|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$471.45 |
| Max. Negotiated Rate |
$695.70 |
| Rate for Payer: Aetna Commercial |
$657.05
|
| Rate for Payer: BCBS Trust/PPO |
$597.37
|
| Rate for Payer: BCN Commercial |
$597.37
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$664.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.40
|
| Rate for Payer: Healthscope Commercial |
$695.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.05
|
| Rate for Payer: PHP Commercial |
$657.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$672.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$471.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$680.24
|
| Rate for Payer: UHC Core |
$645.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.75
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$695.70 |
| Rate for Payer: Aetna Commercial |
$657.05
|
| Rate for Payer: Aetna Medicare |
$200.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$241.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$241.56
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$193.25
|
| Rate for Payer: BCBS Trust/PPO |
$601.01
|
| Rate for Payer: BCN Commercial |
$601.01
|
| Rate for Payer: BCN Medicare Advantage |
$193.25
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$664.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.25
|
| Rate for Payer: Healthscope Commercial |
$695.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.75
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.05
|
| Rate for Payer: PACE Senior Care Partners |
$183.59
|
| Rate for Payer: PACE SWMI |
$193.25
|
| Rate for Payer: PHP Commercial |
$657.05
|
| Rate for Payer: PHP Medicare Advantage |
$193.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$672.51
|
| Rate for Payer: Priority Health Medicare |
$193.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$471.45
|
| Rate for Payer: Railroad Medicare Medicare |
$193.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$680.24
|
| Rate for Payer: UHC Core |
$645.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.25
|
| Rate for Payer: UHC Medicare Advantage |
$199.05
|
| Rate for Payer: VA VA |
$193.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.75
|
|
|
PR INJ, RIMABOTULINUMTOXINB
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J0587
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Medicare |
$13.23
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$12.72
|
| Rate for Payer: BCBS Trust/PPO |
$13.27
|
| Rate for Payer: BCN Commercial |
$12.93
|
| Rate for Payer: BCN Medicare Advantage |
$12.72
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.36
|
| Rate for Payer: PACE SWMI |
$12.72
|
| Rate for Payer: PHP Medicare Advantage |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health Medicare |
$12.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.72
|
| Rate for Payer: UHC Medicare Advantage |
$13.10
|
|
|
PR INJ RISPERDAL CONSTA, 0.5 MG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2794
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$17.31 |
| Rate for Payer: Aetna Commercial |
$16.11
|
| Rate for Payer: Aetna Medicare |
$12.50
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$12.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.80
|
| Rate for Payer: BCN Medicare Advantage |
$12.02
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.62
|
| Rate for Payer: PACE SWMI |
$12.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health Medicare |
$12.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.02
|
| Rate for Payer: UHC Medicare Advantage |
$12.38
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J3111
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna Commercial |
$13.89
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$10.92
|
| Rate for Payer: BCN Commercial |
$10.08
|
| Rate for Payer: BCN Medicare Advantage |
$10.37
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$13.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.89
|
| Rate for Payer: PACE SWMI |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.70
|
| Rate for Payer: Priority Health Medicare |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.37
|
| Rate for Payer: UHC Medicare Advantage |
$10.68
|
|
|
PR INJ TESTOSTERONE CYPIONATE
|
Professional
|
Both
|
$0.16
|
|
|
Service Code
|
HCPCS J1071
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS MAPPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.03
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: PACE SWMI |
$0.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.11
