|
PR INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 19342
|
| Min. Negotiated Rate |
$670.80 |
| Max. Negotiated Rate |
$1,090.05 |
| Rate for Payer: Aetna Commercial |
$976.35
|
| Rate for Payer: Aetna Medicare |
$728.62
|
| Rate for Payer: BCBS Complete |
$670.80
|
| Rate for Payer: BCBS MAPPO |
$728.62
|
| Rate for Payer: BCN Medicare Advantage |
$728.62
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cofinity Commercial |
$976.35
|
| Rate for Payer: Cofinity Commercial |
$1,049.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.62
|
| Rate for Payer: Healthscope Commercial |
$874.34
|
| Rate for Payer: Healthscope Whirlpool |
$874.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$765.05
|
| Rate for Payer: Nomi Health Commercial |
$874.34
|
| Rate for Payer: PACE SWMI |
$728.62
|
| Rate for Payer: PHP Medicare Advantage |
$728.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health Medicare |
$728.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.62
|
| Rate for Payer: UHC Medicare Advantage |
$728.62
|
| Rate for Payer: UHCCP DNSP |
$728.62
|
|
|
PR INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS
|
Professional
|
Both
|
$1,890.00
|
|
|
Service Code
|
HCPCS 61886
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$1,244.89 |
| Rate for Payer: Aetna Commercial |
$1,158.44
|
| Rate for Payer: Aetna Medicare |
$864.51
|
| Rate for Payer: BCBS Complete |
$756.00
|
| Rate for Payer: BCBS MAPPO |
$864.51
|
| Rate for Payer: BCN Medicare Advantage |
$864.51
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cofinity Commercial |
$1,244.89
|
| Rate for Payer: Cofinity Commercial |
$1,158.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.51
|
| Rate for Payer: Healthscope Commercial |
$1,037.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,037.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.74
|
| Rate for Payer: Nomi Health Commercial |
$1,037.41
|
| Rate for Payer: PACE SWMI |
$864.51
|
| Rate for Payer: PHP Medicare Advantage |
$864.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,228.50
|
| Rate for Payer: Priority Health Medicare |
$864.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.51
|
| Rate for Payer: UHC Medicare Advantage |
$864.51
|
| Rate for Payer: UHCCP DNSP |
$864.51
|
|
|
PR INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR
|
Professional
|
Both
|
$1,654.00
|
|
|
Service Code
|
HCPCS 61885
|
| Min. Negotiated Rate |
$518.12 |
| Max. Negotiated Rate |
$1,075.10 |
| Rate for Payer: Aetna Commercial |
$694.28
|
| Rate for Payer: Aetna Medicare |
$518.12
|
| Rate for Payer: BCBS Complete |
$661.60
|
| Rate for Payer: BCBS MAPPO |
$518.12
|
| Rate for Payer: BCN Medicare Advantage |
$518.12
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Cofinity Commercial |
$746.09
|
| Rate for Payer: Cofinity Commercial |
$694.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.12
|
| Rate for Payer: Healthscope Commercial |
$621.74
|
| Rate for Payer: Healthscope Whirlpool |
$621.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$544.03
|
| Rate for Payer: Nomi Health Commercial |
$621.74
|
| Rate for Payer: PACE SWMI |
$518.12
|
| Rate for Payer: PHP Medicare Advantage |
$518.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.10
|
| Rate for Payer: Priority Health Medicare |
$518.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$518.12
|
| Rate for Payer: UHC Medicare Advantage |
$518.12
|
| Rate for Payer: UHCCP DNSP |
$518.12
|
|
|
PR INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR
|
Professional
|
Both
|
$1,897.00
|
|
|
Service Code
|
HCPCS 33249
|
| Min. Negotiated Rate |
$758.80 |
| Max. Negotiated Rate |
$1,245.17 |
| Rate for Payer: Aetna Commercial |
$1,158.70
|
| Rate for Payer: Aetna Medicare |
$864.70
|
| Rate for Payer: BCBS Complete |
$758.80
|
| Rate for Payer: BCBS MAPPO |
$864.70
|
| Rate for Payer: BCN Medicare Advantage |
$864.70
|
| Rate for Payer: Cash Price |
$1,517.60
|
| Rate for Payer: Cash Price |
$1,517.60
|
| Rate for Payer: Cofinity Commercial |
