|
PR RPLCMT CATH CTR VAD SUBQ PORT/PMP
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
HCPCS 36578
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$1,318.11 |
| Rate for Payer: Aetna Commercial |
$256.37
|
| Rate for Payer: Aetna Medicare |
$198.97
|
| Rate for Payer: BCBS Complete |
$133.97
|
| Rate for Payer: BCBS MAPPO |
$191.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.11
|
| Rate for Payer: BCN Commercial |
$636.74
|
| Rate for Payer: BCN Medicare Advantage |
$191.32
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cofinity Commercial |
$275.50
|
| Rate for Payer: Cofinity Commercial |
$256.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.32
|
| Rate for Payer: Mclaren Medicaid |
$127.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.89
|
| Rate for Payer: Meridian Medicaid |
$133.97
|
| Rate for Payer: Nomi Health Commercial |
$229.58
|
| Rate for Payer: PACE SWMI |
$191.32
|
| Rate for Payer: PHP Medicare Advantage |
$191.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.60
|
| Rate for Payer: Priority Health HMO/PPO |
$321.23
|
| Rate for Payer: Priority Health Medicare |
$193.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.32
|
| Rate for Payer: UHC Exchange |
$191.32
|
| Rate for Payer: UHC Medicare Advantage |
$191.32
|
| Rate for Payer: UHCCP Medicaid |
$127.59
|
|
|
PR RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$771.00
|
|
|
Service Code
|
HCPCS 36580
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$1,034.41 |
| Rate for Payer: Aetna Commercial |
$82.29
|
| Rate for Payer: Aetna Medicare |
$63.87
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS MAPPO |
$61.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.41
|
| Rate for Payer: BCN Commercial |
$279.53
|
| Rate for Payer: BCN Medicare Advantage |
$61.41
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$82.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.41
|
| Rate for Payer: Mclaren Medicaid |
$40.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.48
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Nomi Health Commercial |
$73.69
|
| Rate for Payer: PACE SWMI |
$61.41
|
| Rate for Payer: PHP Medicare Advantage |
$61.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health HMO/PPO |
$101.58
|
| Rate for Payer: Priority Health Medicare |
$62.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.41
|
| Rate for Payer: UHC Exchange |
$61.41
|
| Rate for Payer: UHC Medicare Advantage |
$61.41
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
PR RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 36585
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$1,705.98 |
| Rate for Payer: Aetna Commercial |
$392.97
|
| Rate for Payer: Aetna Medicare |
$304.99
|
| Rate for Payer: BCBS Complete |
$205.09
|
| Rate for Payer: BCBS MAPPO |
$293.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,150.02
|
| Rate for Payer: BCN Commercial |
$1,705.98
|
| Rate for Payer: BCN Medicare Advantage |
$293.26
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cofinity Commercial |
$422.29
|
| Rate for Payer: Cofinity Commercial |
$392.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.26
|
| Rate for Payer: Mclaren Medicaid |
$195.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.92
|
| Rate for Payer: Meridian Medicaid |
$205.09
|
| Rate for Payer: Nomi Health Commercial |
$351.91
|
| Rate for Payer: PACE SWMI |
$293.26
|
| Rate for Payer: PHP Medicare Advantage |
$293.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
| Rate for Payer: Priority Health HMO/PPO |
$438.75
|
| Rate for Payer: Priority Health Medicare |
$296.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.26
|
| Rate for Payer: UHC Exchange |
$293.26
|
| Rate for Payer: UHC Medicare Advantage |
$293.26
|
| Rate for Payer: UHCCP Medicaid |
$195.32
|
|
|
PR RPLCMT COMPL TUN CTR VAD W/SUBQ PMP
|
Professional
|
Both
|
$1,945.00
|
|
|
Service Code
|
HCPCS 36583
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$1,698.15 |
| Rate for Payer: Aetna Commercial |
$425.80
|
| Rate for Payer: Aetna Medicare |
$330.47
|
| Rate for Payer: BCBS Complete |
$221.86
|
| Rate for Payer: BCBS MAPPO |
$317.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,556.37
|
| Rate for Payer: BCN Commercial |
$1,698.15
|
| Rate for Payer: BCN Medicare Advantage |
$317.76
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cofinity Commercial |
$457.57
|
| Rate for Payer: Cofinity Commercial |
