|
PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
HCPCS 93503
|
| Min. Negotiated Rate |
$83.22 |
| Max. Negotiated Rate |
$554.45 |
| Rate for Payer: Aetna Commercial |
$111.51
|
| Rate for Payer: Aetna Medicare |
$86.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.51
|
| Rate for Payer: BCBS Complete |
$341.20
|
| Rate for Payer: BCBS MAPPO |
$83.22
|
| Rate for Payer: BCN Medicare Advantage |
$83.22
|
| Rate for Payer: Cash Price |
$682.40
|
| Rate for Payer: Cash Price |
$682.40
|
| Rate for Payer: Cofinity Commercial |
$119.84
|
| Rate for Payer: Cofinity Commercial |
$111.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.38
|
| Rate for Payer: Nomi Health Commercial |
$99.86
|
| Rate for Payer: PACE SWMI |
$83.22
|
| Rate for Payer: PHP Commercial |
$116.51
|
| Rate for Payer: PHP Medicare Advantage |
$83.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.45
|
| Rate for Payer: Priority Health Medicare |
$83.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.22
|
| Rate for Payer: UHC Medicare Advantage |
$83.22
|
| Rate for Payer: UMR Bronson Commercial |
$392.38
|
|
|
PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 32550
|
| Min. Negotiated Rate |
$193.09 |
| Max. Negotiated Rate |
$1,267.50 |
| Rate for Payer: Aetna Commercial |
$258.74
|
| Rate for Payer: Aetna Medicare |
$200.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.74
|
| Rate for Payer: BCBS Complete |
$780.00
|
| Rate for Payer: BCBS MAPPO |
$193.09
|
| Rate for Payer: BCN Medicare Advantage |
$193.09
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cofinity Commercial |
$278.05
|
| Rate for Payer: Cofinity Commercial |
$258.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.74
|
| Rate for Payer: Nomi Health Commercial |
$231.71
|
| Rate for Payer: PACE SWMI |
$193.09
|
| Rate for Payer: PHP Commercial |
$270.33
|
| Rate for Payer: PHP Medicare Advantage |
$193.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,267.50
|
| Rate for Payer: Priority Health Medicare |
$193.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.09
|
| Rate for Payer: UHC Medicare Advantage |
$193.09
|
| Rate for Payer: UMR Bronson Commercial |
$897.00
|
|
|
PR INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 33967
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$488.15 |
| Rate for Payer: Aetna Commercial |
$330.87
|
| Rate for Payer: Aetna Medicare |
$256.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.87
|
| Rate for Payer: BCBS Complete |
$300.40
|
| Rate for Payer: BCBS MAPPO |
$246.92
|
| Rate for Payer: BCN Medicare Advantage |
$246.92
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$355.56
|
| Rate for Payer: Cofinity Commercial |
$330.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.27
|
| Rate for Payer: Nomi Health Commercial |
$296.30
|
| Rate for Payer: PACE SWMI |
$246.92
|
| Rate for Payer: PHP Commercial |
$345.69
|
| Rate for Payer: PHP Medicare Advantage |
$246.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health Medicare |
$246.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.92
|
| Rate for Payer: UHC Medicare Advantage |
$246.92
|
| Rate for Payer: UMR Bronson Commercial |
$345.46
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
58300
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: UMR Bronson Commercial |
$136.16
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$109.52 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Aetna American Axle |
$192.40
|
| Rate for Payer: Aetna Commercial |
$251.60
|
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.40
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$254.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.80
|
| Rate for Payer: Healthscope Commercial |
$266.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.60
|
| Rate for Payer: PHP Commercial |
$251.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health SBD |
$186.48
|
| Rate for Payer: UMR Bronson Commercial |
$109.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.00
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 58300
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: UMR Bronson Commercial |
$136.16
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Aetna American Axle |
$192.40
|
| Rate for Payer: Aetna Commercial |
$251.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$254.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.80
|
| Rate for Payer: Healthscope Commercial |
$266.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.60
|
| Rate for Payer: PHP Commercial |