$1,245.17
|
| Rate for Payer: Cofinity Commercial |
$1,158.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.70
|
| Rate for Payer: Healthscope Commercial |
$1,037.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,037.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.93
|
| Rate for Payer: Nomi Health Commercial |
$1,037.64
|
| Rate for Payer: PACE SWMI |
$864.70
|
| Rate for Payer: PHP Medicare Advantage |
$864.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,233.05
|
| Rate for Payer: Priority Health Medicare |
$864.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.70
|
| Rate for Payer: UHC Medicare Advantage |
$864.70
|
| Rate for Payer: UHCCP DNSP |
$864.70
|
|
|
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 63685
|
| Min. Negotiated Rate |
$326.77 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$437.87
|
| Rate for Payer: Aetna Medicare |
$326.77
|
| Rate for Payer: BCBS Complete |
$914.80
|
| Rate for Payer: BCBS MAPPO |
$326.77
|
| Rate for Payer: BCN Medicare Advantage |
$326.77
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$470.55
|
| Rate for Payer: Cofinity Commercial |
$437.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.77
|
| Rate for Payer: Healthscope Commercial |
$392.12
|
| Rate for Payer: Healthscope Whirlpool |
$392.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.11
|
| Rate for Payer: Nomi Health Commercial |
$392.12
|
| Rate for Payer: PACE SWMI |
$326.77
|
| Rate for Payer: PHP Medicare Advantage |
$326.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health Medicare |
$326.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.77
|
| Rate for Payer: UHC Medicare Advantage |
$326.77
|
| Rate for Payer: UHCCP DNSP |
$326.77
|
|
|
PR INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH
|
Professional
|
Both
|
$1,036.00
|
|
|
Service Code
|
HCPCS 33210
|
| Min. Negotiated Rate |
$153.80 |
| Max. Negotiated Rate |
$673.40 |
| Rate for Payer: Aetna Commercial |
$206.09
|
| Rate for Payer: Aetna Medicare |
$153.80
|
| Rate for Payer: BCBS Complete |
$414.40
|
| Rate for Payer: BCBS MAPPO |
$153.80
|
| Rate for Payer: BCN Medicare Advantage |
$153.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cofinity Commercial |
$221.47
|
| Rate for Payer: Cofinity Commercial |
$206.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.80
|
| Rate for Payer: Healthscope Commercial |
$184.56
|
| Rate for Payer: Healthscope Whirlpool |
$184.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.49
|
| Rate for Payer: Nomi Health Commercial |
$184.56
|
| Rate for Payer: PACE SWMI |
$153.80
|
| Rate for Payer: PHP Medicare Advantage |
$153.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.40
|
| Rate for Payer: Priority Health Medicare |
$153.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.80
|
| Rate for Payer: UHC Medicare Advantage |
$153.80
|
| Rate for Payer: UHCCP DNSP |
$153.80
|
|
|
PR INSJ SUBQ RSVR PUMP/CONT INFUSION SYS VENTR CATH
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 61215
|
| Min. Negotiated Rate |
$509.55 |
| Max. Negotiated Rate |
$1,771.25 |
| Rate for Payer: Aetna Commercial |
$682.80
|
| Rate for Payer: Aetna Medicare |
$509.55
|
| Rate for Payer: BCBS Complete |
$1,090.00
|
| Rate for Payer: BCBS MAPPO |
$509.55
|
| Rate for Payer: BCN Medicare Advantage |
$509.55
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$733.75
|
| Rate for Payer: Cofinity Commercial |
$682.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.55
|
| Rate for Payer: Healthscope Commercial |
$611.46
|
| Rate for Payer: Healthscope Whirlpool |
$611.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.03
|
| Rate for Payer: Nomi Health Commercial |
$611.46
|
| Rate for Payer: PACE SWMI |
$509.55
|
| Rate for Payer: PHP Medicare Advantage |
$509.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health Medicare |
$509.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.55
|
| Rate for Payer: UHC Medicare Advantage |
$509.55
|
| Rate for Payer: UHCCP DNSP |
$509.55
|
|
|