$425.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.76
|
| Rate for Payer: Mclaren Medicaid |
$211.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.65
|
| Rate for Payer: Meridian Medicaid |
$221.86
|
| Rate for Payer: Nomi Health Commercial |
$381.31
|
| Rate for Payer: PACE SWMI |
$317.76
|
| Rate for Payer: PHP Medicare Advantage |
$317.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,264.25
|
| Rate for Payer: Priority Health HMO/PPO |
$523.32
|
| Rate for Payer: Priority Health Medicare |
$320.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.76
|
| Rate for Payer: UHC Exchange |
$317.76
|
| Rate for Payer: UHC Medicare Advantage |
$317.76
|
| Rate for Payer: UHCCP Medicaid |
$211.30
|
|
|
PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 36582
|
| Min. Negotiated Rate |
$181.48 |
| Max. Negotiated Rate |
$2,421.20 |
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: Aetna Medicare |
$283.28
|
| Rate for Payer: BCBS Complete |
$190.55
|
| Rate for Payer: BCBS MAPPO |
$272.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,421.20
|
| Rate for Payer: BCN Commercial |
$1,296.46
|
| Rate for Payer: BCN Medicare Advantage |
$272.38
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cofinity Commercial |
$392.23
|
| Rate for Payer: Cofinity Commercial |
$364.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.38
|
| Rate for Payer: Mclaren Medicaid |
$181.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.00
|
| Rate for Payer: Meridian Medicaid |
$190.55
|
| Rate for Payer: Nomi Health Commercial |
$326.86
|
| Rate for Payer: PACE SWMI |
$272.38
|
| Rate for Payer: PHP Medicare Advantage |
$272.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.60
|
| Rate for Payer: Priority Health HMO/PPO |
$450.99
|
| Rate for Payer: Priority Health Medicare |
$275.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$450.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.38
|
| Rate for Payer: UHC Exchange |
$272.38
|
| Rate for Payer: UHC Medicare Advantage |
$272.38
|
| Rate for Payer: UHCCP Medicaid |
$181.48
|
|
|
PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 36581
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$2,785.20 |
| Rate for Payer: Aetna Commercial |
$231.36
|
| Rate for Payer: Aetna Medicare |
$179.57
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: BCBS MAPPO |
$172.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,785.20
|
| Rate for Payer: BCN Commercial |
$1,146.44
|
| Rate for Payer: BCN Medicare Advantage |
$172.66
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cofinity Commercial |
$248.63
|
| Rate for Payer: Cofinity Commercial |
$231.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.66
|
| Rate for Payer: Mclaren Medicaid |
$115.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.29
|
| Rate for Payer: Meridian Medicaid |
$121.22
|
| Rate for Payer: Nomi Health Commercial |
$207.19
|
| Rate for Payer: PACE SWMI |
$172.66
|
| Rate for Payer: PHP Medicare Advantage |
$172.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.50
|
| Rate for Payer: Priority Health HMO/PPO |
$286.13
|
| Rate for Payer: Priority Health Medicare |
$174.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.66
|
| Rate for Payer: UHC Exchange |
$172.66
|
| Rate for Payer: UHC Medicare Advantage |
$172.66
|
| Rate for Payer: UHCCP Medicaid |
$115.45
|
|
|
PR RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 62194
|
| Min. Negotiated Rate |
$326.32 |
| Max. Negotiated Rate |
$1,218.10 |
| Rate for Payer: Aetna Commercial |
$654.26
|
| Rate for Payer: Aetna Medicare |
$507.78
|
| Rate for Payer: BCBS Complete |
$342.64
|
| Rate for Payer: BCBS MAPPO |
$488.25
|
| Rate for Payer: BCBS Trust/PPO |
$624.98
|
| Rate for Payer: BCN Commercial |
$734.97
|
| Rate for Payer: BCN Medicare Advantage |
$488.25
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cofinity Commercial |
$703.08
|
| Rate for Payer: Cofinity Commercial |
$654.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.25
|
| Rate for Payer: Mclaren Medicaid |
$326.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.66
|
| Rate for Payer: Meridian Medicaid |
$342.64
|
| Rate for Payer: Nomi Health Commercial |
$585.90
|
| Rate for Payer: PACE SWMI |
$488.25
|
| Rate for Payer: PHP Medicare Advantage |
$488.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.10
|
| Rate for Payer: Priority Health HMO/PPO |
$865.01
|
