|
PR RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
HCPCS 49520
|
| Hospital Charge Code |
49520
|
| Min. Negotiated Rate |
$387.87 |
| Max. Negotiated Rate |
$1,329.75 |
| Rate for Payer: Aetna Commercial |
$853.76
|
| Rate for Payer: Aetna Medicare |
$886.50
|
| Rate for Payer: BCBS Complete |
$407.26
|
| Rate for Payer: BCN Commercial |
$958.62
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Mclaren Medicaid |
$387.87
|
| Rate for Payer: Meridian Medicaid |
$407.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,329.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,168.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,168.01
|
| Rate for Payer: UHC Medicaid |
$387.87
|
| Rate for Payer: UHCCP Medicaid |
$387.87
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 49521
|
| Hospital Charge Code |
49521
|
| Min. Negotiated Rate |
$436.86 |
| Max. Negotiated Rate |
$1,616.25 |
| Rate for Payer: Aetna Commercial |
$967.53
|
| Rate for Payer: Aetna Medicare |
$1,077.50
|
| Rate for Payer: BCBS Complete |
$458.70
|
| Rate for Payer: BCN Commercial |
$1,085.60
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Mclaren Medicaid |
$436.86
|
| Rate for Payer: Meridian Medicaid |
$458.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,616.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,322.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,322.72
|
| Rate for Payer: UHC Medicaid |
$436.86
|
| Rate for Payer: UHCCP Medicaid |
$436.86
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 49521
|
| Min. Negotiated Rate |
$436.86 |
| Max. Negotiated Rate |
$1,616.25 |
| Rate for Payer: Aetna Commercial |
$967.53
|
| Rate for Payer: Aetna Medicare |
$1,077.50
|
| Rate for Payer: BCBS Complete |
$458.70
|
| Rate for Payer: BCN Commercial |
$1,085.60
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Mclaren Medicaid |
$436.86
|
| Rate for Payer: Meridian Medicaid |
$458.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,616.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,322.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,322.72
|
| Rate for Payer: UHC Medicaid |
$436.86
|
| Rate for Payer: UHCCP Medicaid |
$436.86
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
49521
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$379.93 |
| Max. Negotiated Rate |
$1,939.50 |
| Rate for Payer: Aetna Commercial |
$1,831.75
|
| Rate for Payer: Aetna Medicare |
$560.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$673.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$673.44
|
| Rate for Payer: BCBS Complete |
$398.89
|
| Rate for Payer: BCBS MAPPO |
$538.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,771.63
|
| Rate for Payer: BCN Commercial |
$1,771.63
|
| Rate for Payer: BCN Medicare Advantage |
$538.75
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Cofinity Commercial |
$1,853.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,724.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.75
|
| Rate for Payer: Healthscope Commercial |
$1,939.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,616.25
|
| Rate for Payer: Mclaren Medicaid |
$379.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$565.69
|
| Rate for Payer: Meridian Medicaid |
$398.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$619.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$592.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,831.75
|
| Rate for Payer: Nomi Health Commercial |
$1,767.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,616.25
|
| Rate for Payer: PACE Senior Care Partners |
$511.81
|
| Rate for Payer: PACE SWMI |
$538.75
|
| Rate for Payer: PHP Commercial |
$1,831.75
|
| Rate for Payer: PHP Medicare Advantage |
$538.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$379.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,874.85
|
| Rate for Payer: Priority Health Medicare |
$544.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,499.88
|
| Rate for Payer: Railroad Medicare Medicare |
$538.75
|
| Rate for Payer: UHC Core |
$1,799.42
|
| Rate for Payer: UHC Exchange |
$538.75
|
| Rate for Payer: UHC Medicaid |
$379.93
|
| Rate for Payer: UHC Medicare Advantage |
$538.75
|
| Rate for Payer: UHCCP Medicaid |