PR INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 51703
|
| Min. Negotiated Rate |
$72.56 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Commercial |
$97.23
|
| Rate for Payer: Aetna Medicare |
$72.56
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS MAPPO |
$72.56
|
| Rate for Payer: BCN Medicare Advantage |
$72.56
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$97.23
|
| Rate for Payer: Cofinity Commercial |
$104.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.56
|
| Rate for Payer: Healthscope Commercial |
$87.07
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.19
|
| Rate for Payer: Nomi Health Commercial |
$87.07
|
| Rate for Payer: PACE SWMI |
$72.56
|
| Rate for Payer: PHP Medicare Advantage |
$72.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health Medicare |
$72.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.56
|
| Rate for Payer: UHC Medicare Advantage |
$72.56
|
| Rate for Payer: UHCCP DNSP |
$72.56
|
|
|
PR INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 51702
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Medicare |
$23.67
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$23.67
|
| Rate for Payer: BCN Medicare Advantage |
$23.67
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$34.08
|
| Rate for Payer: Cofinity Commercial |
$31.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.67
|
| Rate for Payer: Healthscope Commercial |
$28.40
|
| Rate for Payer: Healthscope Whirlpool |
$28.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.85
|
| Rate for Payer: Nomi Health Commercial |
$28.40
|
| Rate for Payer: PACE SWMI |
$23.67
|
| Rate for Payer: PHP Medicare Advantage |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Medicare |
$23.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.67
|
| Rate for Payer: UHC Medicare Advantage |
$23.67
|
| Rate for Payer: UHCCP DNSP |
$23.67
|
|
|
PR INSJ TESTICULAR PROSTH SEPARATE PROCEDURE
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
HCPCS 54660
|
| Min. Negotiated Rate |
$291.60 |
| Max. Negotiated Rate |
$495.40 |
| Rate for Payer: Aetna Commercial |
$461.00
|
| Rate for Payer: Aetna Medicare |
$344.03
|
| Rate for Payer: BCBS Complete |
$291.60
|
| Rate for Payer: BCBS MAPPO |
$344.03
|
| Rate for Payer: BCN Medicare Advantage |
$344.03
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cofinity Commercial |
$495.40
|
| Rate for Payer: Cofinity Commercial |
$461.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.03
|
| Rate for Payer: Healthscope Commercial |
$412.84
|
| Rate for Payer: Healthscope Whirlpool |
$412.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.23
|
| Rate for Payer: Nomi Health Commercial |
$412.84
|
| Rate for Payer: PACE SWMI |
$344.03
|
| Rate for Payer: PHP Medicare Advantage |
$344.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.85
|
| Rate for Payer: Priority Health Medicare |
$344.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.03
|
| Rate for Payer: UHC Medicare Advantage |
$344.03
|
| Rate for Payer: UHCCP DNSP |
$344.03
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
OP
|
$3,446.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36561
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$3,101.40
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$3,342.62
|
| Rate for Payer: ASR Commercial |
$3,342.62
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,821.93
|
| Rate for Payer: BCN Commercial |
$2,671.68
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cofinity Commercial |
$3,239.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,756.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$3,446.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,342.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$3,101.40
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,929.10
|
| Rate for Payer: Nomi Health Commercial |
$2,825.72
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,019.39
