|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Facility
|
IP
|
$2,781.00
|
|
|
Service Code
|
CPT 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$1,807.65 |
| Max. Negotiated Rate |
$2,502.90 |
| Rate for Payer: Aetna Commercial |
$2,363.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,270.13
|
| Rate for Payer: BCN Commercial |
$2,149.16
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cofinity Commercial |
$2,391.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.80
|
| Rate for Payer: Healthscope Commercial |
$2,502.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,085.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.85
|
| Rate for Payer: Nomi Health Commercial |
$2,280.42
|
| Rate for Payer: PHP Commercial |
$2,363.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.65
|
| Rate for Payer: Priority Health HMO/PPO |
$2,419.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,863.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,447.28
|
| Rate for Payer: UHC Core |
$2,322.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,085.75
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-CERVICAL
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 58321
|
| Min. Negotiated Rate |
$46.44 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: Aetna Medicare |
$48.30
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS MAPPO |
$46.44
|
| Rate for Payer: BCN Medicare Advantage |
$46.44
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$66.87
|
| Rate for Payer: Cofinity Commercial |
$62.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.76
|
| Rate for Payer: Nomi Health Commercial |
$55.73
|
| Rate for Payer: PACE SWMI |
$46.44
|
| Rate for Payer: PHP Medicare Advantage |
$46.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
| Rate for Payer: Priority Health Medicare |
$46.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.44
|
| Rate for Payer: UHC Exchange |
$46.44
|
| Rate for Payer: UHC Medicare Advantage |
$46.44
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-UTERINE
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 58322
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$159.25 |
| Rate for Payer: Aetna Commercial |
$73.81
|
| Rate for Payer: Aetna Medicare |
$57.28
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: BCBS MAPPO |
$55.08
|
| Rate for Payer: BCN Medicare Advantage |
$55.08
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$79.32
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.83
|
| Rate for Payer: Nomi Health Commercial |
$66.10
|
| Rate for Payer: PACE SWMI |
$55.08
|
| Rate for Payer: PHP Medicare Advantage |
$55.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health Medicare |
$55.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.08
|
| Rate for Payer: UHC Exchange |
$55.08
|
| Rate for Payer: UHC Medicare Advantage |
$55.08
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 36625
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$133.96
|
| Rate for Payer: Aetna Medicare |
$103.97
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$99.97
|
| Rate for Payer: BCN Medicare Advantage |
$99.97
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$143.96
|
| Rate for Payer: Cofinity Commercial |
$133.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.97
|
| Rate for Payer: Nomi Health Commercial |
$119.96
|
| Rate for Payer: PACE SWMI |
$99.97
|
| Rate for Payer: PHP Medicare Advantage |
$99.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Medicare |
$100.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.97
|
| Rate for Payer: UHC Exchange |
$99.97
|
| Rate for Payer: UHC Medicare Advantage |
$99.97
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 36620
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Commercial |
$55.70
|
| Rate for Payer: Aetna Medicare |
$43.23
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$41.57
|
| Rate for Payer: BCN Medicare Advantage |
$41.57
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$59.86
|
| Rate for Payer: Cofinity Commercial |
$55.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.65
|
| Rate for Payer: Nomi Health Commercial |
$49.88
|
| Rate for Payer: PACE SWMI |
$41.57
|
| Rate for Payer: PHP Medicare Advantage |
$41.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$41.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.57
|
| Rate for Payer: UHC Exchange |
$41.57
|
| Rate for Payer: UHC Medicare Advantage |
$41.57
|
|
|
