|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 58300
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Aetna Commercial |
$251.60
|
| Rate for Payer: BCBS Trust/PPO |
$241.62
|
| Rate for Payer: BCN Commercial |
$228.75
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$254.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.80
|
| Rate for Payer: Healthscope Commercial |
$266.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.60
|
| Rate for Payer: Nomi Health Commercial |
$242.72
|
| Rate for Payer: PHP Commercial |
$251.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health HMO/PPO |
$257.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.48
|
| Rate for Payer: UHC Core |
$247.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.00
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
58300
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Aetna Commercial |
$251.60
|
| Rate for Payer: Aetna Medicare |
$76.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.50
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: BCBS MAPPO |
$74.00
|
| Rate for Payer: BCBS Trust/PPO |
$243.34
|
| Rate for Payer: BCN Commercial |
$230.14
|
| Rate for Payer: BCN Medicare Advantage |
$74.00
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$254.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.00
|
| Rate for Payer: Healthscope Commercial |
$266.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.60
|
| Rate for Payer: Nomi Health Commercial |
$242.72
|
| Rate for Payer: PACE Senior Care Partners |
$70.30
|
| Rate for Payer: PACE SWMI |
$74.00
|
| Rate for Payer: PHP Commercial |
$251.60
|
| Rate for Payer: PHP Medicare Advantage |
$74.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health HMO/PPO |
$257.52
|
| Rate for Payer: Priority Health Medicare |
$74.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.32
|
| Rate for Payer: Railroad Medicare Medicare |
$74.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.48
|
| Rate for Payer: UHC Core |
$247.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.00
|
| Rate for Payer: UHC Exchange |
$74.00
|
| Rate for Payer: UHC Medicare Advantage |
$74.00
|
| Rate for Payer: VA VA |
$74.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.00
|
|
|
PR INSERTION PICC W/O IMG GDN < 5 YR
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 36568
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$119.17
|
| Rate for Payer: Aetna Medicare |
$92.49
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS MAPPO |
$88.93
|
| Rate for Payer: BCN Medicare Advantage |
$88.93
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cofinity Commercial |
$128.06
|
| Rate for Payer: Cofinity Commercial |
$119.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.38
|
| Rate for Payer: Nomi Health Commercial |
$106.72
|
| Rate for Payer: PACE SWMI |
$88.93
|
| Rate for Payer: PHP Medicare Advantage |
$88.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
| Rate for Payer: Priority Health Medicare |
$89.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.93
|
| Rate for Payer: UHC Exchange |
$88.93
|
| Rate for Payer: UHC Medicare Advantage |
$88.93
|
|
|
PR INSERTION PICC W/O IMG GDN 5 YR/>
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 36569
|
| Min. Negotiated Rate |
$90.73 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna Medicare |
$94.36
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: BCBS MAPPO |
$90.73
|
| Rate for Payer: BCN Medicare Advantage |
$90.73
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$121.58
|
| Rate for Payer: Cofinity Commercial |
$130.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.27
|
| Rate for Payer: Nomi Health Commercial |
$108.88
|
| Rate for Payer: PACE SWMI |
$90.73
|
| Rate for Payer: PHP Medicare Advantage |
$90.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health Medicare |
$91.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.73
|
| Rate for Payer: UHC Exchange |
$90.73
|
| Rate for Payer: UHC Medicare Advantage |
$90.73
|
|
|
PR INSERTION PICC W/RS&I < 5 YR
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 36572
|
| Min. Negotiated Rate |
$77.83 |
| Max. Negotiated Rate |
$548.60 |
| Rate for Payer: Aetna Commercial |
$104.29
|
| Rate for Payer: Aetna Medicare |
$80.94
|
| Rate for Payer: BCBS Complete |
$337.60
|
| Rate for Payer: BCBS MAPPO |
$77.83
|
| Rate for Payer: BCN Medicare Advantage |
$77.83
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cofinity Commercial |
$112.08
|
| Rate for Payer: Cofinity Commercial |
$104.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.72
|
| Rate for Payer: Nomi Health Commercial |
$93.40
|
| Rate for Payer: PACE SWMI |
$77.83
|
| Rate for Payer: PHP Medicare Advantage |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.60
|
| Rate for Payer: Priority Health Medicare |
$78.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.83
|
| Rate for Payer: UHC Exchange |
$77.83
|
| Rate for Payer: UHC Medicare Advantage |
$77.83
|
|
|
PR INSERTION PICC W/RS&I 5 YR/>
|
Professional
|
Both
|
$776.00
|
|
|
Service Code
|
HCPCS 36573
|
| Min. Negotiated Rate |
$78.83 |
| Max. Negotiated Rate |
$504.40 |
| Rate for Payer: Aetna Commercial |
$105.63
|
| Rate for Payer: Aetna Medicare |
$81.98
|
