|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$3,060.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$1,224.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Aetna Commercial |
$1,758.50
|
| Rate for Payer: Aetna Commercial |
$1,758.50
|
| Rate for Payer: Aetna Medicare |
$1,364.80
|
| Rate for Payer: Aetna Medicare |
$1,364.80
|
| Rate for Payer: BCBS Complete |
$1,224.00
|
| Rate for Payer: BCBS Complete |
$1,233.60
|
| Rate for Payer: BCBS MAPPO |
$1,312.31
|
| Rate for Payer: BCBS MAPPO |
$1,312.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,312.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,312.31
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cofinity Commercial |
$1,889.73
|
| Rate for Payer: Cofinity Commercial |
$1,758.50
|
| Rate for Payer: Cofinity Commercial |
$1,889.73
|
| Rate for Payer: Cofinity Commercial |
$1,758.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,312.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,312.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,377.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,377.93
|
| Rate for Payer: Nomi Health Commercial |
$1,574.77
|
| Rate for Payer: Nomi Health Commercial |
$1,574.77
|
| Rate for Payer: PACE SWMI |
$1,312.31
|
| Rate for Payer: PACE SWMI |
$1,312.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,312.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,312.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,004.60
|
| Rate for Payer: Priority Health Medicare |
$1,325.43
|
| Rate for Payer: Priority Health Medicare |
$1,325.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,312.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,312.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,312.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,312.31
|
| Rate for Payer: UHC Exchange |
$1,312.31
|
| Rate for Payer: UHC Exchange |
$1,312.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,312.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,312.31
|
|
|
PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 30400
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$1,631.58 |
| Rate for Payer: Aetna Commercial |
$1,518.27
|
| Rate for Payer: Aetna Medicare |
$1,178.36
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$1,133.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.04
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,631.58
|
| Rate for Payer: Cofinity Commercial |
$1,518.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.69
|
| Rate for Payer: Nomi Health Commercial |
$1,359.65
|
| Rate for Payer: PACE SWMI |
$1,133.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$1,144.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,133.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.04
|
| Rate for Payer: UHC Exchange |
$1,133.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.04
|
|
|
PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 90384
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR RHO D IMMUNE GLOBULIN INJ
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS J2790
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$118.92 |
| Rate for Payer: Aetna Commercial |
$110.66
|
| Rate for Payer: Aetna Medicare |
$85.88
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$82.58
|
| Rate for Payer: BCN Medicare Advantage |
$82.58
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$118.92
|
| Rate for Payer: Cofinity Commercial |
$110.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.71
|
| Rate for Payer: Nomi Health Commercial |
$99.10
|
| Rate for Payer: PACE SWMI |
$82.58
|
| Rate for Payer: PHP Medicare Advantage |
$82.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$83.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.58
|
| Rate for Payer: UHC Exchange |
$82.58
|
| Rate for Payer: UHC Medicare Advantage |
$82.58
|
|
|
PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 93042
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Commercial |
$8.59
|
| Rate for Payer: Aetna Medicare |
$6.67
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$6.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.41
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$9.23
|
| Rate for Payer: Cofinity Commercial |
$8.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.73
|
| Rate for Payer: Nomi Health Commercial |
$7.69
|
| Rate for Payer: PACE SWMI |
$6.41
|
| Rate for Payer: PHP Medicare Advantage |
$6.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.41
|
| Rate for Payer: UHC Exchange |
$6.41
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
|
|
PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 93041
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$8.01
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$5.98
|
| Rate for Payer: BCN Medicare Advantage |
$5.98
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$8.61
|
| Rate for Payer: Cofinity Commercial |
$8.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.28
|
| Rate for Payer: Nomi Health Commercial |
$7.18
|
| Rate for Payer: PACE SWMI |
$5.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.98
|
| Rate for Payer: UHC Exchange |
$5.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.98
|
|
|
PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 93040