PR ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 36640
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Aetna Commercial |
$147.72
|
| Rate for Payer: Aetna Medicare |
$114.65
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS MAPPO |
$110.24
|
| Rate for Payer: BCN Medicare Advantage |
$110.24
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$147.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.75
|
| Rate for Payer: Nomi Health Commercial |
$132.29
|
| Rate for Payer: PACE SWMI |
$110.24
|
| Rate for Payer: PHP Medicare Advantage |
$110.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.70
|
| Rate for Payer: Priority Health Medicare |
$111.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.24
|
| Rate for Payer: UHC Exchange |
$110.24
|
| Rate for Payer: UHC Medicare Advantage |
$110.24
|
|
|
PR ARVEN ANAST OPN F/ARM VEIN TRPOS
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 36820
|
| Min. Negotiated Rate |
$609.60 |
| Max. Negotiated Rate |
$1,004.28 |
| Rate for Payer: Aetna Commercial |
$934.54
|
| Rate for Payer: Aetna Medicare |
$725.32
|
| Rate for Payer: BCBS Complete |
$609.60
|
| Rate for Payer: BCBS MAPPO |
$697.42
|
| Rate for Payer: BCN Medicare Advantage |
$697.42
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cofinity Commercial |
$934.54
|
| Rate for Payer: Cofinity Commercial |
$1,004.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.29
|
| Rate for Payer: Nomi Health Commercial |
$836.90
|
| Rate for Payer: PACE SWMI |
$697.42
|
| Rate for Payer: PHP Medicare Advantage |
$697.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health Medicare |
$704.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.42
|
| Rate for Payer: UHC Exchange |
$697.42
|
| Rate for Payer: UHC Medicare Advantage |
$697.42
|
|
|
PR ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS
|
Professional
|
Both
|
$2,435.00
|
|
|
Service Code
|
HCPCS 36819
|
| Min. Negotiated Rate |
$697.29 |
| Max. Negotiated Rate |
$1,582.75 |
| Rate for Payer: Aetna Commercial |
$934.37
|
| Rate for Payer: Aetna Medicare |
$725.18
|
| Rate for Payer: BCBS Complete |
$974.00
|
| Rate for Payer: BCBS MAPPO |
$697.29
|
| Rate for Payer: BCN Medicare Advantage |
$697.29
|
| Rate for Payer: Cash Price |
$1,948.00
|
| Rate for Payer: Cash Price |
$1,948.00
|
| Rate for Payer: Cofinity Commercial |
$934.37
|
| Rate for Payer: Cofinity Commercial |
$1,004.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.15
|
| Rate for Payer: Nomi Health Commercial |
$836.75
|
| Rate for Payer: PACE SWMI |
$697.29
|
| Rate for Payer: PHP Medicare Advantage |
$697.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,582.75
|
| Rate for Payer: Priority Health Medicare |
$704.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.29
|
| Rate for Payer: UHC Exchange |
$697.29
|
| Rate for Payer: UHC Medicare Advantage |
$697.29
|
|
|
PR ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS
|
Professional
|
Both
|
$2,009.00
|
|
|
Service Code
|
HCPCS 36818
|
| Min. Negotiated Rate |
$658.49 |
| Max. Negotiated Rate |
$1,305.85 |
| Rate for Payer: Aetna Commercial |
$882.38
|
| Rate for Payer: Aetna Medicare |
$684.83
|
| Rate for Payer: BCBS Complete |
$803.60
|
| Rate for Payer: BCBS MAPPO |
$658.49
|
| Rate for Payer: BCN Medicare Advantage |
$658.49
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cofinity Commercial |
$948.23
|
| Rate for Payer: Cofinity Commercial |
$882.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.41
|
| Rate for Payer: Nomi Health Commercial |
$790.19
|
| Rate for Payer: PACE SWMI |
$658.49
|
| Rate for Payer: PHP Medicare Advantage |
$658.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.85
|
| Rate for Payer: Priority Health Medicare |
$665.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.49
|
| Rate for Payer: UHC Exchange |
$658.49
|
| Rate for Payer: UHC Medicare Advantage |
$658.49
|
|
|
PR ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART
|
Professional
|
Both
|
$8,427.00
|
|
|
Service Code
|
HCPCS 61705
|
| Min. Negotiated Rate |
$2,581.80 |
| Max. Negotiated Rate |
$5,477.55 |
| Rate for Payer: Aetna Commercial |
$3,459.61
|
| Rate for Payer: Aetna Medicare |
$2,685.07
|
| Rate for Payer: BCBS Complete |
$3,370.80
|
| Rate for Payer: BCBS MAPPO |
$2,581.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,581.80
|
| Rate for Payer: Cash Price |
$6,741.60
|
| Rate for Payer: Cash Price |
$6,741.60
|
| Rate for Payer: Cofinity Commercial |
$3,717.79
|
| Rate for Payer: Cofinity Commercial |