| Rate for Payer: BCBS Complete |
$310.40
|
| Rate for Payer: BCBS MAPPO |
$78.83
|
| Rate for Payer: BCN Medicare Advantage |
$78.83
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Cofinity Commercial |
$105.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.77
|
| Rate for Payer: Nomi Health Commercial |
$94.60
|
| Rate for Payer: PACE SWMI |
$78.83
|
| Rate for Payer: PHP Medicare Advantage |
$78.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.40
|
| Rate for Payer: Priority Health Medicare |
$79.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.83
|
| Rate for Payer: UHC Exchange |
$78.83
|
| Rate for Payer: UHC Medicare Advantage |
$78.83
|
|
|
PR INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 33285
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$174.20 |
| Rate for Payer: Aetna Commercial |
$111.76
|
| Rate for Payer: Aetna Medicare |
$86.74
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS MAPPO |
$83.40
|
| Rate for Payer: BCN Medicare Advantage |
$83.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$120.10
|
| Rate for Payer: Cofinity Commercial |
$111.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.57
|
| Rate for Payer: Nomi Health Commercial |
$100.08
|
| Rate for Payer: PACE SWMI |
$83.40
|
| Rate for Payer: PHP Medicare Advantage |
$83.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.20
|
| Rate for Payer: Priority Health Medicare |
$84.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.40
|
| Rate for Payer: UHC Exchange |
$83.40
|
| Rate for Payer: UHC Medicare Advantage |
$83.40
|
|
|
PR INSERTION TANDEM CUFF
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 53444
|
| Min. Negotiated Rate |
$606.80 |
| Max. Negotiated Rate |
$1,092.28 |
| Rate for Payer: Aetna Commercial |
$1,016.43
|
| Rate for Payer: Aetna Medicare |
$788.87
|
| Rate for Payer: BCBS Complete |
$606.80
|
| Rate for Payer: BCBS MAPPO |
$758.53
|
| Rate for Payer: BCN Medicare Advantage |
$758.53
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cofinity Commercial |
$1,092.28
|
| Rate for Payer: Cofinity Commercial |
$1,016.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$758.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$796.46
|
| Rate for Payer: Nomi Health Commercial |
$910.24
|
| Rate for Payer: PACE SWMI |
$758.53
|
| Rate for Payer: PHP Medicare Advantage |
$758.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.05
|
| Rate for Payer: Priority Health Medicare |
$766.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$758.53
|
| Rate for Payer: UHC Exchange |
$758.53
|
| Rate for Payer: UHC Medicare Advantage |
$758.53
|
|
|
PR INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 49421
|
| Min. Negotiated Rate |
$219.80 |
| Max. Negotiated Rate |
$850.20 |
| Rate for Payer: Aetna Commercial |
$294.53
|
| Rate for Payer: Aetna Medicare |
$228.59
|
| Rate for Payer: BCBS Complete |
$523.20
|
| Rate for Payer: BCBS MAPPO |
$219.80
|
| Rate for Payer: BCN Medicare Advantage |
$219.80
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cofinity Commercial |
$316.51
|
| Rate for Payer: Cofinity Commercial |
$294.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.79
|
| Rate for Payer: Nomi Health Commercial |
$263.76
|
| Rate for Payer: PACE SWMI |
$219.80
|
| Rate for Payer: PHP Medicare Advantage |
$219.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.20
|
| Rate for Payer: Priority Health Medicare |
$222.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.80
|
| Rate for Payer: UHC Exchange |
$219.80
|
| Rate for Payer: UHC Medicare Advantage |
$219.80
|
|
|
PR INSERTION VAGINAL RADIATION DEVICE
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 57156
|
| Min. Negotiated Rate |
$144.78 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: Aetna Commercial |
$194.01
|
| Rate for Payer: Aetna Medicare |
$150.57
|
| Rate for Payer: BCBS Complete |
$156.40
|
| Rate for Payer: BCBS MAPPO |
$144.78
|
| Rate for Payer: BCN Medicare Advantage |
$144.78
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Cofinity Commercial |
$208.48
|
| Rate for Payer: Cofinity Commercial |
$194.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.02
|
| Rate for Payer: Nomi Health Commercial |
$173.74
|
| Rate for Payer: PACE SWMI |
$144.78
|
| Rate for Payer: PHP Medicare Advantage |
$144.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.15
|
| Rate for Payer: Priority Health Medicare |
$146.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.78
|
| Rate for Payer: UHC Exchange |
$144.78
|
| Rate for Payer: UHC Medicare Advantage |
$144.78
|
|
|
PR INSERTION VASCULAR PEDICLE CARPAL BONE
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 25430
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$1,020.44 |
| Rate for Payer: Aetna Commercial |
$949.58
|
| Rate for Payer: Aetna Medicare |
$736.99
|
| Rate for Payer: BCBS Complete |
$494.00
|
| Rate for Payer: BCBS MAPPO |
$708.64
|
| Rate for Payer: BCN Medicare Advantage |
$708.64
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cofinity Commercial |
$949.58
|
| Rate for Payer: Cofinity Commercial |
$1,020.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$744.07
|
| Rate for Payer: Nomi Health Commercial |
$850.37
|
| Rate for Payer: PACE SWMI |
$708.64
|