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,415.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,032.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$3,446.00
|
|
|
Service Code
|
HCPCS 36561
|
| Min. Negotiated Rate |
$314.43 |
| Max. Negotiated Rate |
$2,239.90 |
| Rate for Payer: Aetna Commercial |
$421.34
|
| Rate for Payer: Aetna Medicare |
$314.43
|
| Rate for Payer: BCBS Complete |
$1,378.40
|
| Rate for Payer: BCBS MAPPO |
$314.43
|
| Rate for Payer: BCN Medicare Advantage |
$314.43
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cofinity Commercial |
$452.78
|
| Rate for Payer: Cofinity Commercial |
$421.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.43
|
| Rate for Payer: Healthscope Commercial |
$377.32
|
| Rate for Payer: Healthscope Whirlpool |
$377.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.15
|
| Rate for Payer: Nomi Health Commercial |
$377.32
|
| Rate for Payer: PACE SWMI |
$314.43
|
| Rate for Payer: PHP Medicare Advantage |
$314.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: Priority Health Medicare |
$314.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.43
|
| Rate for Payer: UHC Medicare Advantage |
$314.43
|
| Rate for Payer: UHCCP DNSP |
$314.43
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$3,446.00
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
36561
|
| Min. Negotiated Rate |
$314.43 |
| Max. Negotiated Rate |
$2,239.90 |
| Rate for Payer: Aetna Commercial |
$421.34
|
| Rate for Payer: Aetna Medicare |
$314.43
|
| Rate for Payer: BCBS Complete |
$1,378.40
|
| Rate for Payer: BCBS MAPPO |
$314.43
|
| Rate for Payer: BCN Medicare Advantage |
$314.43
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cofinity Commercial |
$452.78
|
| Rate for Payer: Cofinity Commercial |
$421.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.43
|
| Rate for Payer: Healthscope Commercial |
$377.32
|
| Rate for Payer: Healthscope Whirlpool |
$377.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.15
|
| Rate for Payer: Nomi Health Commercial |
$377.32
|
| Rate for Payer: PACE SWMI |
$314.43
|
| Rate for Payer: PHP Medicare Advantage |
$314.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: Priority Health Medicare |
$314.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.43
|
| Rate for Payer: UHC Medicare Advantage |
$314.43
|
| Rate for Payer: UHCCP DNSP |
$314.43
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
IP
|
$3,446.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36561
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,239.90 |
| Max. Negotiated Rate |
$3,446.00 |
| Rate for Payer: Aetna Commercial |
$3,101.40
|
| Rate for Payer: ASR ASR |
$3,342.62
|
| Rate for Payer: ASR Commercial |
$3,342.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,808.15
|
| Rate for Payer: BCN Commercial |
$2,671.68
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cofinity Commercial |
$3,239.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,756.80
|
| Rate for Payer: Healthscope Commercial |
$3,446.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,342.62
|
| Rate for Payer: Mclaren Commercial |
$3,101.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,929.10
|
| Rate for Payer: Nomi Health Commercial |
$2,825.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,032.48
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR
|
Professional
|
Both
|
$3,579.00
|
|
|
Service Code
|
HCPCS 36560
|
| Min. Negotiated Rate |
$370.88 |
| Max. Negotiated Rate |
$2,326.35 |
| Rate for Payer: Aetna Commercial |
$496.98
|
| Rate for Payer: Aetna Medicare |
$370.88
|
| Rate for Payer: BCBS Complete |
$1,431.60
|
| Rate for Payer: BCBS MAPPO |
$370.88
|
| Rate for Payer: BCN Medicare Advantage |
$370.88
|
| Rate for Payer: Cash Price |
$2,863.20
|
| Rate for Payer: Cash Price |
$2,863.20
|
| Rate for Payer: Cofinity Commercial |
$534.07
|
| Rate for Payer: Cofinity Commercial |
$496.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.88
|
| Rate for Payer: Healthscope Commercial |
$445.06
|
| Rate for Payer: Healthscope Whirlpool |
