|
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 |
$362.40 |
| Rate for Payer: Aetna Commercial |
$337.24
|
| Rate for Payer: Aetna Medicare |
$261.74
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$264.25
|
| 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 |
$254.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.67
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.22
|
| 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 |
$331.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.83
|
| Rate for Payer: UHC Exchange |
$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 |
$573.95 |
| Rate for Payer: Aetna Commercial |
$439.80
|
| Rate for Payer: Aetna Medicare |
$341.34
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.62
|
| 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 |
$331.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.21
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.23
|
| 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 |
$183.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.12
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.98
|
| 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 |
$115.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.27
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$510.66
|
| 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 |
$491.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.34
|
| Rate for Payer: UHC Exchange |
$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 |
$640.90 |
| Rate for Payer: Aetna Commercial |
$589.04
|
| Rate for Payer: Aetna Medicare |
$457.16
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.56
|
| 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 |
$443.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.58
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,874.55
|
| 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 |
$1,803.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,785.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,785.29
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$759.03
|
| 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 |
$730.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.89
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.49
|
| 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 |
$340.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.61
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.46
|
| 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 |
$242.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.44
|
| Rate for Payer: UHC Exchange |
$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 |
$1,112.93 |
| Rate for Payer: Aetna Commercial |
$1,035.65
|
| Rate for Payer: Aetna Medicare |
$803.78
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.51
|
| 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 |
$780.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$772.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.87
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.25
|
| 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 |
$24.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.05
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.30
|
| 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 |
$81.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.29
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.29
|
| 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 |
$81.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.28
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.60
|
| 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 |
$514.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.14
|
| Rate for Payer: UHC Exchange |
$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 |
$583.05 |
| Rate for Payer: Aetna Commercial |
$460.40
|
| Rate for Payer: Aetna Medicare |
$357.32
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.76
|
| 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 |
$347.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.58
|
| Rate for Payer: UHC Exchange |
$343.58
|
| Rate for Payer: UHC Medicare Advantage |
$343.58
|
|
|
PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL&VEN ACCESS
|
Professional
|
Both
|
$3,380.00
|
|
|
Service Code
|
HCPCS 33991
|
| Min. Negotiated Rate |
$433.90 |
| Max. Negotiated Rate |
$2,197.00 |
| Rate for Payer: Aetna Commercial |
$581.43
|
| Rate for Payer: Aetna Medicare |
$451.26
|
| Rate for Payer: BCBS Complete |
$1,352.00
|
| Rate for Payer: BCBS MAPPO |
$433.90
|
| Rate for Payer: BCN Medicare Advantage |
$433.90
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cofinity Commercial |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$581.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.60
|
| Rate for Payer: Nomi Health Commercial |
$520.68
|
| Rate for Payer: PACE SWMI |
$433.90
|
| Rate for Payer: PHP Medicare Advantage |
$433.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.00
|
| Rate for Payer: Priority Health Medicare |
$438.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.90
|
| Rate for Payer: UHC Exchange |
$433.90
|
| Rate for Payer: UHC Medicare Advantage |
$433.90
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
IP
|
$1,733.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
36571
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,126.45 |
| Max. Negotiated Rate |
$1,559.70 |
| Rate for Payer: Aetna Commercial |
$1,473.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,414.65
|
| Rate for Payer: BCN Commercial |
$1,339.26
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cofinity Commercial |
$1,490.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,386.40
|
| Rate for Payer: Healthscope Commercial |
$1,559.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,299.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,473.05
|
| Rate for Payer: Nomi Health Commercial |
$1,421.06
|
| Rate for Payer: PHP Commercial |
$1,473.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,507.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,161.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,525.04
|
| Rate for Payer: UHC Core |
$1,447.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,299.75
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 36571
|
| Min. Negotiated Rate |
$298.11 |
| Max. Negotiated Rate |
$1,126.45 |
| Rate for Payer: Aetna Commercial |
$399.47
|
| Rate for Payer: Aetna Medicare |
$310.03
|
| Rate for Payer: BCBS Complete |
$693.20
|
| Rate for Payer: BCBS MAPPO |
$298.11
|
| Rate for Payer: BCN Medicare Advantage |
$298.11