|
| Rate for Payer: Priority Health Medicare |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.03
|
| Rate for Payer: UHC Medicare Advantage |
$0.03
|
|
|
PR INSERT CANNULA PROLONG CP INSUFF
|
Professional
|
Both
|
$1,551.00
|
|
|
Service Code
|
HCPCS 36822
|
| Min. Negotiated Rate |
$620.40 |
| Max. Negotiated Rate |
$1,085.70 |
| Rate for Payer: BCBS Complete |
$620.40
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,085.70
|
|
|
PR INSERT GASTROSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 49440
|
| Min. Negotiated Rate |
$126.31 |
| Max. Negotiated Rate |
$1,231.95 |
| Rate for Payer: Aetna Commercial |
$265.09
|
| Rate for Payer: Aetna Medicare |
$205.74
|
| Rate for Payer: BCBS Complete |
$132.63
|
| Rate for Payer: BCBS MAPPO |
$197.83
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$1,231.95
|
| Rate for Payer: BCN Medicare Advantage |
$197.83
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$265.09
|
| Rate for Payer: Cofinity Commercial |
$284.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.83
|
| Rate for Payer: Mclaren Medicaid |
$126.31
|
| Rate for Payer: Meridian Medicaid |
$132.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$207.72
|
| Rate for Payer: PACE SWMI |
$197.83
|
| Rate for Payer: PHP Medicare Advantage |
$197.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$349.85
|
| Rate for Payer: Priority Health Medicare |
$197.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$349.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.83
|
| Rate for Payer: UHC Medicare Advantage |
$203.76
|
|
|
PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 19340
|
| Min. Negotiated Rate |
$487.13 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$998.86
|
| Rate for Payer: Aetna Medicare |
$775.24
|
| Rate for Payer: BCBS Complete |
$511.49
|
| Rate for Payer: BCBS MAPPO |
$745.42
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$1,112.23
|
| Rate for Payer: BCN Medicare Advantage |
$745.42
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$1,073.40
|
| Rate for Payer: Cofinity Commercial |
$998.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.42
|
| Rate for Payer: Mclaren Medicaid |
$487.13
|
| Rate for Payer: Meridian Medicaid |
$511.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$782.69
|
| Rate for Payer: PACE SWMI |
$745.42
|
| Rate for Payer: PHP Medicare Advantage |
$745.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,176.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.52
|
| Rate for Payer: Priority Health Medicare |
$745.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$935.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$745.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.42
|
| Rate for Payer: UHC Medicare Advantage |
$767.78
|
|
|
PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 59200
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$155.89 |
| Rate for Payer: Aetna Commercial |
$59.44
|
| Rate for Payer: Aetna Medicare |
$46.13
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS MAPPO |
$44.36
|
| Rate for Payer: BCBS Trust/PPO |
$90.87
|
| Rate for Payer: BCN Commercial |
$155.89
|
| Rate for Payer: BCN Medicare Advantage |
$44.36
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$59.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.58
|
| Rate for Payer: PACE SWMI |
$44.36
|
| Rate for Payer: PHP Medicare Advantage |
$44.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.33
|
| Rate for Payer: Priority Health Medicare |
$44.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.36
|
| Rate for Payer: UHC Medicare Advantage |
$45.69
|
|
|
PR INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 11981
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$977.96 |
| Rate for Payer: Aetna Commercial |
$83.05
|
| Rate for Payer: Aetna Medicare |
$64.46
|
| Rate for Payer: BCBS Complete |
$41.82
|
| Rate for Payer: BCBS MAPPO |
$61.98
|
| Rate for Payer: BCBS Trust/PPO |
$977.96
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: BCN Medicare Advantage |
$61.98
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cofinity Commercial |
$89.25
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.98
|
| Rate for Payer: Mclaren Medicaid |
$39.83
|
| Rate for Payer: Meridian Medicaid |
$41.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.08
|
| Rate for Payer: PACE SWMI |
$61.98
|
| Rate for Payer: PHP Medicare Advantage |
$61.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.45
|
| Rate for Payer: Priority Health Medicare |