$445.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.42
|
| Rate for Payer: Nomi Health Commercial |
$445.06
|
| Rate for Payer: PACE SWMI |
$370.88
|
| Rate for Payer: PHP Medicare Advantage |
$370.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,326.35
|
| Rate for Payer: Priority Health Medicare |
$370.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.88
|
| Rate for Payer: UHC Medicare Advantage |
$370.88
|
| Rate for Payer: UHCCP DNSP |
$370.88
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PUMP
|
Professional
|
Both
|
$3,589.00
|
|
|
Service Code
|
HCPCS 36563
|
| Min. Negotiated Rate |
$346.72 |
| Max. Negotiated Rate |
$2,332.85 |
| Rate for Payer: Aetna Commercial |
$464.60
|
| Rate for Payer: Aetna Medicare |
$346.72
|
| Rate for Payer: BCBS Complete |
$1,435.60
|
| Rate for Payer: BCBS MAPPO |
$346.72
|
| Rate for Payer: BCN Medicare Advantage |
$346.72
|
| Rate for Payer: Cash Price |
$2,871.20
|
| Rate for Payer: Cash Price |
$2,871.20
|
| Rate for Payer: Cofinity Commercial |
$499.28
|
| Rate for Payer: Cofinity Commercial |
$464.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.72
|
| Rate for Payer: Healthscope Commercial |
$416.06
|
| Rate for Payer: Healthscope Whirlpool |
$416.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.06
|
| Rate for Payer: Nomi Health Commercial |
$416.06
|
| Rate for Payer: PACE SWMI |
$346.72
|
| Rate for Payer: PHP Medicare Advantage |
$346.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.85
|
| Rate for Payer: Priority Health Medicare |
$346.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.72
|
| Rate for Payer: UHC Medicare Advantage |
$346.72
|
| Rate for Payer: UHCCP DNSP |
$346.72
|
|
|
PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>
|
Professional
|
Both
|
$1,982.00
|
|
|
Service Code
|
HCPCS 36558
|
| Min. Negotiated Rate |
$244.86 |
| Max. Negotiated Rate |
$1,288.30 |
| Rate for Payer: Aetna Commercial |
$328.11
|
| Rate for Payer: Aetna Medicare |
$244.86
|
| Rate for Payer: BCBS Complete |
$792.80
|
| Rate for Payer: BCBS MAPPO |
$244.86
|
| Rate for Payer: BCN Medicare Advantage |
$244.86
|
| Rate for Payer: Cash Price |
$1,585.60
|
| Rate for Payer: Cash Price |
$1,585.60
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Cofinity Commercial |
$328.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.86
|
| Rate for Payer: Healthscope Commercial |
$293.83
|
| Rate for Payer: Healthscope Whirlpool |
$293.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.10
|
| Rate for Payer: Nomi Health Commercial |
$293.83
|
| Rate for Payer: PACE SWMI |
$244.86
|
| Rate for Payer: PHP Medicare Advantage |
$244.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.30
|
| Rate for Payer: Priority Health Medicare |
$244.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.86
|
| Rate for Payer: UHC Medicare Advantage |
$244.86
|
| Rate for Payer: UHCCP DNSP |
$244.86
|
|
|
PR INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 36565
|
| Min. Negotiated Rate |
$322.82 |
| Max. Negotiated Rate |
$1,129.70 |
| Rate for Payer: Aetna Commercial |
$432.58
|
| Rate for Payer: Aetna Medicare |
$322.82
|
| Rate for Payer: BCBS Complete |
$695.20
|
| Rate for Payer: BCBS MAPPO |
$322.82
|
| Rate for Payer: BCN Medicare Advantage |
$322.82
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$464.86
|
| Rate for Payer: Cofinity Commercial |
$432.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.82
|
| Rate for Payer: Healthscope Commercial |
$387.38
|
| Rate for Payer: Healthscope Whirlpool |
$387.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.96
|
| Rate for Payer: Nomi Health Commercial |
$387.38
|
| Rate for Payer: PACE SWMI |
$322.82
|
| Rate for Payer: PHP Medicare Advantage |
$322.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health Medicare |
$322.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.82
|
| Rate for Payer: UHC Medicare Advantage |
$322.82
|
| Rate for Payer: UHCCP DNSP |
$322.82
|
|
|
PR INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT
|