| Rate for Payer: Priority Health Medicare |
$493.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$865.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$488.25
|
| Rate for Payer: UHC Exchange |
$488.25
|
| Rate for Payer: UHC Medicare Advantage |
$488.25
|
| Rate for Payer: UHCCP Medicaid |
$326.32
|
|
|
PR RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 63744
|
| Min. Negotiated Rate |
$468.60 |
| Max. Negotiated Rate |
$1,472.90 |
| Rate for Payer: Aetna Commercial |
$944.87
|
| Rate for Payer: Aetna Medicare |
$733.34
|
| Rate for Payer: BCBS Complete |
$492.03
|
| Rate for Payer: BCBS MAPPO |
$705.13
|
| Rate for Payer: BCBS Trust/PPO |
$672.00
|
| Rate for Payer: BCN Commercial |
$1,110.58
|
| Rate for Payer: BCN Medicare Advantage |
$705.13
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cofinity Commercial |
$944.87
|
| Rate for Payer: Cofinity Commercial |
$1,015.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.13
|
| Rate for Payer: Mclaren Medicaid |
$468.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.39
|
| Rate for Payer: Meridian Medicaid |
$492.03
|
| Rate for Payer: Nomi Health Commercial |
$846.16
|
| Rate for Payer: PACE SWMI |
$705.13
|
| Rate for Payer: PHP Medicare Advantage |
$705.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$468.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1,192.60
|
| Rate for Payer: Priority Health Medicare |
$712.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,192.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$705.13
|
| Rate for Payer: UHC Exchange |
$705.13
|
| Rate for Payer: UHC Medicare Advantage |
$705.13
|
| Rate for Payer: UHCCP Medicaid |
$468.60
|
|
|
PR RPLCMT/IRRIGATION VENTRICULAR CATHETER
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 62225
|
| Min. Negotiated Rate |
$354.86 |
| Max. Negotiated Rate |
$1,771.25 |
| Rate for Payer: Aetna Commercial |
$710.23
|
| Rate for Payer: Aetna Medicare |
$551.22
|
| Rate for Payer: BCBS Complete |
$372.60
|
| Rate for Payer: BCBS MAPPO |
$530.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.05
|
| Rate for Payer: BCN Commercial |
$1,103.00
|
| Rate for Payer: BCN Medicare Advantage |
$530.02
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$763.23
|
| Rate for Payer: Cofinity Commercial |
$710.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.02
|
| Rate for Payer: Mclaren Medicaid |
$354.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.52
|
| Rate for Payer: Meridian Medicaid |
$372.60
|
| Rate for Payer: Nomi Health Commercial |
$636.02
|
| Rate for Payer: PACE SWMI |
$530.02
|
| Rate for Payer: PHP Medicare Advantage |
$530.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health HMO/PPO |
$938.37
|
| Rate for Payer: Priority Health Medicare |
$535.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$938.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.02
|
| Rate for Payer: UHC Exchange |
$530.02
|
| Rate for Payer: UHC Medicare Advantage |
$530.02
|
| Rate for Payer: UHCCP Medicaid |
$354.86
|
|
|
PR RPLCMT OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 69717
|
| Min. Negotiated Rate |
$359.97 |
| Max. Negotiated Rate |
$1,881.80 |
| Rate for Payer: Aetna Commercial |
$710.90
|
| Rate for Payer: Aetna Medicare |
$551.74
|
| Rate for Payer: BCBS Complete |
$377.97
|
| Rate for Payer: BCBS MAPPO |
$530.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,881.80
|
| Rate for Payer: BCN Commercial |
$822.45
|
| Rate for Payer: BCN Medicare Advantage |
$530.52
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cofinity Commercial |
$763.95
|
| Rate for Payer: Cofinity Commercial |
$710.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.52
|
| Rate for Payer: Mclaren Medicaid |
$359.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.05
|
| Rate for Payer: Meridian Medicaid |
$377.97
|
| Rate for Payer: Nomi Health Commercial |
$636.62
|
| Rate for Payer: PACE SWMI |
$530.52
|
| Rate for Payer: PHP Medicare Advantage |
$530.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$359.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health HMO/PPO |
$822.46
|
| Rate for Payer: Priority Health Medicare |
$535.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$822.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.52
|
| Rate for Payer: UHC Exchange |
$530.52
|
| Rate for Payer: UHC Medicare Advantage |
$530.52
|
| Rate for Payer: UHCCP Medicaid |
$359.97
|
|
|
PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT
|
Professional
|
Both
|
$4,753.00
|
|
|
Service Code
|
HCPCS 33405
|
| Min. Negotiated Rate |
$683.09 |
| Max. Negotiated Rate |
$3,550.46 |
| Rate for Payer: Aetna Commercial |
$2,915.28
|
| Rate for Payer: Aetna Medicare |
$2,262.60
|
| Rate for Payer: BCBS Complete |
$1,498.00
|
| Rate for Payer: BCBS MAPPO |
$2,175.58
|
| Rate for Payer: BCBS Trust/PPO |
$683.09
|
| Rate for Payer: BCN Commercial |
$3,251.17
|
| Rate for Payer: BCN Medicare Advantage |
$2,175.58
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cofinity Commercial |
$3,132.84
|
| Rate for Payer: Cofinity Commercial |
$2,915.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,175.58
|
| Rate for Payer: Mclaren Medicaid |
$1,426.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,284.36
|
| Rate for Payer: Meridian Medicaid |
$1,498.00
|
| Rate for Payer: Nomi Health Commercial |
$2,610.70
|
| Rate for Payer: PACE SWMI |
$2,175.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,175.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,426.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,089.45
|
| Rate for Payer: Priority Health HMO/PPO |
$3,550.46
|
| Rate for Payer: Priority Health Medicare |
$2,197.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,550.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,175.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,175.58
|
| Rate for Payer: UHC Exchange |
$2,175.58
|
| Rate for Payer: UHC Medicare Advantage |
$2,175.58
|
| Rate for Payer: UHCCP Medicaid |
$1,426.67
|
|
|
PR RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS
|
Professional
|
Both
|
$3,555.00
|
|
|
Service Code
|
HCPCS 62230
|
| Min. Negotiated Rate |
$549.75 |
| Max. Negotiated Rate |
$2,310.75 |
| Rate for Payer: Aetna Commercial |
$1,113.20
|
| Rate for Payer: Aetna Medicare |
$863.98
|
| Rate for Payer: BCBS Complete |
$577.24
|
| Rate for Payer: BCBS MAPPO |
$830.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.05
|
| Rate for Payer: BCN Commercial |
$1,726.70
|
| Rate for Payer: BCN Medicare Advantage |
$830.75
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,196.28
|
| Rate for Payer: Cofinity Commercial |
$1,113.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.75
|
| Rate for Payer: Mclaren Medicaid |
$549.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.29
|
| Rate for Payer: Meridian Medicaid |
$577.24
|
| Rate for Payer: Nomi Health Commercial |
$996.90
|
| Rate for Payer: PACE SWMI |
$830.75
|
| Rate for Payer: PHP Medicare Advantage |
$830.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,310.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,462.73
|
| Rate for Payer: Priority Health Medicare |
$839.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,462.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.75
|
| Rate for Payer: UHC Exchange |
$830.75
|
| Rate for Payer: UHC Medicare Advantage |
$830.75
|
| Rate for Payer: UHCCP Medicaid |
$549.75
|
|
|
PR RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP
|
Professional
|
Both
|
$3,924.00
|
|
|
Service Code
|
HCPCS 20822
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$2,709.18 |
| Rate for Payer: Aetna Commercial |
$2,281.78
|
| Rate for Payer: Aetna Medicare |
$1,770.93
|
| Rate for Payer: BCBS Complete |
$1,199.22
|
| Rate for Payer: BCBS MAPPO |
$1,702.82
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$2,584.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,702.82
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cofinity Commercial |
$2,452.06
|
| Rate for Payer: Cofinity Commercial |
$2,281.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,702.82
|
| Rate for Payer: Mclaren Medicaid |
$1,142.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,787.96
|
| Rate for Payer: Meridian Medicaid |
$1,199.22
|
| Rate for Payer: Nomi Health Commercial |
$2,043.38
|
| Rate for Payer: PACE SWMI |
$1,702.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,702.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,142.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,550.60
|
| Rate for Payer: Priority Health HMO/PPO |
$2,709.18
|
| Rate for Payer: Priority Health Medicare |
$1,719.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,709.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,702.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,702.82
|
| Rate for Payer: UHC Exchange |
