| Rate for Payer: UHC Medicare Advantage |
$722.89
|
|
|
PR INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 33970
|
| Min. Negotiated Rate |
$337.61 |
| Max. Negotiated Rate |
$882.70 |
| Rate for Payer: Aetna Commercial |
$452.40
|
| Rate for Payer: Aetna Medicare |
$351.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.40
|
| Rate for Payer: BCBS Complete |
$543.20
|
| Rate for Payer: BCBS MAPPO |
$337.61
|
| Rate for Payer: BCN Medicare Advantage |
$337.61
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cofinity Commercial |
$486.16
|
| Rate for Payer: Cofinity Commercial |
$452.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.61
|
| Rate for Payer: Healthscope Commercial |
$540.18
|
| Rate for Payer: Healthscope Commercial |
$624.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$882.70
|
| Rate for Payer: Nomi Health Commercial |
$405.13
|
| Rate for Payer: PACE SWMI |
$337.61
|
| Rate for Payer: PHP Medicare Advantage |
$337.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$882.70
|
| Rate for Payer: Priority Health Medicare |
$337.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.61
|
| Rate for Payer: UHC Medicare Advantage |
$337.61
|
|
|
PR INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 57267
|
| Min. Negotiated Rate |
$240.44 |
| Max. Negotiated Rate |
$532.35 |
| Rate for Payer: Aetna Commercial |
$322.19
|
| Rate for Payer: Aetna Medicare |
$250.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.19
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: BCBS MAPPO |
$240.44
|
| Rate for Payer: BCN Medicare Advantage |
$240.44
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$346.23
|
| Rate for Payer: Cofinity Commercial |
$322.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.44
|
| Rate for Payer: Healthscope Commercial |
$444.81
|
| Rate for Payer: Healthscope Commercial |
$384.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$532.35
|
| Rate for Payer: Nomi Health Commercial |
$288.53
|
| Rate for Payer: PACE SWMI |
$240.44
|
| Rate for Payer: PHP Medicare Advantage |
$240.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health Medicare |
$240.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.44
|
| Rate for Payer: UHC Medicare Advantage |
$240.44
|
|
|
PR INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
HCPCS 54405
|
| Min. Negotiated Rate |
$586.40 |
| Max. Negotiated Rate |
$1,429.81 |
| Rate for Payer: Aetna Commercial |
$1,035.65
|
| Rate for Payer: Aetna Medicare |
$803.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.65
|
| Rate for Payer: BCBS Complete |
$586.40
|
| Rate for Payer: BCBS MAPPO |
$772.87
|
| Rate for Payer: BCN Medicare Advantage |
$772.87
|
| Rate for Payer: Cash Price |
$1,172.80
|
| Rate for Payer: Cash Price |
$1,172.80
|
| Rate for Payer: Cofinity Commercial |
$1,112.93
|
| Rate for Payer: Cofinity Commercial |
$1,035.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.87
|
| Rate for Payer: Healthscope Commercial |
$1,236.59
|
| Rate for Payer: Healthscope Commercial |
$1,429.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.90
|
| Rate for Payer: Nomi Health Commercial |
$927.44
|
| Rate for Payer: PACE SWMI |
$772.87
|
| Rate for Payer: PHP Medicare Advantage |
$772.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.90
|
| Rate for Payer: Priority Health Medicare |
$772.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.87
|
| Rate for Payer: UHC Medicare Advantage |
$772.87
|
|
|
PR INSJ NON-NDWELLG BLADDER CATHETER
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 51701
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare |
$25.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.23
|
| Rate for Payer: BCBS Complete |
$64.80
|
| Rate for Payer: BCBS MAPPO |
$24.05
|
| Rate for Payer: BCN Medicare Advantage |
$24.05
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$34.63
|
| Rate for Payer: Cofinity Commercial |
$32.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$44.49
|
| Rate for Payer: Healthscope Commercial |
$38.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.30
|
| Rate for Payer: Nomi Health Commercial |
$28.86
|
| Rate for Payer: PACE SWMI |
$24.05
|
| Rate for Payer: PHP Medicare Advantage |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health Medicare |
$24.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.05
|
| Rate for Payer: UHC Medicare Advantage |
$24.05