$61.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.98
|
| Rate for Payer: UHC Medicare Advantage |
$63.84
|
|
|
PR INSERTION EPICARDIAL ELECTRODE OPEN
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 33202
|
| Min. Negotiated Rate |
$485.85 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,016.36
|
| Rate for Payer: Aetna Medicare |
$788.82
|
| Rate for Payer: BCBS Complete |
$510.14
|
| Rate for Payer: BCBS MAPPO |
$758.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.69
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$758.48
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cofinity Commercial |
$1,092.21
|
| Rate for Payer: Cofinity Commercial |
$1,016.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$758.48
|
| Rate for Payer: Mclaren Medicaid |
$485.85
|
| Rate for Payer: Meridian Medicaid |
$510.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$796.40
|
| Rate for Payer: PACE SWMI |
$758.48
|
| Rate for Payer: PHP Medicare Advantage |
$758.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,627.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,208.61
|
| Rate for Payer: Priority Health Medicare |
$758.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,208.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$758.48
|
| Rate for Payer: UHC Medicare Advantage |
$781.23
|
|
|
PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
HCPCS 93503
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Aetna Commercial |
$116.16
|
| Rate for Payer: Aetna Medicare |
$90.16
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS MAPPO |
$86.69
|
| Rate for Payer: BCBS Trust/PPO |
$456.45
|
| Rate for Payer: BCN Commercial |
$126.08
|
| Rate for Payer: BCN Medicare Advantage |
$86.69
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Cofinity Commercial |
$124.83
|
| Rate for Payer: Cofinity Commercial |
$116.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.69
|
| Rate for Payer: Mclaren Medicaid |
$54.74
|
| Rate for Payer: Meridian Medicaid |
$57.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.02
|
| Rate for Payer: PACE SWMI |
$86.69
|
| Rate for Payer: PHP Medicare Advantage |
$86.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.00
|
| Rate for Payer: Priority Health Medicare |
$86.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.69
|
| Rate for Payer: UHC Medicare Advantage |
$89.29
|
|
|
PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER
|
Professional
|
Both
|
$1,912.00
|
|
|
Service Code
|
HCPCS 32550
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$1,338.40 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna Medicare |
$208.07
|
| Rate for Payer: BCBS Complete |
$134.19
|
| Rate for Payer: BCBS MAPPO |
$200.07
|
| Rate for Payer: BCBS Trust/PPO |
$421.58
|
| Rate for Payer: BCN Commercial |
$1,161.10
|
| Rate for Payer: BCN Medicare Advantage |
$200.07
|
| Rate for Payer: Cash Price |
$1,529.60
|
| Rate for Payer: Cash Price |
$1,529.60
|
| Rate for Payer: Cofinity Commercial |
$268.09
|
| Rate for Payer: Cofinity Commercial |
$288.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.07
|
| Rate for Payer: Mclaren Medicaid |
$127.80
|
| Rate for Payer: Meridian Medicaid |
$134.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$210.07
|
| Rate for Payer: PACE SWMI |
$200.07
|
| Rate for Payer: PHP Medicare Advantage |
$200.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.82
|
| Rate for Payer: Priority Health Medicare |
$200.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.07
|
| Rate for Payer: UHC Medicare Advantage |
$206.07
|
|
|
PR INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 33967
|
| Min. Negotiated Rate |
$161.24 |
| Max. Negotiated Rate |
$815.17 |
| Rate for Payer: Aetna Commercial |
$338.99
|
| Rate for Payer: Aetna Medicare |
$263.10
|
| Rate for Payer: BCBS Complete |
$169.30
|
| Rate for Payer: BCBS MAPPO |
$252.98
|
| Rate for Payer: BCBS Trust/PPO |
$815.17
|
| Rate for Payer: BCN Commercial |
$367.97
|
| Rate for Payer: BCN Medicare Advantage |
$252.98
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$338.99
|
| Rate for Payer: Cofinity Commercial |
$364.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.98
|
| Rate for Payer: Mclaren Medicaid |
$161.24
|
| Rate for Payer: Meridian Medicaid |
$169.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$265.63
|
| Rate for Payer: PACE SWMI |
$252.98
|
| Rate for Payer: PHP Medicare Advantage |
$252.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.56
|
| Rate for Payer: Priority Health Medicare |