$1,702.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,702.82
|
| Rate for Payer: UHCCP Medicaid |
$1,142.11
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Hospital Charge Code |
49553
|
| Min. Negotiated Rate |
$409.81 |
| Max. Negotiated Rate |
$1,814.71 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$640.93
|
| Rate for Payer: BCBS Complete |
$430.30
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: BCN Commercial |
$928.49
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Mclaren Medicaid |
$409.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Meridian Medicaid |
$430.30
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,139.49
|
| Rate for Payer: Priority Health Medicare |
$622.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,139.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Exchange |
$616.28
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
| Rate for Payer: UHCCP Medicaid |
$409.81
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$733.85 |
| Max. Negotiated Rate |
$1,016.10 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: BCBS Trust/PPO |
$921.60
|
| Rate for Payer: BCN Commercial |
$872.49
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$970.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Healthscope Commercial |
$1,016.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: Nomi Health Commercial |
$925.78
|
| Rate for Payer: PHP Commercial |
$959.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO |
$982.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$756.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.52
|
| Rate for Payer: UHC Core |
$942.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.75
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Min. Negotiated Rate |
$409.81 |
| Max. Negotiated Rate |
$1,814.71 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$640.93
|
| Rate for Payer: BCBS Complete |
$430.30
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: BCN Commercial |
$928.49
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Mclaren Medicaid |
$409.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Meridian Medicaid |
$430.30
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,139.49
|
| Rate for Payer: Priority Health Medicare |
$622.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,139.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Exchange |
$616.28
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
| Rate for Payer: UHCCP Medicaid |
$409.81
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$268.14 |
| Max. Negotiated Rate |
$2,625.09 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: Aetna Medicare |
$293.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$352.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$352.81
|
| Rate for Payer: BCBS Complete |
$2,625.09
|
| Rate for Payer: BCBS MAPPO |
$282.25
|
| Rate for Payer: BCBS Trust/PPO |
$928.15
|
| Rate for Payer: BCN Commercial |
$877.80
|
| Rate for Payer: BCN Medicare Advantage |
$282.25
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$970.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.25
|
| Rate for Payer: Healthscope Commercial |
$1,016.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.75
|
| Rate for Payer: Mclaren Medicaid |
$2,499.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.36
|
| Rate for Payer: Meridian Medicaid |
$2,625.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$324.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: Nomi Health Commercial |
$925.78
|
| Rate for Payer: PACE Senior Care Partners |
$268.14
|
| Rate for Payer: PACE SWMI |
$282.25
|
| Rate for Payer: PHP Commercial |
$959.65
|
| Rate for Payer: PHP Medicare Advantage |
$282.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,499.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO |
$982.23
|
| Rate for Payer: Priority Health Medicare |
$285.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$756.43
|
| Rate for Payer: Railroad Medicare Medicare |
$282.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.52
|
| Rate for Payer: UHC Core |
$942.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.25
|
| Rate for Payer: UHC Exchange |
$282.25
|
| Rate for Payer: UHC Medicare Advantage |
$282.25
|
| Rate for Payer: UHCCP Medicaid |
$2,499.92
|
| Rate for Payer: VA VA |
$282.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.75