$251.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health SBD |
$186.48
|
| Rate for Payer: UMR Bronson Commercial |
$130.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.00
|
|
|
PR INSERTION PICC W/O IMG GDN < 5 YR
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 36568
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$119.17
|
| Rate for Payer: Aetna Medicare |
$92.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.06
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS MAPPO |
$88.93
|
| Rate for Payer: BCN Medicare Advantage |
$88.93
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cofinity Commercial |
$119.17
|
| Rate for Payer: Cofinity Commercial |
$128.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.38
|
| Rate for Payer: Nomi Health Commercial |
$106.72
|
| Rate for Payer: PACE SWMI |
$88.93
|
| Rate for Payer: PHP Commercial |
$124.50
|
| Rate for Payer: PHP Medicare Advantage |
$88.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
| Rate for Payer: Priority Health Medicare |
$88.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.93
|
| Rate for Payer: UHC Medicare Advantage |
$88.93
|
| Rate for Payer: UMR Bronson Commercial |
$80.04
|
|
|
PR INSERTION PICC W/O IMG GDN 5 YR/>
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 36569
|
| Min. Negotiated Rate |
$90.73 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna Medicare |
$94.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.58
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: BCBS MAPPO |
$90.73
|
| Rate for Payer: BCN Medicare Advantage |
$90.73
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$130.65
|
| Rate for Payer: Cofinity Commercial |
$121.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.27
|
| Rate for Payer: Nomi Health Commercial |
$108.88
|
| Rate for Payer: PACE SWMI |
$90.73
|
| Rate for Payer: PHP Commercial |
$127.02
|
| Rate for Payer: PHP Medicare Advantage |
$90.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health Medicare |
$90.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.73
|
| Rate for Payer: UHC Medicare Advantage |
$90.73
|
| Rate for Payer: UMR Bronson Commercial |
$225.40
|
|
|
PR INSERTION PICC W/RS&I < 5 YR
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 36572
|
| Min. Negotiated Rate |
$77.83 |
| Max. Negotiated Rate |
$548.60 |
| Rate for Payer: Aetna Commercial |
$104.29
|
| Rate for Payer: Aetna Medicare |
$80.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.29
|
| Rate for Payer: BCBS Complete |
$337.60
|
| Rate for Payer: BCBS MAPPO |
$77.83
|
| Rate for Payer: BCN Medicare Advantage |
$77.83
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cofinity Commercial |
$112.08
|
| Rate for Payer: Cofinity Commercial |
$104.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.72
|
| Rate for Payer: Nomi Health Commercial |
$93.40
|
| Rate for Payer: PACE SWMI |
$77.83
|
| Rate for Payer: PHP Commercial |
$108.96
|
| Rate for Payer: PHP Medicare Advantage |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.60
|
| Rate for Payer: Priority Health Medicare |
$77.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.83
|
| Rate for Payer: UHC Medicare Advantage |
$77.83
|
| Rate for Payer: UMR Bronson Commercial |
$388.24
|
|
|
PR INSERTION PICC W/RS&I 5 YR/>
|
Professional
|
Both
|
$776.00
|
|
|
Service Code
|
HCPCS 36573
|
| Min. Negotiated Rate |
$78.83 |
| Max. Negotiated Rate |
$504.40 |
| Rate for Payer: Aetna Commercial |
$105.63
|
| Rate for Payer: Aetna Medicare |
$81.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.63
|
| Rate for Payer: BCBS Complete |
$310.40
|
| Rate for Payer: BCBS MAPPO |
$78.83
|
| Rate for Payer: BCN Medicare Advantage |
$78.83
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Cofinity Commercial |
$105.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.77
|
| Rate for Payer: Nomi Health Commercial |
$94.60
|
| Rate for Payer: PACE SWMI |
$78.83
|
| Rate for Payer: PHP Commercial |
$110.36
|
| Rate for Payer: PHP Medicare Advantage |
$78.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.40
|
| Rate for Payer: Priority Health Medicare |
$78.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.83
|
| Rate for Payer: UHC Medicare Advantage |
$78.83
|
| Rate for Payer: UMR Bronson Commercial |
$356.96
|
|
|
PR INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 33285
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$174.20 |
| Rate for Payer: Aetna Commercial |
$111.76
|
| Rate for Payer: Aetna Medicare |
$86.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.76
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS MAPPO |