Professional
|
Both
|
$2,907.00
|
|
|
Service Code
|
HCPCS 36566
|
| Min. Negotiated Rate |
$339.58 |
| Max. Negotiated Rate |
$1,889.55 |
| Rate for Payer: Aetna Commercial |
$455.04
|
| Rate for Payer: Aetna Medicare |
$339.58
|
| Rate for Payer: BCBS Complete |
$1,162.80
|
| Rate for Payer: BCBS MAPPO |
$339.58
|
| Rate for Payer: BCN Medicare Advantage |
$339.58
|
| Rate for Payer: Cash Price |
$2,325.60
|
| Rate for Payer: Cash Price |
$2,325.60
|
| Rate for Payer: Cofinity Commercial |
$489.00
|
| Rate for Payer: Cofinity Commercial |
$455.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.58
|
| Rate for Payer: Healthscope Commercial |
$407.50
|
| Rate for Payer: Healthscope Whirlpool |
$407.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.56
|
| Rate for Payer: Nomi Health Commercial |
$407.50
|
| Rate for Payer: PACE SWMI |
$339.58
|
| Rate for Payer: PHP Medicare Advantage |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,889.55
|
| Rate for Payer: Priority Health Medicare |
$339.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.58
|
| Rate for Payer: UHC Medicare Advantage |
$339.58
|
| Rate for Payer: UHCCP DNSP |
$339.58
|
|
|
PR INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL
|
Professional
|
Both
|
$1,514.00
|
|
|
Service Code
|
HCPCS 33206
|
| Min. Negotiated Rate |
$431.04 |
| Max. Negotiated Rate |
$984.10 |
| Rate for Payer: Aetna Commercial |
$577.59
|
| Rate for Payer: Aetna Medicare |
$431.04
|
| Rate for Payer: BCBS Complete |
$605.60
|
| Rate for Payer: BCBS MAPPO |
$431.04
|
| Rate for Payer: BCN Medicare Advantage |
$431.04
|
| Rate for Payer: Cash Price |
$1,211.20
|
| Rate for Payer: Cash Price |
$1,211.20
|
| Rate for Payer: Cofinity Commercial |
$620.70
|
| Rate for Payer: Cofinity Commercial |
$577.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$431.04
|
| Rate for Payer: Healthscope Commercial |
$517.25
|
| Rate for Payer: Healthscope Whirlpool |
$517.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$452.59
|
| Rate for Payer: Nomi Health Commercial |
$517.25
|
| Rate for Payer: PACE SWMI |
$431.04
|
| Rate for Payer: PHP Medicare Advantage |
$431.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.10
|
| Rate for Payer: Priority Health Medicare |
$431.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$431.04
|
| Rate for Payer: UHC Medicare Advantage |
$431.04
|
| Rate for Payer: UHCCP DNSP |
$431.04
|
|
|
PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 33208
|
| Min. Negotiated Rate |
$491.57 |
| Max. Negotiated Rate |
$1,082.25 |
| Rate for Payer: Aetna Commercial |
$658.70
|
| Rate for Payer: Aetna Medicare |
$491.57
|
| Rate for Payer: BCBS Complete |
$666.00
|
| Rate for Payer: BCBS MAPPO |
$491.57
|
| Rate for Payer: BCN Medicare Advantage |
$491.57
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$707.86
|
| Rate for Payer: Cofinity Commercial |
$658.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.57
|
| Rate for Payer: Healthscope Commercial |
$589.88
|
| Rate for Payer: Healthscope Whirlpool |
$589.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$516.15
|
| Rate for Payer: Nomi Health Commercial |
$589.88
|
| Rate for Payer: PACE SWMI |
$491.57
|
| Rate for Payer: PHP Medicare Advantage |
$491.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health Medicare |
$491.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$491.57
|
| Rate for Payer: UHC Medicare Advantage |
$491.57
|
| Rate for Payer: UHCCP DNSP |
$491.57
|
|
|
PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
HCPCS 33207
|
| Min. Negotiated Rate |
$455.01 |
| Max. Negotiated Rate |
$1,180.40 |
| Rate for Payer: Aetna Commercial |
$609.71
|
| Rate for Payer: Aetna Medicare |
$455.01
|
| Rate for Payer: BCBS Complete |
$726.40
|
| Rate for Payer: BCBS MAPPO |
$455.01
|
| Rate for Payer: BCN Medicare Advantage |
$455.01
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cofinity Commercial |
$655.21
|
| Rate for Payer: Cofinity Commercial |
$609.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.01