| Rate for Payer: PHP Medicare Advantage |
$708.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.75
|
| Rate for Payer: Priority Health Medicare |
$715.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$708.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$708.64
|
| Rate for Payer: UHC Exchange |
$708.64
|
| Rate for Payer: UHC Medicare Advantage |
$708.64
|
|
|
PR INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 20650
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna Commercial |
$216.07
|
| Rate for Payer: Aetna Medicare |
$167.70
|
| Rate for Payer: BCBS Complete |
$132.00
|
| Rate for Payer: BCBS MAPPO |
$161.25
|
| Rate for Payer: BCN Medicare Advantage |
$161.25
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$232.20
|
| Rate for Payer: Cofinity Commercial |
$216.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.31
|
| Rate for Payer: Nomi Health Commercial |
$193.50
|
| Rate for Payer: PACE SWMI |
$161.25
|
| Rate for Payer: PHP Medicare Advantage |
$161.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health Medicare |
$162.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.25
|
| Rate for Payer: UHC Exchange |
$161.25
|
| Rate for Payer: UHC Medicare Advantage |
$161.25
|
|
|
PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, EA ADD
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 0172T
|
| Min. Negotiated Rate |
$211.60 |
| Max. Negotiated Rate |
$343.85 |
| Rate for Payer: Aetna Medicare |
$264.50
|
| Rate for Payer: BCBS Complete |
$211.60
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.85
|
|
|
PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, SINGLE
|
Professional
|
Both
|
$2,734.00
|
|
|
Service Code
|
HCPCS 0171T
|
| Min. Negotiated Rate |
$1,093.60 |
| Max. Negotiated Rate |
$1,777.10 |
| Rate for Payer: Aetna Medicare |
$1,367.00
|
| Rate for Payer: BCBS Complete |
$1,093.60
|
| Rate for Payer: Cash Price |
$2,187.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,777.10
|
|
|
PR INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT
|
Professional
|
Both
|
$1,168.00
|
|
|
Service Code
|
HCPCS 53855
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$759.20 |
| Rate for Payer: Aetna Commercial |
$104.55
|
| Rate for Payer: Aetna Medicare |
$81.14
|
| Rate for Payer: BCBS Complete |
$467.20
|
| Rate for Payer: BCBS MAPPO |
$78.02
|
| Rate for Payer: BCN Medicare Advantage |
$78.02
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cofinity Commercial |
$104.55
|
| Rate for Payer: Cofinity Commercial |
$112.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.92
|
| Rate for Payer: Nomi Health Commercial |
$93.62
|
| Rate for Payer: PACE SWMI |
$78.02
|
| Rate for Payer: PHP Medicare Advantage |
$78.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.20
|
| Rate for Payer: Priority Health Medicare |
$78.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.02
|
| Rate for Payer: UHC Exchange |
$78.02
|
| Rate for Payer: UHC Medicare Advantage |
$78.02
|
|
|
PR INSERT TRAY W/O BAG/CATH
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.54 |
| Rate for Payer: Aetna Commercial |
$14.46
|
| Rate for Payer: Aetna Medicare |
$11.22
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.33
|
| 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 |
$10.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.79
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.50
|
| 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 |
$313.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.00
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$218.97
|
| 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 |
$210.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.54
|
| Rate for Payer: UHC Exchange |
$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 |
$2,306.06 |
| Rate for Payer: Aetna Commercial |
$2,145.92
|
| Rate for Payer: Aetna Medicare |
$1,665.49
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,681.50
|
| 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 |
$1,617.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,601.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,601.43
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,451.22
|
| 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 |
$1,395.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,382.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,382.11
|
| Rate for Payer: UHC Exchange |
$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 |
$1,853.15 |
| Rate for Payer: Aetna Commercial |
$1,719.98
|
| Rate for Payer: Aetna Medicare |
$1,334.91
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,347.75
|
| 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 |
$1,296.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,283.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,283.57
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.17
|
| 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 |
$355.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.59
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.31
|
| 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 |
$353.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.82
|
| Rate for Payer: UHC Exchange |
$349.82
|
| Rate for Payer: UHC Medicare Advantage |
$349.82
|
|