$83.40
|
| Rate for Payer: BCN Medicare Advantage |
$83.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$120.10
|
| Rate for Payer: Cofinity Commercial |
$111.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.57
|
| Rate for Payer: Nomi Health Commercial |
$100.08
|
| Rate for Payer: PACE SWMI |
$83.40
|
| Rate for Payer: PHP Commercial |
$116.76
|
| Rate for Payer: PHP Medicare Advantage |
$83.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.20
|
| Rate for Payer: Priority Health Medicare |
$83.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.40
|
| Rate for Payer: UHC Medicare Advantage |
$83.40
|
| Rate for Payer: UMR Bronson Commercial |
$123.28
|
|
|
PR INSERTION TANDEM CUFF
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 53444
|
| Min. Negotiated Rate |
$606.80 |
| Max. Negotiated Rate |
$1,092.28 |
| Rate for Payer: Aetna Commercial |
$1,016.43
|
| Rate for Payer: Aetna Medicare |
$788.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,092.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.43
|
| Rate for Payer: BCBS Complete |
$606.80
|
| Rate for Payer: BCBS MAPPO |
$758.53
|
| Rate for Payer: BCN Medicare Advantage |
$758.53
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cofinity Commercial |
$1,092.28
|
| Rate for Payer: Cofinity Commercial |
$1,016.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$758.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$796.46
|
| Rate for Payer: Nomi Health Commercial |
$910.24
|
| Rate for Payer: PACE SWMI |
$758.53
|
| Rate for Payer: PHP Commercial |
$1,061.94
|
| Rate for Payer: PHP Medicare Advantage |
$758.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.05
|
| Rate for Payer: Priority Health Medicare |
$758.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$758.53
|
| Rate for Payer: UHC Medicare Advantage |
$758.53
|
| Rate for Payer: UMR Bronson Commercial |
$697.82
|
|
|
PR INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 49421
|
| Min. Negotiated Rate |
$219.80 |
| Max. Negotiated Rate |
$850.20 |
| Rate for Payer: Aetna Commercial |
$294.53
|
| Rate for Payer: Aetna Medicare |
$228.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.53
|
| Rate for Payer: BCBS Complete |
$523.20
|
| Rate for Payer: BCBS MAPPO |
$219.80
|
| Rate for Payer: BCN Medicare Advantage |
$219.80
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cofinity Commercial |
$316.51
|
| Rate for Payer: Cofinity Commercial |
$294.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.79
|
| Rate for Payer: Nomi Health Commercial |
$263.76
|
| Rate for Payer: PACE SWMI |
$219.80
|
| Rate for Payer: PHP Commercial |
$307.72
|
| Rate for Payer: PHP Medicare Advantage |
$219.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.20
|
| Rate for Payer: Priority Health Medicare |
$219.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.80
|
| Rate for Payer: UHC Medicare Advantage |
$219.80
|
| Rate for Payer: UMR Bronson Commercial |
$601.68
|
|
|
PR INSERTION VAGINAL RADIATION DEVICE
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 57156
|
| Min. Negotiated Rate |
$144.78 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: Aetna Commercial |
$194.01
|
| Rate for Payer: Aetna Medicare |
$150.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.01
|
| Rate for Payer: BCBS Complete |
$156.40
|
| Rate for Payer: BCBS MAPPO |
$144.78
|
| Rate for Payer: BCN Medicare Advantage |
$144.78
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Cofinity Commercial |
$208.48
|
| Rate for Payer: Cofinity Commercial |
$194.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.02
|
| Rate for Payer: Nomi Health Commercial |
$173.74
|
| Rate for Payer: PACE SWMI |
$144.78
|
| Rate for Payer: PHP Commercial |
$202.69
|
| Rate for Payer: PHP Medicare Advantage |
$144.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.15
|
| Rate for Payer: Priority Health Medicare |
$144.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.78
|
| Rate for Payer: UHC Medicare Advantage |
$144.78
|
| Rate for Payer: UMR Bronson Commercial |
$179.86
|
|
|
PR INSERTION VASCULAR PEDICLE CARPAL BONE
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 25430
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$1,020.44 |
| Rate for Payer: Aetna Commercial |
$949.58
|
| Rate for Payer: Aetna Medicare |
$736.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$949.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.44
|
| Rate for Payer: BCBS Complete |
$494.00
|
| Rate for Payer: BCBS MAPPO |
$708.64
|
| Rate for Payer: BCN Medicare Advantage |
