|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,130.30 |
| Max. Negotiated Rate |
$1,461.60 |
| Rate for Payer: Aetna Commercial |
$1,380.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.26
|
| Rate for Payer: BCN Commercial |
$1,341.26
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$1,396.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.20
|
| Rate for Payer: Healthscope Commercial |
$1,461.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,218.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,380.40
|
| Rate for Payer: Nomi Health Commercial |
$1,331.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PHP Commercial |
$1,380.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,412.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,130.30
|
| Rate for Payer: UHC Core |
$1,356.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,218.00
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
38525
|
| Min. Negotiated Rate |
$274.56 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$545.65
|
| Rate for Payer: Aetna Medicare |
$812.00
|
| Rate for Payer: BCBS Complete |
$288.29
|
| Rate for Payer: BCN Commercial |
$668.79
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Mclaren Medicaid |
$274.56
|
| Rate for Payer: Meridian Medicaid |
$288.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$889.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$889.87
|
| Rate for Payer: UHC Medicaid |
$274.56
|
| Rate for Payer: UHCCP Medicaid |
$274.56
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 38525
|
| Min. Negotiated Rate |
$274.56 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$545.65
|
| Rate for Payer: Aetna Medicare |
$812.00
|
| Rate for Payer: BCBS Complete |
$288.29
|
| Rate for Payer: BCN Commercial |
$668.79
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Mclaren Medicaid |
$274.56
|
| Rate for Payer: Meridian Medicaid |
$288.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$889.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$889.87
|
| Rate for Payer: UHC Medicaid |
$274.56
|
| Rate for Payer: UHCCP Medicaid |
$274.56
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 38510
|
| Min. Negotiated Rate |
$241.12 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$517.41
|
| Rate for Payer: Aetna Medicare |
$812.00
|
| Rate for Payer: BCBS Complete |
$253.18
|
| Rate for Payer: BCN Commercial |
$629.95
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Mclaren Medicaid |
$241.12
|
| Rate for Payer: Meridian Medicaid |
$253.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$838.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$838.19
|
| Rate for Payer: UHC Medicaid |
$241.12
|
| Rate for Payer: UHCCP Medicaid |
$241.12
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,130.30 |
| Max. Negotiated Rate |
$1,461.60 |
| Rate for Payer: Aetna Commercial |
$1,380.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.26
|
| Rate for Payer: BCN Commercial |
$1,341.26
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$1,396.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.20
|
| Rate for Payer: Healthscope Commercial |
$1,461.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,218.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,380.40
|
| Rate for Payer: Nomi Health Commercial |
$1,331.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PHP Commercial |
$1,380.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,412.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,130.30
|
| Rate for Payer: UHC Core |
$1,356.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,218.00
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
OP
|
$1,624.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$286.31 |
| Max. Negotiated Rate |
$1,461.60 |
| Rate for Payer: Aetna Commercial |
$1,380.40
|
| Rate for Payer: Aetna Medicare |
$422.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$507.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$507.50
|
| Rate for Payer: BCBS Complete |
$300.60
|
| Rate for Payer: BCBS MAPPO |
$406.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.09
|
| Rate for Payer: BCN Commercial |
$1,335.09
|
| Rate for Payer: BCN Medicare Advantage |
$406.00
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$1,396.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.00
|
| Rate for Payer: Healthscope Commercial |
$1,461.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,218.00
|
| Rate for Payer: Mclaren Medicaid |
$286.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$426.30
|
| Rate for Payer: Meridian Medicaid |