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: BCBS Trust/PPO |
$705.28
|
| Rate for Payer: BCN Commercial |
$667.70
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$743.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.20
|
| Rate for Payer: Healthscope Commercial |
$777.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.40
|
| Rate for Payer: Nomi Health Commercial |
$708.48
|
| Rate for Payer: PHP Commercial |
$734.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO |
$751.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.32
|
| Rate for Payer: UHC Core |
$721.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.00
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
49550
|
| Min. Negotiated Rate |
$375.31 |
| Max. Negotiated Rate |
$6,312.66 |
| Rate for Payer: Aetna Commercial |
$755.99
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: BCBS Complete |
$394.08
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCBS Trust/PPO |
$6,312.66
|
| Rate for Payer: BCN Commercial |
$848.35
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$812.40
|
| Rate for Payer: Cofinity Commercial |
$755.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Mclaren Medicaid |
$375.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Meridian Medicaid |
$394.08
|
| Rate for Payer: Nomi Health Commercial |
$677.00
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,042.25
|
| Rate for Payer: Priority Health Medicare |
$569.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,042.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$564.17
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
| Rate for Payer: UHCCP Medicaid |
$375.31
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 49550
|
| Min. Negotiated Rate |
$375.31 |
| Max. Negotiated Rate |
$6,312.66 |
| Rate for Payer: Aetna Commercial |
$755.99
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: BCBS Complete |
$394.08
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCBS Trust/PPO |
$6,312.66
|
| Rate for Payer: BCN Commercial |
$848.35
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$812.40
|
| Rate for Payer: Cofinity Commercial |
$755.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Mclaren Medicaid |
$375.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Meridian Medicaid |
$394.08
|
| Rate for Payer: Nomi Health Commercial |
$677.00
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,042.25
|
| Rate for Payer: Priority Health Medicare |
$569.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,042.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$564.17
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
| Rate for Payer: UHCCP Medicaid |
$375.31
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$2,625.09 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna Medicare |
$224.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$270.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$270.00
|
| Rate for Payer: BCBS Complete |
$2,625.09
|
| Rate for Payer: BCBS MAPPO |
$216.00
|
| Rate for Payer: BCBS Trust/PPO |
$710.29
|
| Rate for Payer: BCN Commercial |
$671.76
|
| Rate for Payer: BCN Medicare Advantage |
$216.00
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$743.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.00
|
| Rate for Payer: Healthscope Commercial |
$777.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.00
|
| Rate for Payer: Mclaren Medicaid |
$2,499.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.80
|
| Rate for Payer: Meridian Medicaid |
$2,625.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.40
|
| Rate for Payer: Nomi Health Commercial |
$708.48
|
| Rate for Payer: PACE Senior Care Partners |
$205.20
|
| Rate for Payer: PACE SWMI |
$216.00
|
| Rate for Payer: PHP Commercial |
$734.40
|
| Rate for Payer: PHP Medicare Advantage |
$216.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,499.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO |
$751.68
|
| Rate for Payer: Priority Health Medicare |
$218.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.88
|
| Rate for Payer: Railroad Medicare Medicare |
$216.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.32
|
| Rate for Payer: UHC Core |
$721.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.00
|
| Rate for Payer: UHC Exchange |
$216.00
|
| Rate for Payer: UHC Medicare Advantage |
$216.00
|
| Rate for Payer: UHCCP Medicaid |
$2,499.92
|
| Rate for Payer: VA VA |