$708.64
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cofinity Commercial |
$949.58
|
| Rate for Payer: Cofinity Commercial |
$1,020.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$744.07
|
| Rate for Payer: Nomi Health Commercial |
$850.37
|
| Rate for Payer: PACE SWMI |
$708.64
|
| Rate for Payer: PHP Commercial |
$992.10
|
| Rate for Payer: PHP Medicare Advantage |
$708.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.75
|
| Rate for Payer: Priority Health Medicare |
$708.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$708.64
|
| Rate for Payer: UHC Medicare Advantage |
$708.64
|
| Rate for Payer: UMR Bronson Commercial |
$568.10
|
|
|
PR INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 20650
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna Commercial |
$216.07
|
| Rate for Payer: Aetna Medicare |
$167.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.07
|
| Rate for Payer: BCBS Complete |
$132.00
|
| Rate for Payer: BCBS MAPPO |
$161.25
|
| Rate for Payer: BCN Medicare Advantage |
$161.25
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$232.20
|
| Rate for Payer: Cofinity Commercial |
$216.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.31
|
| Rate for Payer: Nomi Health Commercial |
$193.50
|
| Rate for Payer: PACE SWMI |
$161.25
|
| Rate for Payer: PHP Commercial |
$225.75
|
| Rate for Payer: PHP Medicare Advantage |
$161.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health Medicare |
$161.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.25
|
| Rate for Payer: UHC Medicare Advantage |
$161.25
|
| Rate for Payer: UMR Bronson Commercial |
$151.80
|
|
|
PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, EA ADD
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 0172T
|
| Min. Negotiated Rate |
$211.60 |
| Max. Negotiated Rate |
$343.85 |
| Rate for Payer: Aetna Medicare |
$264.50
|
| Rate for Payer: BCBS Complete |
$211.60
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.85
|
| Rate for Payer: UMR Bronson Commercial |
$243.34
|
|
|
PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, SINGLE
|
Professional
|
Both
|
$2,734.00
|
|
|
Service Code
|
HCPCS 0171T
|
| Min. Negotiated Rate |
$1,093.60 |
| Max. Negotiated Rate |
$1,777.10 |
| Rate for Payer: Aetna Medicare |
$1,367.00
|
| Rate for Payer: BCBS Complete |
$1,093.60
|
| Rate for Payer: Cash Price |
$2,187.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,777.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,257.64
|
|
|
PR INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT
|
Professional
|
Both
|
$1,168.00
|
|
|
Service Code
|
HCPCS 53855
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$759.20 |
| Rate for Payer: Aetna Commercial |
$104.55
|
| Rate for Payer: Aetna Medicare |
$81.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.55
|
| Rate for Payer: BCBS Complete |
$467.20
|
| Rate for Payer: BCBS MAPPO |
$78.02
|
| Rate for Payer: BCN Medicare Advantage |
$78.02
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cofinity Commercial |
$104.55
|
| Rate for Payer: Cofinity Commercial |
$112.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.92
|
| Rate for Payer: Nomi Health Commercial |
$93.62
|
| Rate for Payer: PACE SWMI |
$78.02
|
| Rate for Payer: PHP Commercial |
$109.23
|
| Rate for Payer: PHP Medicare Advantage |
$78.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.20
|
| Rate for Payer: Priority Health Medicare |
$78.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.02
|
| Rate for Payer: UHC Medicare Advantage |
$78.02
|
| Rate for Payer: UMR Bronson Commercial |
$537.28
|
|
|
PR INSERT TRAY W/O BAG/CATH
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.54 |
| Rate for Payer: Aetna Commercial |
$14.46
|
| Rate for Payer: Aetna Medicare |
$11.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$10.79
|
| Rate for Payer: BCN Medicare Advantage |
$10.79
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.33
|
| Rate for Payer: Nomi Health Commercial |
$12.95
|
| Rate for Payer: PACE SWMI |
$10.79
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Medicare Advantage |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$10.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.79
|
| Rate for Payer: UHC Medicare Advantage |
$10.79
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR
|
Professional
|
Both
|
$2,147.00
|
|
|
Service Code
|
HCPCS 36557
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$1,395.55 |
| Rate for Payer: Aetna Commercial |
$415.40
|
| Rate for Payer: Aetna Medicare |
$322.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.40