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$16.60
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Nomi Health Commercial |
$14.87
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$12.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.39
|
| Rate for Payer: UHC Exchange |
$12.39
|
| Rate for Payer: UHC Medicare Advantage |
$12.39
|
|
|
PR RHYTIDECTOMY 3 HOURS
|
Professional
|
Both
|
$4,896.00
|
|
|
Service Code
|
HCPCS 00539
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,958.40 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
|
|
PR RHYTIDECTOMY SMAS FLAP
|
Professional
|
Both
|
$4,896.00
|
|
|
Service Code
|
HCPCS 15829
|
| Min. Negotiated Rate |
$1,958.40 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 93451
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$1,055.72 |
| Rate for Payer: Aetna Commercial |
$982.41
|
| Rate for Payer: Aetna Medicare |
$762.47
|
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: BCBS MAPPO |
$733.14
|
| Rate for Payer: BCN Medicare Advantage |
$733.14
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$1,055.72
|
| Rate for Payer: Cofinity Commercial |
$982.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$769.80
|
| Rate for Payer: Nomi Health Commercial |
$879.77
|
| Rate for Payer: PACE SWMI |
$733.14
|
| Rate for Payer: PHP Medicare Advantage |
$733.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health Medicare |
$740.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$733.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.14
|
| Rate for Payer: UHC Exchange |
$733.14
|
| Rate for Payer: UHC Medicare Advantage |
$733.14
|
|
|
PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 35697
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$188.86
|
| Rate for Payer: Aetna Medicare |
$146.58
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$140.94
|
| Rate for Payer: BCN Medicare Advantage |
$140.94
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$202.95
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.99
|
| Rate for Payer: Nomi Health Commercial |
$169.13
|
| Rate for Payer: PACE SWMI |
$140.94
|
| Rate for Payer: PHP Medicare Advantage |
$140.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$142.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.94
|
| Rate for Payer: UHC Exchange |
$140.94
|
| Rate for Payer: UHC Medicare Advantage |
$140.94
|
|
|
PR RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J7120
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna Medicare |
$2.51
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$2.41
|
| Rate for Payer: BCN Medicare Advantage |
$2.41
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: PACE SWMI |
$2.41
|
| Rate for Payer: PHP Medicare Advantage |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.41
|
| Rate for Payer: UHC Exchange |
$2.41
|
| Rate for Payer: UHC Medicare Advantage |
$2.41
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Min. Negotiated Rate |
$747.82 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna Commercial |
$1,002.08
|
| Rate for Payer: Aetna Medicare |
$777.73
|
| Rate for Payer: BCBS Complete |
$1,052.80
|
| Rate for Payer: BCBS MAPPO |
$747.82
|
| Rate for Payer: BCN Medicare Advantage |
$747.82
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,076.86
|
| Rate for Payer: Cofinity Commercial |
$1,002.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.21
|
| Rate for Payer: Nomi Health Commercial |
$897.38
|
| Rate for Payer: PACE SWMI |
$747.82
|
| Rate for Payer: PHP Medicare Advantage |
$747.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health Medicare |
$755.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$747.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.82
|
| Rate for Payer: UHC Exchange |
$747.82
|
| Rate for Payer: UHC Medicare Advantage |
$747.82
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$747.82 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna Commercial |
$1,002.08
|
| Rate for Payer: Aetna Medicare |
$777.73
|
| Rate for Payer: BCBS Complete |
$1,052.80
|
| Rate for Payer: BCBS MAPPO |
$747.82
|
| Rate for Payer: BCN Medicare Advantage |
$747.82
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,076.86
|
| Rate for Payer: Cofinity Commercial |
$1,002.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.21
|
| Rate for Payer: Nomi Health Commercial |
$897.38
|
| Rate for Payer: PACE SWMI |
$747.82
|
| Rate for Payer: PHP Medicare Advantage |
$747.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health Medicare |
$755.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$747.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.82
|
| Rate for Payer: UHC Exchange |
$747.82
|
| Rate for Payer: UHC Medicare Advantage |
$747.82
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
IP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,710.80 |
| Max. Negotiated Rate |
$2,368.80 |
| Rate for Payer: Aetna Commercial |
$2,237.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,148.50
|
| Rate for Payer: BCN Commercial |
$2,034.01
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$2,263.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Healthscope Commercial |
$2,368.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,974.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: Nomi Health Commercial |
$2,158.24