$3,459.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,581.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,710.89
|
| Rate for Payer: Nomi Health Commercial |
$3,098.16
|
| Rate for Payer: PACE SWMI |
$2,581.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,581.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,477.55
|
| Rate for Payer: Priority Health Medicare |
$2,607.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,581.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,581.80
|
| Rate for Payer: UHC Exchange |
$2,581.80
|
| Rate for Payer: UHC Medicare Advantage |
$2,581.80
|
|
|
PR ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
HCPCS 31400
|
| Min. Negotiated Rate |
$834.80 |
| Max. Negotiated Rate |
$1,367.90 |
| Rate for Payer: Aetna Commercial |
$1,272.91
|
| Rate for Payer: Aetna Medicare |
$987.93
|
| Rate for Payer: BCBS Complete |
$834.80
|
| Rate for Payer: BCBS MAPPO |
$949.93
|
| Rate for Payer: BCN Medicare Advantage |
$949.93
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cofinity Commercial |
$1,367.90
|
| Rate for Payer: Cofinity Commercial |
$1,272.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$949.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$997.43
|
| Rate for Payer: Nomi Health Commercial |
$1,139.92
|
| Rate for Payer: PACE SWMI |
$949.93
|
| Rate for Payer: PHP Medicare Advantage |
$949.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.55
|
| Rate for Payer: Priority Health Medicare |
$959.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$949.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$949.93
|
| Rate for Payer: UHC Exchange |
$949.93
|
| Rate for Payer: UHC Medicare Advantage |
$949.93
|
|
|
PR AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT
|
Professional
|
Both
|
$6,622.00
|
|
|
Service Code
|
HCPCS 33863
|
| Min. Negotiated Rate |
$2,648.80 |
| Max. Negotiated Rate |
$4,337.29 |
| Rate for Payer: Aetna Commercial |
$4,036.09
|
| Rate for Payer: Aetna Medicare |
$3,132.49
|
| Rate for Payer: BCBS Complete |
$2,648.80
|
| Rate for Payer: BCBS MAPPO |
$3,012.01
|
| Rate for Payer: BCN Medicare Advantage |
$3,012.01
|
| Rate for Payer: Cash Price |
$5,297.60
|
| Rate for Payer: Cash Price |
$5,297.60
|
| Rate for Payer: Cofinity Commercial |
$4,337.29
|
| Rate for Payer: Cofinity Commercial |
$4,036.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,012.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,162.61
|
| Rate for Payer: Nomi Health Commercial |
$3,614.41
|
| Rate for Payer: PACE SWMI |
$3,012.01
|
| Rate for Payer: PHP Medicare Advantage |
$3,012.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,304.30
|
| Rate for Payer: Priority Health Medicare |
$3,042.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,012.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,012.01
|
| Rate for Payer: UHC Exchange |
$3,012.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,012.01
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DISSECTION
|
Professional
|
Both
|
$7,125.00
|
|
|
Service Code
|
HCPCS 33858
|
| Min. Negotiated Rate |
$2,850.00 |
| Max. Negotiated Rate |
$4,681.41 |
| Rate for Payer: Aetna Commercial |
$4,356.31
|
| Rate for Payer: Aetna Medicare |
$3,381.02
|
| Rate for Payer: BCBS Complete |
$2,850.00
|
| Rate for Payer: BCBS MAPPO |
$3,250.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,250.98
|
| Rate for Payer: Cash Price |
$5,700.00
|
| Rate for Payer: Cash Price |
$5,700.00
|
| Rate for Payer: Cofinity Commercial |
$4,681.41
|
| Rate for Payer: Cofinity Commercial |
$4,356.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,250.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,413.53
|
| Rate for Payer: Nomi Health Commercial |
$3,901.18
|
| Rate for Payer: PACE SWMI |
$3,250.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,250.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.25
|
| Rate for Payer: Priority Health Medicare |
$3,283.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,250.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,250.98
|
| Rate for Payer: UHC Exchange |
$3,250.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,250.98
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/THN DSJ
|
Professional
|
Both
|
$5,111.00
|
|
|
Service Code
|
HCPCS 33859
|
| Min. Negotiated Rate |
$2,044.40 |
| Max. Negotiated Rate |
$3,362.27 |
| Rate for Payer: Aetna Commercial |
$3,128.78
|
| Rate for Payer: Aetna Medicare |
$2,428.31
|