$300.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$466.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$446.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,380.40
|
| Rate for Payer: Nomi Health Commercial |
$1,331.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PACE Senior Care Partners |
$385.70
|
| Rate for Payer: PACE SWMI |
$406.00
|
| Rate for Payer: PHP Commercial |
$1,380.40
|
| Rate for Payer: PHP Medicare Advantage |
$406.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,412.88
|
| Rate for Payer: Priority Health Medicare |
$410.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,130.30
|
| Rate for Payer: Railroad Medicare Medicare |
$406.00
|
| Rate for Payer: UHC Core |
$1,356.04
|
| Rate for Payer: UHC Exchange |
$406.00
|
| Rate for Payer: UHC Medicaid |
$286.31
|
| Rate for Payer: UHC Medicare Advantage |
$406.00
|
| Rate for Payer: UHCCP Medicaid |
$286.31
|
| Rate for Payer: VA VA |
$406.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,218.00
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
38510
|
| Min. Negotiated Rate |
$241.12 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$517.41
|
| Rate for Payer: Aetna Medicare |
$812.00
|
| Rate for Payer: BCBS Complete |
$253.18
|
| Rate for Payer: BCN Commercial |
$629.95
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Mclaren Medicaid |
$241.12
|
| Rate for Payer: Meridian Medicaid |
$253.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$838.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$838.19
|
| Rate for Payer: UHC Medicaid |
$241.12
|
| Rate for Payer: UHCCP Medicaid |
$241.12
|
|
|
PR BX/EXC LYMPH NODE OPEN INT MAMMARY NODE
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 38530
|
| Min. Negotiated Rate |
$338.46 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna Commercial |
$697.32
|
| Rate for Payer: Aetna Medicare |
$876.00
|
| Rate for Payer: BCBS Complete |
$355.38
|
| Rate for Payer: BCN Commercial |
$862.00
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Mclaren Medicaid |
$338.46
|
| Rate for Payer: Meridian Medicaid |
$355.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$338.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,146.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,146.97
|
| Rate for Payer: UHC Medicaid |
$338.46
|
| Rate for Payer: UHCCP Medicaid |
$338.46
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.89 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Aetna Commercial |
$828.75
|
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$304.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$304.69
|
| Rate for Payer: BCBS Complete |
$180.47
|
| Rate for Payer: BCBS MAPPO |
$243.75
|
| Rate for Payer: BCBS Trust/PPO |
$801.55
|
| Rate for Payer: BCN Commercial |
$801.55
|
| Rate for Payer: BCN Medicare Advantage |
$243.75
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$838.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.75
|
| Rate for Payer: Healthscope Commercial |
$877.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.25
|
| Rate for Payer: Mclaren Medicaid |
$171.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.94
|
| Rate for Payer: Meridian Medicaid |
$180.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$268.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.75
|
| Rate for Payer: Nomi Health Commercial |
$799.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: PACE Senior Care Partners |
$231.56
|
| Rate for Payer: PACE SWMI |
$243.75
|
| Rate for Payer: PHP Commercial |
$828.75
|
| Rate for Payer: PHP Medicare Advantage |
$243.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$848.25
|
| Rate for Payer: Priority Health Medicare |
$246.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$678.60
|
| Rate for Payer: Railroad Medicare Medicare |
$243.75
|
| Rate for Payer: UHC Core |
$814.12
|
| Rate for Payer: UHC Exchange |
$243.75
|
| Rate for Payer: UHC Medicaid |
$171.89
|
| Rate for Payer: UHC Medicare Advantage |
$243.75
|
| Rate for Payer: UHCCP Medicaid |
$171.89
|
| Rate for Payer: VA VA |
$243.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.25
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 38500
|
| Min. Negotiated Rate |
$156.56 |
| Max. Negotiated Rate |
$731.25 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: Aetna Medicare |
$487.50
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCN Commercial |
$384.94
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Mclaren Medicaid |
$156.56