|
| Rate for Payer: Healthscope Commercial |
$546.01
|
| Rate for Payer: Healthscope Whirlpool |
$546.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.76
|
| Rate for Payer: Nomi Health Commercial |
$546.01
|
| Rate for Payer: PACE SWMI |
$455.01
|
| Rate for Payer: PHP Medicare Advantage |
$455.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.40
|
| Rate for Payer: Priority Health Medicare |
$455.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$455.01
|
| Rate for Payer: UHC Medicare Advantage |
$455.01
|
| Rate for Payer: UHCCP DNSP |
$455.01
|
|
|
PR INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS
|
Professional
|
Both
|
$1,271.00
|
|
|
Service Code
|
HCPCS 33213
|
| Min. Negotiated Rate |
$320.17 |
| Max. Negotiated Rate |
$826.15 |
| Rate for Payer: Aetna Commercial |
$429.03
|
| Rate for Payer: Aetna Medicare |
$320.17
|
| Rate for Payer: BCBS Complete |
$508.40
|
| Rate for Payer: BCBS MAPPO |
$320.17
|
| Rate for Payer: BCN Medicare Advantage |
$320.17
|
| Rate for Payer: Cash Price |
$1,016.80
|
| Rate for Payer: Cash Price |
$1,016.80
|
| Rate for Payer: Cofinity Commercial |
$461.04
|
| Rate for Payer: Cofinity Commercial |
$429.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.17
|
| Rate for Payer: Healthscope Commercial |
$384.20
|
| Rate for Payer: Healthscope Whirlpool |
$384.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.18
|
| Rate for Payer: Nomi Health Commercial |
$384.20
|
| Rate for Payer: PACE SWMI |
$320.17
|
| Rate for Payer: PHP Medicare Advantage |
$320.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.15
|
| Rate for Payer: Priority Health Medicare |
$320.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.17
|
| Rate for Payer: UHC Medicare Advantage |
$320.17
|
| Rate for Payer: UHCCP DNSP |
$320.17
|
|
|
PR INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 33221
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$487.32 |
| Rate for Payer: Aetna Commercial |
$453.48
|
| Rate for Payer: Aetna Medicare |
$338.42
|
| Rate for Payer: BCBS Complete |
$297.60
|
| Rate for Payer: BCBS MAPPO |
$338.42
|
| Rate for Payer: BCN Medicare Advantage |
$338.42
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cofinity Commercial |
$487.32
|
| Rate for Payer: Cofinity Commercial |
$453.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.42
|
| Rate for Payer: Healthscope Commercial |
$406.10
|
| Rate for Payer: Healthscope Whirlpool |
$406.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.34
|
| Rate for Payer: Nomi Health Commercial |
$406.10
|
| Rate for Payer: PACE SWMI |
$338.42
|
| Rate for Payer: PHP Medicare Advantage |
$338.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.60
|
| Rate for Payer: Priority Health Medicare |
$338.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.42
|
| Rate for Payer: UHC Medicare Advantage |
$338.42
|
| Rate for Payer: UHCCP DNSP |
$338.42
|
|
|
PR INS PM PLS GEN W/EXIST SINGLE LEAD
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 33212
|
| Min. Negotiated Rate |
$307.65 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$412.25
|
| Rate for Payer: Aetna Medicare |
$307.65
|
| Rate for Payer: BCBS Complete |
$448.00
|
| Rate for Payer: BCBS MAPPO |
$307.65
|
| Rate for Payer: BCN Medicare Advantage |
$307.65
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$443.02
|
| Rate for Payer: Cofinity Commercial |
$412.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.65
|
| Rate for Payer: Healthscope Commercial |
$369.18
|
| Rate for Payer: Healthscope Whirlpool |
$369.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.03
|
| Rate for Payer: Nomi Health Commercial |
$369.18
|
| Rate for Payer: PACE SWMI |
$307.65
|
| Rate for Payer: PHP Medicare Advantage |
$307.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.00
|
| Rate for Payer: Priority Health Medicare |
$307.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$307.65
|
| Rate for Payer: UHC Medicare Advantage |
$307.65
|
| Rate for Payer: UHCCP DNSP |
$307.65
|
|