$252.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$400.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.98
|
| Rate for Payer: UHC Medicare Advantage |
$260.57
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$246.50
|
| Rate for Payer: Aetna Medicare |
$75.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.62
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$72.50
|
| Rate for Payer: BCBS Trust/PPO |
$225.48
|
| Rate for Payer: BCN Commercial |
$225.48
|
| Rate for Payer: BCN Medicare Advantage |
$72.50
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$249.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.50
|
| Rate for Payer: Healthscope Commercial |
$261.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: PACE Senior Care Partners |
$68.88
|
| Rate for Payer: PACE SWMI |
$72.50
|
| Rate for Payer: PHP Commercial |
$246.50
|
| Rate for Payer: PHP Medicare Advantage |
$72.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.30
|
| Rate for Payer: Priority Health Medicare |
$72.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.87
|
| Rate for Payer: Railroad Medicare Medicare |
$72.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.20
|
| Rate for Payer: UHC Core |
$242.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.50
|
| Rate for Payer: UHC Medicare Advantage |
$74.68
|
| Rate for Payer: VA VA |
$72.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.50
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
58300
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$417.36 |
| Rate for Payer: Aetna Commercial |
$60.86
|
| Rate for Payer: BCBS Complete |
$33.55
|
| Rate for Payer: BCBS Trust/PPO |
$417.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Mclaren Medicaid |
$31.95
|
| Rate for Payer: Meridian Medicaid |
$33.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.01
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$176.87 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$246.50
|
| Rate for Payer: BCBS Trust/PPO |
$224.11
|
| Rate for Payer: BCN Commercial |
$224.11
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$249.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.00
|
| Rate for Payer: Healthscope Commercial |
$261.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: PHP Commercial |
$246.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.20
|
| Rate for Payer: UHC Core |
$242.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.50
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 58300
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$417.36 |
| Rate for Payer: Aetna Commercial |
$60.86
|
| Rate for Payer: BCBS Complete |
$33.55
|
| Rate for Payer: BCBS Trust/PPO |
$417.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Mclaren Medicaid |
$31.95
|
| Rate for Payer: Meridian Medicaid |
$33.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.01
|
|
|
PR INSERTION PICC W/O IMG GDN < 5 YR
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 36568
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$967.32 |
| Rate for Payer: Aetna Commercial |
$122.50
|
| Rate for Payer: Aetna Medicare |
$95.08
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS MAPPO |
$91.42
|
| Rate for Payer: BCBS Trust/PPO |
$967.32
|
| Rate for Payer: BCN Commercial |
$132.43
|
| Rate for Payer: BCN Medicare Advantage |
$91.42
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$131.64
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.42
|
| Rate for Payer: Mclaren Medicaid |
$57.51
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.99
|
| Rate for Payer: PACE SWMI |
$91.42
|
| Rate for Payer: PHP Medicare Advantage |
$91.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.15
|
| Rate for Payer: Priority Health Medicare |
$91.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.42
|
| Rate for Payer: UHC Medicare Advantage |
$94.16
|
|
|
PR INSERTION PICC W/O IMG GDN 5 YR/>
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 36569
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$563.70 |
| Rate for Payer: Aetna Commercial |
$123.39
|
| Rate for Payer: Aetna Medicare |
$95.76
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$92.08
|
| Rate for Payer: BCBS Trust/PPO |
$563.70
|
| Rate for Payer: BCN Commercial |
$134.38
|
| Rate for Payer: BCN Medicare Advantage |
$92.08
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$132.60
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.08
|
| Rate for Payer: Mclaren Medicaid |
$59.43
|
| Rate for Payer: Meridian Medicaid |
$62.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.68
|
| Rate for Payer: PACE SWMI |