|
| Rate for Payer: PHP Commercial |
$2,237.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,289.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,763.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,316.16
|
| Rate for Payer: UHC Core |
$2,197.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,974.00
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
OP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$625.10 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: Aetna Commercial |
$2,237.20
|
| Rate for Payer: Aetna Medicare |
$684.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$822.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$822.50
|
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: BCBS MAPPO |
$658.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,163.77
|
| Rate for Payer: BCN Commercial |
$2,046.38
|
| Rate for Payer: BCN Medicare Advantage |
$658.00
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$2,263.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.00
|
| Rate for Payer: Healthscope Commercial |
$2,368.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,974.00
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.90
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$756.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: Nomi Health Commercial |
$2,158.24
|
| Rate for Payer: PACE Senior Care Partners |
$625.10
|
| Rate for Payer: PACE SWMI |
$658.00
|
| Rate for Payer: PHP Commercial |
$2,237.20
|
| Rate for Payer: PHP Medicare Advantage |
$658.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,289.84
|
| Rate for Payer: Priority Health Medicare |
$664.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,763.44
|
| Rate for Payer: Railroad Medicare Medicare |
$658.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,316.16
|
| Rate for Payer: UHC Core |
$2,197.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.00
|
| Rate for Payer: UHC Exchange |
$658.00
|
| Rate for Payer: UHC Medicare Advantage |
$658.00
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
| Rate for Payer: VA VA |
$658.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,974.00
|
|
|
PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 90673
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$141.35 |
| Rate for Payer: Aetna Commercial |
$131.53
|
| Rate for Payer: Aetna Medicare |
$102.09
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$98.16
|
| Rate for Payer: BCN Medicare Advantage |
$98.16
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$141.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.07
|
| Rate for Payer: Nomi Health Commercial |
$117.79
|
| Rate for Payer: PACE SWMI |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$98.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$99.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.16
|
| Rate for Payer: UHC Exchange |
$98.16
|
| Rate for Payer: UHC Medicare Advantage |
$98.16
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 90682
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Aetna Medicare |
$46.50
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$2,919.00
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$1,897.35 |
| Rate for Payer: Aetna Commercial |
$1,596.72
|
| Rate for Payer: Aetna Commercial |
$1,596.72
|
| Rate for Payer: Aetna Medicare |
$1,239.24
|
| Rate for Payer: Aetna Medicare |
$1,239.24
|
| Rate for Payer: BCBS Complete |
$1,121.60
|
| Rate for Payer: BCBS Complete |
$1,167.60
|
| Rate for Payer: BCBS MAPPO |
$1,191.58
|
| Rate for Payer: BCBS MAPPO |
$1,191.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.58
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cofinity Commercial |
$1,715.88
|
| Rate for Payer: Cofinity Commercial |
$1,596.72
|
| Rate for Payer: Cofinity Commercial |
$1,715.88
|
| Rate for Payer: Cofinity Commercial |
$1,596.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.16
|
| Rate for Payer: Nomi Health Commercial |
$1,429.90
|
| Rate for Payer: Nomi Health Commercial |
$1,429.90
|
| Rate for Payer: PACE SWMI |
$1,191.58
|
| Rate for Payer: PACE SWMI |
$1,191.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.60
|
| Rate for Payer: Priority Health Medicare |
$1,203.50
|
| Rate for Payer: Priority Health Medicare |
$1,203.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,191.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,191.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,191.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,191.58
|
| Rate for Payer: UHC Exchange |
$1,191.58
|
| Rate for Payer: UHC Exchange |
$1,191.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,191.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,191.58
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$1,555.33 |
| Rate for Payer: Aetna Commercial |
$1,447.32
|
| Rate for Payer: Aetna Medicare |
$1,123.29
|
| Rate for Payer: BCBS Complete |
$491.60
|
| Rate for Payer: BCBS MAPPO |
$1,080.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,080.09
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,555.33
|
| Rate for Payer: Cofinity Commercial |
$1,447.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,080.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,134.09
|
| Rate for Payer: Nomi Health Commercial |
$1,296.11
|
| Rate for Payer: PACE SWMI |