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$512.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.20
|
| Rate for Payer: UHC Medicaid |
$156.56
|
| Rate for Payer: UHCCP Medicaid |
$156.56
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
38500
|
| Min. Negotiated Rate |
$156.56 |
| Max. Negotiated Rate |
$731.25 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: Aetna Medicare |
$487.50
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCN Commercial |
$384.94
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Mclaren Medicaid |
$156.56
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$512.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.20
|
| Rate for Payer: UHC Medicaid |
$156.56
|
| Rate for Payer: UHCCP Medicaid |
$156.56
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$678.60 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Aetna Commercial |
$828.75
|
| Rate for Payer: BCBS Trust/PPO |
$805.25
|
| Rate for Payer: BCN Commercial |
$805.25
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$838.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.00
|
| Rate for Payer: Healthscope Commercial |
$877.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.75
|
| Rate for Payer: Nomi Health Commercial |
$799.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: PHP Commercial |
$828.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$848.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$678.60
|
| Rate for Payer: UHC Core |
$814.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.25
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Professional
|
Both
|
$1,902.00
|
|
|
Service Code
|
HCPCS 38520
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Aetna Commercial |
$576.38
|
| Rate for Payer: Aetna Medicare |
$951.00
|
| Rate for Payer: BCBS Complete |
$295.22
|
| Rate for Payer: BCN Commercial |
$709.63
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Mclaren Medicaid |
$281.16
|
| Rate for Payer: Meridian Medicaid |
$295.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,426.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$944.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$944.21
|
| Rate for Payer: UHC Medicaid |
$281.16
|
| Rate for Payer: UHCCP Medicaid |
$281.16
|
|
|
PR BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 44100
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: BCBS Complete |
$61.28
|
| Rate for Payer: BCN Commercial |
$156.37
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Mclaren Medicaid |
$58.36
|
| Rate for Payer: Meridian Medicaid |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.53
|
| Rate for Payer: UHC Medicaid |
$58.36
|
| Rate for Payer: UHCCP Medicaid |
$58.36
|
|
|
PR BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 47001
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: Aetna Commercial |
$140.29
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCN Commercial |
$154.87
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Mclaren Medicaid |
$59.00
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.71
|
| Rate for Payer: UHC Medicaid |
$59.00
|
| Rate for Payer: UHCCP Medicaid |
$59.00
|
|
|
PR BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 42806
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$178.76
|
| Rate for Payer: Aetna Medicare |
$208.00
|
| Rate for Payer: BCBS Complete |
$86.11
|
| Rate for Payer: BCN Commercial |
$214.13
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Mclaren Medicaid |
$82.01
|
| Rate for Payer: Meridian Medicaid |
$86.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$260.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.91
|
| Rate for Payer: UHC Medicaid |
$82.01
|
| Rate for Payer: UHCCP Medicaid |
$82.01
|
|
|
PR BX OF BREAST, NEEDLE CORE, IMAGE GUIDE
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS 19102
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna Medicare |
$213.00
|
| Rate for Payer: BCBS Complete |
$170.40
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.50
|
|
|
PR BX PROSTATE EA ADDL MRI-US FUSION/IN-BORE CT/MRI
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 55715
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: BCBS Complete |
$31.53
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Mclaren Medicaid |
$30.03
|
| Rate for Payer: Meridian Medicaid |
$31.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.44
|
| Rate for Payer: UHC Medicaid |
$30.03
|
| Rate for Payer: UHCCP Medicaid |
$30.03
|
|
|
PR BX PROSTATE TRANSRECTAL MRI-US GID TRGT LES 1ST
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 55711