$92.08
|
| Rate for Payer: PHP Medicare Advantage |
$92.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.29
|
| Rate for Payer: Priority Health Medicare |
$92.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.08
|
| Rate for Payer: UHC Medicare Advantage |
$94.84
|
|
|
PR INSERTION PICC W/RS&I < 5 YR
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 36572
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,072.45 |
| Rate for Payer: Aetna Commercial |
$107.45
|
| Rate for Payer: Aetna Medicare |
$83.40
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$80.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.45
|
| Rate for Payer: BCN Commercial |
$552.21
|
| Rate for Payer: BCN Medicare Advantage |
$80.19
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cofinity Commercial |
$107.45
|
| Rate for Payer: Cofinity Commercial |
$115.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.19
|
| Rate for Payer: Mclaren Medicaid |
$50.69
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.20
|
| Rate for Payer: PACE SWMI |
$80.19
|
| Rate for Payer: PHP Medicare Advantage |
$80.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.60
|
| Rate for Payer: Priority Health Medicare |
$80.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.19
|
| Rate for Payer: UHC Medicare Advantage |
$82.60
|
|
|
PR INSERTION PICC W/RS&I 5 YR/>
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 36573
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$921.36 |
| Rate for Payer: Aetna Commercial |
$110.40
|
| Rate for Payer: Aetna Medicare |
$85.69
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS MAPPO |
$82.39
|
| Rate for Payer: BCBS Trust/PPO |
$921.36
|
| Rate for Payer: BCN Commercial |
$565.89
|
| Rate for Payer: BCN Medicare Advantage |
$82.39
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cofinity Commercial |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$118.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.39
|
| Rate for Payer: Mclaren Medicaid |
$51.97
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.51
|
| Rate for Payer: PACE SWMI |
$82.39
|
| Rate for Payer: PHP Medicare Advantage |
$82.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.39
|
| Rate for Payer: Priority Health Medicare |
$82.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.39
|
| Rate for Payer: UHC Medicare Advantage |
$84.86
|
|
|
PR INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 64590
|
| Min. Negotiated Rate |
$157.22 |
| Max. Negotiated Rate |
$1,604.98 |
| Rate for Payer: Aetna Commercial |
$210.67
|
| Rate for Payer: Aetna Medicare |
$163.51
|
| Rate for Payer: BCBS Complete |
$197.48
|
| Rate for Payer: BCBS MAPPO |
$157.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.98
|
| Rate for Payer: BCN Commercial |
$384.59
|
| Rate for Payer: BCN Medicare Advantage |
$157.22
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$210.67
|
| Rate for Payer: Cofinity Commercial |
$226.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.22
|
| Rate for Payer: Mclaren Medicaid |
$188.08
|
| Rate for Payer: Meridian Medicaid |
$197.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.08
|
| Rate for Payer: PACE SWMI |
$157.22
|
| Rate for Payer: PHP Medicare Advantage |
$157.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.22
|
| Rate for Payer: Priority Health Medicare |
$157.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.22
|
| Rate for Payer: UHC Medicare Advantage |
$161.94
|
|
|
PR INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 33285
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$6,374.79 |
| Rate for Payer: Aetna Commercial |
$115.95
|
| Rate for Payer: Aetna Medicare |
$89.99
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS MAPPO |
$86.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,495.09
|
| Rate for Payer: BCN Commercial |
$6,374.79
|
| Rate for Payer: BCN Medicare Advantage |
$86.53
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cofinity Commercial |
$124.60
|
| Rate for Payer: Cofinity Commercial |
$115.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.53
|
| Rate for Payer: Mclaren Medicaid |
$54.74
|
| Rate for Payer: Meridian Medicaid |
$57.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.86
|
| Rate for Payer: PACE SWMI |
$86.53
|
| Rate for Payer: PHP Medicare Advantage |
$86.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.78
|
| Rate for Payer: Priority Health Medicare |
$86.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.53
|
| Rate for Payer: UHC Medicare Advantage |
$89.13
|
|