$1,080.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,080.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: Priority Health Medicare |
$1,090.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,080.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,080.09
|
| Rate for Payer: UHC Exchange |
$1,080.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.09
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$268.80 |
| Max. Negotiated Rate |
$1,428.81 |
| Rate for Payer: Aetna Commercial |
$1,329.59
|
| Rate for Payer: Aetna Medicare |
$1,031.92
|
| Rate for Payer: BCBS Complete |
$268.80
|
| Rate for Payer: BCBS MAPPO |
$992.23
|
| Rate for Payer: BCN Medicare Advantage |
$992.23
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$1,428.81
|
| Rate for Payer: Cofinity Commercial |
$1,329.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.84
|
| Rate for Payer: Nomi Health Commercial |
$1,190.68
|
| Rate for Payer: PACE SWMI |
$992.23
|
| Rate for Payer: PHP Medicare Advantage |
$992.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.80
|
| Rate for Payer: Priority Health Medicare |
$1,002.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$992.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.23
|
| Rate for Payer: UHC Exchange |
$992.23
|
| Rate for Payer: UHC Medicare Advantage |
$992.23
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,796.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$718.40 |
| Max. Negotiated Rate |
$1,176.24 |
| Rate for Payer: Aetna Commercial |
$1,094.55
|
| Rate for Payer: Aetna Medicare |
$849.50
|
| Rate for Payer: BCBS Complete |
$718.40
|
| Rate for Payer: BCBS MAPPO |
$816.83
|
| Rate for Payer: BCN Medicare Advantage |
$816.83
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cofinity Commercial |
$1,176.24
|
| Rate for Payer: Cofinity Commercial |
$1,094.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$857.67
|
| Rate for Payer: Nomi Health Commercial |
$980.20
|
| Rate for Payer: PACE SWMI |
$816.83
|
| Rate for Payer: PHP Medicare Advantage |
$816.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.40
|
| Rate for Payer: Priority Health Medicare |
$825.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$816.83
|
| Rate for Payer: UHC Exchange |
$816.83
|
| Rate for Payer: UHC Medicare Advantage |
$816.83
|
|
|
PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA
|
Professional
|
Both
|
$2,480.00
|
|
|
Service Code
|
HCPCS 33974
|
| Min. Negotiated Rate |
$852.73 |
| Max. Negotiated Rate |
$1,612.00 |
| Rate for Payer: Aetna Commercial |
$1,142.66
|
| Rate for Payer: Aetna Medicare |
$886.84
|
| Rate for Payer: BCBS Complete |
$992.00
|
| Rate for Payer: BCBS MAPPO |
$852.73
|
| Rate for Payer: BCN Medicare Advantage |
$852.73
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cofinity Commercial |
$1,227.93
|
| Rate for Payer: Cofinity Commercial |
$1,142.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.37
|
| Rate for Payer: Nomi Health Commercial |
$1,023.28
|
| Rate for Payer: PACE SWMI |
$852.73
|
| Rate for Payer: PHP Medicare Advantage |
$852.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.00
|
| Rate for Payer: Priority Health Medicare |
$861.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$852.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.73
|
| Rate for Payer: UHC Exchange |
$852.73
|
| Rate for Payer: UHC Medicare Advantage |
$852.73
|
|
|
PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 62142
|
| Min. Negotiated Rate |
$885.13 |
| Max. Negotiated Rate |
$2,191.15 |
| Rate for Payer: Aetna Commercial |
$1,186.07
|
| Rate for Payer: Aetna Medicare |
$920.54
|
| Rate for Payer: BCBS Complete |
$1,348.40
|
| Rate for Payer: BCBS MAPPO |
$885.13
|
| Rate for Payer: BCN Medicare Advantage |
$885.13
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cofinity Commercial |
$1,274.59
|
| Rate for Payer: Cofinity Commercial |
$1,186.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$929.39
|
| Rate for Payer: Nomi Health Commercial |
$1,062.16
|
| Rate for Payer: PACE SWMI |
$885.13
|
| Rate for Payer: PHP Medicare Advantage |
$885.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,191.15
|
| Rate for Payer: Priority Health Medicare |
$893.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.13
|
| Rate for Payer: UHC Exchange |
$885.13
|
| Rate for Payer: UHC Medicare Advantage |
$885.13
|
|
|
PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 62256
|
| Min. Negotiated Rate |
$602.64 |
| Max. Negotiated Rate |
$1,434.55 |
| Rate for Payer: Aetna Commercial |
$807.54
|
| Rate for Payer: Aetna Medicare |
$626.75
|
| Rate for Payer: BCBS Complete |
$882.80
|
| Rate for Payer: BCBS MAPPO |
$602.64
|
| Rate for Payer: BCN Medicare Advantage |
$602.64
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cofinity Commercial |
$867.80
|
| Rate for Payer: Cofinity Commercial |
$807.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.77
|
| Rate for Payer: Nomi Health Commercial |
$723.17
|
| Rate for Payer: PACE SWMI |
$602.64
|
| Rate for Payer: PHP Medicare Advantage |
$602.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.55
|
| Rate for Payer: Priority Health Medicare |
$608.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.64
|
| Rate for Payer: UHC Exchange |
$602.64
|
| Rate for Payer: UHC Medicare Advantage |
$602.64
|
|