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cofinity Commercial |
$429.28
|
| Rate for Payer: Cofinity Commercial |
$399.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.02
|
| Rate for Payer: Nomi Health Commercial |
$357.73
|
| Rate for Payer: PACE SWMI |
$298.11
|
| Rate for Payer: PHP Medicare Advantage |
$298.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health Medicare |
$301.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.11
|
| Rate for Payer: UHC Exchange |
$298.11
|
| Rate for Payer: UHC Medicare Advantage |
$298.11
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
36571
|
| Min. Negotiated Rate |
$298.11 |
| Max. Negotiated Rate |
$1,126.45 |
| Rate for Payer: Aetna Commercial |
$399.47
|
| Rate for Payer: Aetna Medicare |
$310.03
|
| Rate for Payer: BCBS Complete |
$693.20
|
| Rate for Payer: BCBS MAPPO |
$298.11
|
| Rate for Payer: BCN Medicare Advantage |
$298.11
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cofinity Commercial |
$429.28
|
| Rate for Payer: Cofinity Commercial |
$399.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.02
|
| Rate for Payer: Nomi Health Commercial |
$357.73
|
| Rate for Payer: PACE SWMI |
$298.11
|
| Rate for Payer: PHP Medicare Advantage |
$298.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health Medicare |
$301.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.11
|
| Rate for Payer: UHC Exchange |
$298.11
|
| Rate for Payer: UHC Medicare Advantage |
$298.11
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
36571
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$411.59 |
| Max. Negotiated Rate |
$2,389.58 |
| Rate for Payer: Aetna Commercial |
$1,473.05
|
| Rate for Payer: Aetna Medicare |
$450.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$541.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$541.56
|
| Rate for Payer: BCBS Complete |
$2,389.58
|
| Rate for Payer: BCBS MAPPO |
$433.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,424.70
|
| Rate for Payer: BCN Commercial |
$1,347.41
|
| Rate for Payer: BCN Medicare Advantage |
$433.25
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cofinity Commercial |
$1,490.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,386.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.25
|
| Rate for Payer: Healthscope Commercial |
$1,559.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,299.75
|
| Rate for Payer: Mclaren Medicaid |
$2,275.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$454.91
|
| Rate for Payer: Meridian Medicaid |
$2,389.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$498.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,473.05
|
| Rate for Payer: Nomi Health Commercial |
$1,421.06
|
| Rate for Payer: PACE Senior Care Partners |
$411.59
|
| Rate for Payer: PACE SWMI |
$433.25
|
| Rate for Payer: PHP Commercial |
$1,473.05
|
| Rate for Payer: PHP Medicare Advantage |
$433.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,275.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,507.71
|
| Rate for Payer: Priority Health Medicare |
$437.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,161.11
|
| Rate for Payer: Railroad Medicare Medicare |
$433.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,525.04
|
| Rate for Payer: UHC Core |
$1,447.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.25
|
| Rate for Payer: UHC Exchange |
$433.25
|
| Rate for Payer: UHC Medicare Advantage |
$433.25
|
| Rate for Payer: UHCCP Medicaid |
$2,275.64
|
| Rate for Payer: VA VA |
$433.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,299.75
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR
|
Professional
|
Both
|
$3,086.00
|
|
|
Service Code
|
HCPCS 36570
|
| Min. Negotiated Rate |
$320.99 |
| Max. Negotiated Rate |
$2,005.90 |
| Rate for Payer: Aetna Commercial |
$430.13
|
| Rate for Payer: Aetna Medicare |
$333.83
|
| Rate for Payer: BCBS Complete |
$1,234.40
|
| Rate for Payer: BCBS MAPPO |
$320.99
|
| Rate for Payer: BCN Medicare Advantage |
$320.99
|
| Rate for Payer: Cash Price |
$2,468.80
|
| Rate for Payer: Cash Price |
$2,468.80
|
| Rate for Payer: Cofinity Commercial |
$462.23
|
| Rate for Payer: Cofinity Commercial |
$430.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$337.04
|
| Rate for Payer: Nomi Health Commercial |
$385.19
|
| Rate for Payer: PACE SWMI |
$320.99
|
| Rate for Payer: PHP Medicare Advantage |
$320.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,005.90
|
| Rate for Payer: Priority Health Medicare |
$324.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.99
|
| Rate for Payer: UHC Exchange |
$320.99
|
| Rate for Payer: UHC Medicare Advantage |
$320.99
|
|
|
PR INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 19342
|
| Min. Negotiated Rate |
$670.80 |
| Max. Negotiated Rate |
$1,090.05 |
| Rate for Payer: Aetna Commercial |
$976.35
|
| Rate for Payer: Aetna Medicare |
$757.76
|
| Rate for Payer: BCBS Complete |
$670.80
|
| Rate for Payer: BCBS MAPPO |
$728.62
|
| Rate for Payer: BCN Medicare Advantage |
$728.62
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cofinity Commercial |
$976.35
|
| Rate for Payer: Cofinity Commercial |
$1,049.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$765.05
|
| Rate for Payer: Nomi Health Commercial |
$874.34
|
| Rate for Payer: PACE SWMI |
$728.62
|
| Rate for Payer: PHP Medicare Advantage |
$728.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health Medicare |
$735.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.62
|
| Rate for Payer: UHC Exchange |
$728.62
|
| Rate for Payer: UHC Medicare Advantage |
$728.62
|
|
|
PR INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS
|
Professional
|
Both
|
$1,890.00
|
|
|
Service Code
|
HCPCS 61886
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$1,244.89 |
| Rate for Payer: Aetna Commercial |
$1,158.44
|
| Rate for Payer: Aetna Medicare |
$899.09
|
| Rate for Payer: BCBS Complete |
$756.00
|
| Rate for Payer: BCBS MAPPO |
$864.51
|
| Rate for Payer: BCN Medicare Advantage |
$864.51
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cofinity Commercial |
$1,244.89
|
| Rate for Payer: Cofinity Commercial |
$1,158.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.74
|
| Rate for Payer: Nomi Health Commercial |
$1,037.41
|
| Rate for Payer: PACE SWMI |
$864.51
|
| Rate for Payer: PHP Medicare Advantage |
$864.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,228.50
|
| Rate for Payer: Priority Health Medicare |
$873.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$864.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.51
|
| Rate for Payer: UHC Exchange |
$864.51
|
| Rate for Payer: UHC Medicare Advantage |
$864.51
|
|