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 36555
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$651.95 |
| Rate for Payer: Aetna Commercial |
$107.59
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.59
|
| Rate for Payer: BCBS Complete |
$401.20
|
| Rate for Payer: BCBS MAPPO |
$80.29
|
| Rate for Payer: BCN Medicare Advantage |
$80.29
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Cofinity Commercial |
$107.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.29
|
| Rate for Payer: Healthscope Commercial |
$128.46
|
| Rate for Payer: Healthscope Commercial |
$148.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.95
|
| Rate for Payer: Nomi Health Commercial |
$96.35
|
| Rate for Payer: PACE SWMI |
$80.29
|
| Rate for Payer: PHP Medicare Advantage |
$80.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.95
|
| Rate for Payer: Priority Health Medicare |
$80.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.29
|
| Rate for Payer: UHC Medicare Advantage |
$80.29
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 36556
|
| Min. Negotiated Rate |
$80.28 |
| Max. Negotiated Rate |
$558.35 |
| Rate for Payer: Aetna Commercial |
$107.58
|
| Rate for Payer: Aetna Medicare |
$83.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: BCBS Complete |
$343.60
|
| Rate for Payer: BCBS MAPPO |
$80.28
|
| Rate for Payer: BCN Medicare Advantage |
$80.28
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$115.60
|
| Rate for Payer: Cofinity Commercial |
$107.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.28
|
| Rate for Payer: Healthscope Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$128.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.35
|
| Rate for Payer: Nomi Health Commercial |
$96.34
|
| Rate for Payer: PACE SWMI |
$80.28
|
| Rate for Payer: PHP Medicare Advantage |
$80.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.35
|
| Rate for Payer: Priority Health Medicare |
$80.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.28
|
| Rate for Payer: UHC Medicare Advantage |
$80.28
|
|
|
PR INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID
|
Professional
|
Both
|
$1,596.00
|
|
|
Service Code
|
HCPCS 54400
|
| Min. Negotiated Rate |
$509.14 |
| Max. Negotiated Rate |
$1,037.40 |
| Rate for Payer: Aetna Commercial |
$682.25
|
| Rate for Payer: Aetna Medicare |
$529.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.25
|
| Rate for Payer: BCBS Complete |
$638.40
|
| Rate for Payer: BCBS MAPPO |
$509.14
|
| Rate for Payer: BCN Medicare Advantage |
$509.14
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cofinity Commercial |
$733.16
|
| Rate for Payer: Cofinity Commercial |
$682.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.14
|
| Rate for Payer: Healthscope Commercial |
$814.62
|
| Rate for Payer: Healthscope Commercial |
$941.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.40
|
| Rate for Payer: Nomi Health Commercial |
$610.97
|
| Rate for Payer: PACE SWMI |
$509.14
|
| Rate for Payer: PHP Medicare Advantage |
$509.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,037.40
|
| Rate for Payer: Priority Health Medicare |
$509.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.14
|
| Rate for Payer: UHC Medicare Advantage |
$509.14
|
|
|
PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL ACCESS ONLY
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 33990
|
| Min. Negotiated Rate |
$343.58 |
| Max. Negotiated Rate |
$635.62 |
| Rate for Payer: Aetna Commercial |
$460.40
|
| Rate for Payer: Aetna Medicare |
$357.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.40
|
| Rate for Payer: BCBS Complete |
$358.80
|
| Rate for Payer: BCBS MAPPO |
$343.58
|
| Rate for Payer: BCN Medicare Advantage |
$343.58
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cofinity Commercial |
$494.76
|
| Rate for Payer: Cofinity Commercial |
$460.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.58
|
| Rate for Payer: Healthscope Commercial |
$635.62
|
| Rate for Payer: Healthscope Commercial |
$549.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.05
|
| Rate for Payer: Nomi Health Commercial |
$412.30
|
| Rate for Payer: PACE SWMI |
$343.58
|
| Rate for Payer: PHP Medicare Advantage |
$343.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.05
|
| Rate for Payer: Priority Health Medicare |
$343.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.58
|
| Rate for Payer: UHC Medicare Advantage |
$343.58
|
|