$216.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.00
|
|
|
PR RPR 1ST INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 49561
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$1,457.95 |
| Rate for Payer: Aetna Medicare |
$1,121.50
|
| Rate for Payer: BCBS Complete |
$897.20
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
OP
|
$1,665.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$395.44 |
| Max. Negotiated Rate |
$2,625.09 |
| Rate for Payer: Aetna Commercial |
$1,415.25
|
| Rate for Payer: Aetna Medicare |
$432.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.31
|
| Rate for Payer: BCBS Complete |
$2,625.09
|
| Rate for Payer: BCBS MAPPO |
$416.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,368.80
|
| Rate for Payer: BCN Commercial |
$1,294.54
|
| Rate for Payer: BCN Medicare Advantage |
$416.25
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,431.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.25
|
| Rate for Payer: Healthscope Commercial |
$1,498.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,248.75
|
| Rate for Payer: Mclaren Medicaid |
$2,499.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.06
|
| Rate for Payer: Meridian Medicaid |
$2,625.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$478.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: Nomi Health Commercial |
$1,365.30
|
| Rate for Payer: PACE Senior Care Partners |
$395.44
|
| Rate for Payer: PACE SWMI |
$416.25
|
| Rate for Payer: PHP Commercial |
$1,415.25
|
| Rate for Payer: PHP Medicare Advantage |
$416.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,499.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,448.55
|
| Rate for Payer: Priority Health Medicare |
$420.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,115.55
|
| Rate for Payer: Railroad Medicare Medicare |
$416.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,465.20
|
| Rate for Payer: UHC Core |
$1,390.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.25
|
| Rate for Payer: UHC Exchange |
$416.25
|
| Rate for Payer: UHC Medicare Advantage |
$416.25
|
| Rate for Payer: UHCCP Medicaid |
$2,499.92
|
| Rate for Payer: VA VA |
$416.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,248.75
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 49507
|
| Min. Negotiated Rate |
$381.06 |
| Max. Negotiated Rate |
$1,082.25 |
| Rate for Payer: Aetna Commercial |
$767.03
|
| Rate for Payer: Aetna Medicare |
$595.31
|
| Rate for Payer: BCBS Complete |
$400.11
|
| Rate for Payer: BCBS MAPPO |
$572.41
|
| Rate for Payer: BCBS Trust/PPO |
$781.36
|
| Rate for Payer: BCN Commercial |
$863.01
|
| Rate for Payer: BCN Medicare Advantage |
$572.41
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$824.27
|
| Rate for Payer: Cofinity Commercial |
$767.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.41
|
| Rate for Payer: Mclaren Medicaid |
$381.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.03
|
| Rate for Payer: Meridian Medicaid |
$400.11
|
| Rate for Payer: Nomi Health Commercial |
$686.89
|
| Rate for Payer: PACE SWMI |
$572.41
|
| Rate for Payer: PHP Medicare Advantage |
$572.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,060.15
|
| Rate for Payer: Priority Health Medicare |
$578.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,060.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.41
|
| Rate for Payer: UHC Exchange |
$572.41
|
| Rate for Payer: UHC Medicare Advantage |
$572.41
|
| Rate for Payer: UHCCP Medicaid |
$381.06
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
IP
|
$1,665.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,082.25 |
| Max. Negotiated Rate |
$1,498.50 |
| Rate for Payer: Aetna Commercial |
$1,415.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,359.14
|
| Rate for Payer: BCN Commercial |
$1,286.71
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,431.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Healthscope Commercial |
$1,498.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,248.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: Nomi Health Commercial |
$1,365.30
|
| Rate for Payer: PHP Commercial |
$1,415.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,448.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,115.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,465.20
|
| Rate for Payer: UHC Core |
$1,390.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,248.75
|
|