$379.93
|
| Rate for Payer: VA VA |
$538.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,616.25
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
49521
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,499.88 |
| Max. Negotiated Rate |
$1,939.50 |
| Rate for Payer: Aetna Commercial |
$1,831.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,779.81
|
| Rate for Payer: BCN Commercial |
$1,779.81
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Cofinity Commercial |
$1,853.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,724.00
|
| Rate for Payer: Healthscope Commercial |
$1,939.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,616.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,831.75
|
| Rate for Payer: Nomi Health Commercial |
$1,767.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,616.25
|
| Rate for Payer: PHP Commercial |
$1,831.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,874.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,499.88
|
| Rate for Payer: UHC Core |
$1,799.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,616.25
|
|
|
PR RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT
|
Professional
|
Both
|
$4,603.00
|
|
|
Service Code
|
HCPCS 38115
|
| Min. Negotiated Rate |
$766.37 |
| Max. Negotiated Rate |
$3,452.25 |
| Rate for Payer: Aetna Commercial |
$1,592.12
|
| Rate for Payer: Aetna Medicare |
$2,301.50
|
| Rate for Payer: BCBS Complete |
$804.69
|
| Rate for Payer: BCN Commercial |
$1,937.14
|
| Rate for Payer: Cash Price |
$3,682.40
|
| Rate for Payer: Cash Price |
$3,682.40
|
| Rate for Payer: Mclaren Medicaid |
$766.37
|
| Rate for Payer: Meridian Medicaid |
$804.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,452.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,577.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,577.53
|
| Rate for Payer: UHC Medicaid |
$766.37
|
| Rate for Payer: UHCCP Medicaid |
$766.37
|
|
|
PR RPR SINUS VALSALVA FISTULA
|
Professional
|
Both
|
$3,326.00
|
|
|
Service Code
|
HCPCS 33702
|
| Min. Negotiated Rate |
$933.37 |
| Max. Negotiated Rate |
$2,494.50 |
| Rate for Payer: Aetna Commercial |
$2,076.08
|
| Rate for Payer: Aetna Medicare |
$1,663.00
|
| Rate for Payer: BCBS Complete |
$980.04
|
| Rate for Payer: BCN Commercial |
$2,286.23
|
| Rate for Payer: Cash Price |
$2,660.80
|
| Rate for Payer: Cash Price |
$2,660.80
|
| Rate for Payer: Mclaren Medicaid |
$933.37
|
| Rate for Payer: Meridian Medicaid |
$980.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,494.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$933.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,458.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,458.56
|
| Rate for Payer: UHC Medicaid |
$933.37
|
| Rate for Payer: UHCCP Medicaid |
$933.37
|
|
|
PR RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 49600
|
| Min. Negotiated Rate |
$448.79 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: Aetna Commercial |
$991.65
|
| Rate for Payer: Aetna Medicare |
$1,015.00
|
| Rate for Payer: BCBS Complete |
$471.23
|
| Rate for Payer: BCN Commercial |
$1,112.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Mclaren Medicaid |
$448.79
|
| Rate for Payer: Meridian Medicaid |
$471.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,522.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,354.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,354.89
|
| Rate for Payer: UHC Medicaid |
$448.79
|
| Rate for Payer: UHCCP Medicaid |
$448.79
|
|
|
PR RPR SPIGELIAN HERNIA
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 49590
|
| Min. Negotiated Rate |
$670.00 |
| Max. Negotiated Rate |
$1,256.25 |
| Rate for Payer: Aetna Medicare |
$837.50
|
| Rate for Payer: BCBS Complete |
$670.00
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,256.25
|
|
|
PR RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL
|
Professional
|
Both
|
$8,123.00
|
|
|
Service Code
|
HCPCS 38780
|
| Min. Negotiated Rate |
$624.30 |
| Max. Negotiated Rate |
$6,092.25 |
| Rate for Payer: Aetna Commercial |
$1,285.27
|
| Rate for Payer: Aetna Medicare |
$4,061.50
|
| Rate for Payer: BCBS Complete |
$655.51
|
| Rate for Payer: BCN Commercial |
$1,586.56
|
| Rate for Payer: Cash Price |