|
| Rate for Payer: BCBS Complete |
$858.80
|
| Rate for Payer: BCBS MAPPO |
$310.00
|
| Rate for Payer: BCN Medicare Advantage |
$310.00
|
| Rate for Payer: Cash Price |
$1,717.60
|
| Rate for Payer: Cash Price |
$1,717.60
|
| Rate for Payer: Cofinity Commercial |
$446.40
|
| Rate for Payer: Cofinity Commercial |
$415.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.50
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: PACE SWMI |
$310.00
|
| Rate for Payer: PHP Commercial |
$434.00
|
| Rate for Payer: PHP Medicare Advantage |
$310.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.55
|
| Rate for Payer: Priority Health Medicare |
$310.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.00
|
| Rate for Payer: UHC Medicare Advantage |
$310.00
|
| Rate for Payer: UMR Bronson Commercial |
$987.62
|
|
|
PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 37191
|
| Min. Negotiated Rate |
$208.54 |
| Max. Negotiated Rate |
$1,803.10 |
| Rate for Payer: Aetna Commercial |
$279.44
|
| Rate for Payer: Aetna Medicare |
$216.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.44
|
| Rate for Payer: BCBS Complete |
$1,109.60
|
| Rate for Payer: BCBS MAPPO |
$208.54
|
| Rate for Payer: BCN Medicare Advantage |
$208.54
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cofinity Commercial |
$300.30
|
| Rate for Payer: Cofinity Commercial |
$279.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$218.97
|
| Rate for Payer: Nomi Health Commercial |
$250.25
|
| Rate for Payer: PACE SWMI |
$208.54
|
| Rate for Payer: PHP Commercial |
$291.96
|
| Rate for Payer: PHP Medicare Advantage |
$208.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health Medicare |
$208.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.54
|
| Rate for Payer: UHC Medicare Advantage |
$208.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,276.04
|
|
|
PR IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART
|
Professional
|
Both
|
$3,309.00
|
|
|
Service Code
|
HCPCS 35585
|
| Min. Negotiated Rate |
$1,323.60 |
| Max. Negotiated Rate |
$2,306.06 |
| Rate for Payer: Aetna Commercial |
$2,145.92
|
| Rate for Payer: Aetna Medicare |
$1,665.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,306.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,145.92
|
| Rate for Payer: BCBS Complete |
$1,323.60
|
| Rate for Payer: BCBS MAPPO |
$1,601.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,601.43
|
| Rate for Payer: Cash Price |
$2,647.20
|
| Rate for Payer: Cash Price |
$2,647.20
|
| Rate for Payer: Cofinity Commercial |
$2,306.06
|
| Rate for Payer: Cofinity Commercial |
$2,145.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,601.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,681.50
|
| Rate for Payer: Nomi Health Commercial |
$1,921.72
|
| Rate for Payer: PACE SWMI |
$1,601.43
|
| Rate for Payer: PHP Commercial |
$2,242.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,601.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,150.85
|
| Rate for Payer: Priority Health Medicare |
$1,601.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,601.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,601.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,522.14
|
|
|
PR IN-SITU VEIN BYPASS FEMORAL-POPLITEAL
|
Professional
|
Both
|
$4,664.00
|
|
|
Service Code
|
HCPCS 35583
|
| Min. Negotiated Rate |
$1,382.11 |
| Max. Negotiated Rate |
$3,031.60 |
| Rate for Payer: Aetna Commercial |
$1,852.03
|
| Rate for Payer: Aetna Medicare |
$1,437.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,990.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,852.03
|
| Rate for Payer: BCBS Complete |
$1,865.60
|
| Rate for Payer: BCBS MAPPO |
$1,382.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,382.11
|
| Rate for Payer: Cash Price |
$3,731.20
|
| Rate for Payer: Cash Price |
$3,731.20
|
| Rate for Payer: Cofinity Commercial |
$1,990.24
|
| Rate for Payer: Cofinity Commercial |
$1,852.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,382.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,451.22
|
| Rate for Payer: Nomi Health Commercial |
$1,658.53
|
| Rate for Payer: PACE SWMI |
$1,382.11
|
| Rate for Payer: PHP Commercial |
$1,934.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,382.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,031.60
|
| Rate for Payer: Priority Health Medicare |
$1,382.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,382.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,382.11
|
| Rate for Payer: UMR Bronson Commercial |
$2,145.44
|
|