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Aetna Medicare |
$439.50
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Mclaren Medicaid |
$86.48
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$659.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.95
|
| Rate for Payer: UHC Medicaid |
$86.48
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR BX PROSTATE TRANSRECTAL US GID W/MRI FUS GDN 1ST
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 55708
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Aetna Medicare |
$203.00
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Mclaren Medicaid |
$108.20
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$250.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.18
|
| Rate for Payer: UHC Medicaid |
$108.20
|
| Rate for Payer: UHCCP Medicaid |
$108.20
|
|
|
PR BX PRST8 NDL STRTCTC SATURATION SAMPLING IMG GID
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 55706
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$616.24 |
| Rate for Payer: Aetna Commercial |
$479.18
|
| Rate for Payer: Aetna Medicare |
$368.00
|
| Rate for Payer: BCBS Complete |
$136.21
|
| Rate for Payer: BCN Commercial |
$565.70
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Mclaren Medicaid |
$129.72
|
| Rate for Payer: Meridian Medicaid |
$136.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$616.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$616.24
|
| Rate for Payer: UHC Medicaid |
$129.72
|
| Rate for Payer: UHCCP Medicaid |
$129.72
|
|
|
PR BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 35681
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$245.25 |
| Rate for Payer: Aetna Commercial |
$108.37
|
| Rate for Payer: Aetna Medicare |
$163.50
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCN Commercial |
$115.53
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Mclaren Medicaid |
$45.80
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.23
|
| Rate for Payer: UHC Medicaid |
$45.80
|
| Rate for Payer: UHCCP Medicaid |
$45.80
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC
|
Professional
|
Both
|
$3,404.00
|
|
|
Service Code
|
HCPCS 35632
|
| Min. Negotiated Rate |
$1,046.26 |
| Max. Negotiated Rate |
$2,837.17 |
| Rate for Payer: Aetna Commercial |
$2,431.56
|
| Rate for Payer: Aetna Medicare |
$1,702.00
|
| Rate for Payer: BCBS Complete |
$1,098.57
|
| Rate for Payer: BCN Commercial |
$2,638.30
|
| Rate for Payer: Cash Price |
$2,723.20
|
| Rate for Payer: Cash Price |
$2,723.20
|
| Rate for Payer: Mclaren Medicaid |
$1,046.26
|
| Rate for Payer: Meridian Medicaid |
$1,098.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,553.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,837.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,837.17
|
| Rate for Payer: UHC Medicaid |
$1,046.26
|
| Rate for Payer: UHCCP Medicaid |
$1,046.26
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC
|
Professional
|
Both
|
$3,813.00
|
|
|
Service Code
|
HCPCS 35633
|
| Min. Negotiated Rate |
$1,149.35 |
| Max. Negotiated Rate |
$3,101.18 |
| Rate for Payer: Aetna Commercial |
$2,665.69
|
| Rate for Payer: Aetna Medicare |
$1,906.50
|
| Rate for Payer: BCBS Complete |
$1,206.82
|
| Rate for Payer: BCN Commercial |
$2,883.81
|
| Rate for Payer: Cash Price |
$3,050.40
|
| Rate for Payer: Cash Price |
$3,050.40
|
| Rate for Payer: Mclaren Medicaid |
$1,149.35
|
| Rate for Payer: Meridian Medicaid |
$1,206.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,859.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,149.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,101.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,101.18
|
| Rate for Payer: UHC Medicaid |
$1,149.35
|
| Rate for Payer: UHCCP Medicaid |
$1,149.35
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL
|
Professional
|
Both
|
$3,329.00
|
|
|
Service Code
|
HCPCS 35634
|
| Min. Negotiated Rate |
$1,024.10 |
| Max. Negotiated Rate |
$2,776.65 |
| Rate for Payer: Aetna Commercial |
$2,379.07
|
| Rate for Payer: Aetna Medicare |
$1,664.50
|
| Rate for Payer: BCBS Complete |
$1,075.31
|
| Rate for Payer: BCN Commercial |
$2,582.03
|
| Rate for Payer: Cash Price |
$2,663.20
|
| Rate for Payer: Cash Price |
$2,663.20
|
| Rate for Payer: Mclaren Medicaid |
$1,024.10
|
| Rate for Payer: Meridian Medicaid |
$1,075.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,024.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,776.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,776.65
|
| Rate for Payer: UHC Medicaid |
$1,024.10
|
| Rate for Payer: UHCCP Medicaid |
$1,024.10
|
|