| Rate for Payer: BCBS Complete |
$2,044.40
|
| Rate for Payer: BCBS MAPPO |
$2,334.91
|
| Rate for Payer: BCN Medicare Advantage |
$2,334.91
|
| Rate for Payer: Cash Price |
$4,088.80
|
| Rate for Payer: Cash Price |
$4,088.80
|
| Rate for Payer: Cofinity Commercial |
$3,362.27
|
| Rate for Payer: Cofinity Commercial |
$3,128.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,334.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,451.66
|
| Rate for Payer: Nomi Health Commercial |
$2,801.89
|
| Rate for Payer: PACE SWMI |
$2,334.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,334.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,322.15
|
| Rate for Payer: Priority Health Medicare |
$2,358.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,334.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,334.91
|
| Rate for Payer: UHC Exchange |
$2,334.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,334.91
|
|
|
PR ASCEND AORTA GRAFT INCL VAVLE SUSPENSION
|
Professional
|
Both
|
$10,055.00
|
|
|
Service Code
|
HCPCS 33860
|
| Min. Negotiated Rate |
$4,022.00 |
| Max. Negotiated Rate |
$6,535.75 |
| Rate for Payer: Aetna Medicare |
$5,027.50
|
| Rate for Payer: BCBS Complete |
$4,022.00
|
| Rate for Payer: Cash Price |
$8,044.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,535.75
|
|
|
PR ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL
|
Professional
|
Both
|
$5,228.00
|
|
|
Service Code
|
HCPCS 33864
|
| Min. Negotiated Rate |
$2,091.20 |
| Max. Negotiated Rate |
$4,434.38 |
| Rate for Payer: Aetna Commercial |
$4,126.44
|
| Rate for Payer: Aetna Medicare |
$3,202.61
|
| Rate for Payer: BCBS Complete |
$2,091.20
|
| Rate for Payer: BCBS MAPPO |
$3,079.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,079.43
|
| Rate for Payer: Cash Price |
$4,182.40
|
| Rate for Payer: Cash Price |
$4,182.40
|
| Rate for Payer: Cofinity Commercial |
$4,434.38
|
| Rate for Payer: Cofinity Commercial |
$4,126.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,079.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,233.40
|
| Rate for Payer: Nomi Health Commercial |
$3,695.32
|
| Rate for Payer: PACE SWMI |
$3,079.43
|
| Rate for Payer: PHP Medicare Advantage |
$3,079.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,398.20
|
| Rate for Payer: Priority Health Medicare |
$3,110.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,079.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,079.43
|
| Rate for Payer: UHC Exchange |
$3,079.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,079.43
|
|
|
PR ASPIRATION AND/OR INJECTION THYROID CYST
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 60300
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$61.73
|
| Rate for Payer: Aetna Medicare |
$47.91
|
| Rate for Payer: BCBS Complete |
$64.80
|
| Rate for Payer: BCBS MAPPO |
$46.07
|
| Rate for Payer: BCN Medicare Advantage |
$46.07
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Cofinity Commercial |
$66.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.37
|
| Rate for Payer: Nomi Health Commercial |
$55.28
|
| Rate for Payer: PACE SWMI |
$46.07
|
| Rate for Payer: PHP Medicare Advantage |
$46.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health Medicare |
$46.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.07
|
| Rate for Payer: UHC Exchange |
$46.07
|
| Rate for Payer: UHC Medicare Advantage |
$46.07
|
|
|
PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 51102
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: Aetna Commercial |
$179.95
|
| Rate for Payer: Aetna Medicare |
$139.66
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$134.29
|
| Rate for Payer: BCN Medicare Advantage |
$134.29
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$193.38
|
| Rate for Payer: Cofinity Commercial |
$179.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.00
|
| Rate for Payer: Nomi Health Commercial |
$161.15
|
| Rate for Payer: PACE SWMI |
$134.29
|
| Rate for Payer: PHP Medicare Advantage |
$134.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$135.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.29
|
| Rate for Payer: UHC Exchange |
$134.29
|
| Rate for Payer: UHC Medicare Advantage |
$134.29
|
|
|
PR ASPIRATION BLADDER NEEDLE
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 51100
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS MAPPO |
$37.28
|
| Rate for Payer: BCN Medicare Advantage |
$37.28
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$49.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.14
|
| Rate for Payer: Nomi Health Commercial |
$44.74
|
| Rate for Payer: PACE SWMI |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health Medicare |
$37.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.28
|
| Rate for Payer: UHC Exchange |
$37.28
|
| Rate for Payer: UHC Medicare Advantage |
$37.28
|
|
|
PR ASPIRATION BLADDER TROCAR/INTRACATHETER
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 51101
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna Commercial |
$65.43
|
| Rate for Payer: Aetna Medicare |
$50.78
|
| Rate for Payer: BCBS Complete |
$154.80
|
| Rate for Payer: BCBS MAPPO |
$48.83
|
| Rate for Payer: BCN Medicare Advantage |
$48.83
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cofinity Commercial |
$70.32
|
| Rate for Payer: Cofinity Commercial |
$65.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.27
|
| Rate for Payer: Nomi Health Commercial |
$58.60
|
| Rate for Payer: PACE SWMI |
$48.83
|
| Rate for Payer: PHP Medicare Advantage |
$48.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.55
|
| Rate for Payer: Priority Health Medicare |
$49.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.83
|
| Rate for Payer: UHC Exchange |
$48.83
|
| Rate for Payer: UHC Medicare Advantage |
$48.83
|
|
|
PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 20612
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna Commercial |
$52.80
|
| Rate for Payer: Aetna Medicare |
$40.98
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS MAPPO |
$39.40
|
| Rate for Payer: BCN Medicare Advantage |
$39.40
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$56.74
|
| Rate for Payer: Cofinity Commercial |
$52.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.37
|
| Rate for Payer: Nomi Health Commercial |
$47.28
|
| Rate for Payer: PACE SWMI |
$39.40
|
| Rate for Payer: PHP Medicare Advantage |
$39.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health Medicare |
$39.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.40
|
| Rate for Payer: UHC Exchange |
$39.40
|
| Rate for Payer: UHC Medicare Advantage |
$39.40
|
|
|
PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 96105
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$121.94
|
| Rate for Payer: Aetna Medicare |
$94.64
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$91.00
|
| Rate for Payer: BCN Medicare Advantage |
$91.00
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$121.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.55
|
| Rate for Payer: Nomi Health Commercial |
$109.20
|
| Rate for Payer: PACE SWMI |
$91.00
|
| Rate for Payer: PHP Medicare Advantage |
$91.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health Medicare |
$91.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.00
|
| Rate for Payer: UHC Exchange |
$91.00
|
| Rate for Payer: UHC Medicare Advantage |
$91.00
|
|
|
PR ASSESSMENT FOR HEARING AID
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS V5010
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
|
|
PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 99483
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$263.20 |
| Rate for Payer: Aetna Commercial |
$244.93
|
| Rate for Payer: Aetna Medicare |
$190.09
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$182.78
|
| Rate for Payer: BCN Medicare Advantage |
$182.78
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$244.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.92
|
| Rate for Payer: Nomi Health Commercial |
$219.34
|
| Rate for Payer: PACE SWMI |
$182.78
|
| Rate for Payer: PHP Medicare Advantage |
$182.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$184.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.78
|
| Rate for Payer: UHC Exchange |
$182.78
|
| Rate for Payer: UHC Medicare Advantage |
$182.78
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$109.73
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.32 |
| Max. Negotiated Rate |
$98.76 |
| Rate for Payer: Aetna Commercial |
$93.27
|
| Rate for Payer: BCBS Trust/PPO |
$89.57
|
| Rate for Payer: BCN Commercial |
$84.80
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.27
|
| Rate for Payer: Nomi Health Commercial |
$89.98
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: Priority Health HMO/PPO |
$95.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.56
|
| Rate for Payer: UHC Core |
$91.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.30
|
|