$6,498.40
|
| Rate for Payer: Cash Price |
$6,498.40
|
| Rate for Payer: Mclaren Medicaid |
$624.30
|
| Rate for Payer: Meridian Medicaid |
$655.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,092.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,111.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,111.06
|
| Rate for Payer: UHC Medicaid |
$624.30
|
| Rate for Payer: UHCCP Medicaid |
$624.30
|
|
|
PR RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON
|
Professional
|
Both
|
$1,291.00
|
|
|
Service Code
|
HCPCS 28200
|
| Min. Negotiated Rate |
$199.58 |
| Max. Negotiated Rate |
$968.25 |
| Rate for Payer: Aetna Commercial |
$428.78
|
| Rate for Payer: Aetna Medicare |
$645.50
|
| Rate for Payer: BCBS Complete |
$209.56
|
| Rate for Payer: BCN Commercial |
$497.98
|
| Rate for Payer: Cash Price |
$1,032.80
|
| Rate for Payer: Cash Price |
$1,032.80
|
| Rate for Payer: Mclaren Medicaid |
$199.58
|
| Rate for Payer: Meridian Medicaid |
$209.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$968.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$532.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.34
|
| Rate for Payer: UHC Medicaid |
$199.58
|
| Rate for Payer: UHCCP Medicaid |
$199.58
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS
|
Professional
|
Both
|
$1,292.00
|
|
|
Service Code
|
HCPCS 25263
|
| Min. Negotiated Rate |
$387.66 |
| Max. Negotiated Rate |
$1,042.29 |
| Rate for Payer: Aetna Commercial |
$843.92
|
| Rate for Payer: Aetna Medicare |
$646.00
|
| Rate for Payer: BCBS Complete |
$407.04
|
| Rate for Payer: BCN Commercial |
$975.05
|
| Rate for Payer: Cash Price |
$1,033.60
|
| Rate for Payer: Cash Price |
$1,033.60
|
| Rate for Payer: Mclaren Medicaid |
$387.66
|
| Rate for Payer: Meridian Medicaid |
$407.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,042.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,042.29
|
| Rate for Payer: UHC Medicaid |
$387.66
|
| Rate for Payer: UHCCP Medicaid |
$387.66
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 25260
|
| Min. Negotiated Rate |
$382.12 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna Commercial |
$841.29
|
| Rate for Payer: Aetna Medicare |
$876.00
|
| Rate for Payer: BCBS Complete |
$401.23
|
| Rate for Payer: BCN Commercial |
$977.53
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Mclaren Medicaid |
$382.12
|
| Rate for Payer: Meridian Medicaid |
$401.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,044.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,044.96
|
| Rate for Payer: UHC Medicaid |
$382.12
|
| Rate for Payer: UHCCP Medicaid |
$382.12
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
HCPCS 25270
|
| Min. Negotiated Rate |
$300.33 |
| Max. Negotiated Rate |
$1,095.75 |
| Rate for Payer: Aetna Commercial |
$656.88
|
| Rate for Payer: Aetna Medicare |
$730.50
|
| Rate for Payer: BCBS Complete |
$315.35
|
| Rate for Payer: BCN Commercial |
$762.90
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Mclaren Medicaid |
$300.33
|
| Rate for Payer: Meridian Medicaid |
$315.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,095.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$815.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$815.53
|
| Rate for Payer: UHC Medicaid |
$300.33
|
| Rate for Payer: UHCCP Medicaid |
$300.33
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 25272
|
| Min. Negotiated Rate |
$341.65 |
| Max. Negotiated Rate |
$1,252.50 |
| Rate for Payer: Aetna Commercial |
$747.23
|
| Rate for Payer: Aetna Medicare |
$835.00
|
| Rate for Payer: BCBS Complete |
$358.73
|
| Rate for Payer: BCN Commercial |
$861.01
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Mclaren Medicaid |
$341.65
|
| Rate for Payer: Meridian Medicaid |
$358.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,252.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$920.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$920.39
|
| Rate for Payer: UHC Medicaid |
$341.65
|
| Rate for Payer: UHCCP Medicaid |
$341.65
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN
|
Professional
|
Both
|
$2,371.00
|
|
|
Service Code
|
HCPCS 25274
|
| Min. Negotiated Rate |
$392.77 |
| Max. Negotiated Rate |
$1,778.25 |
| Rate for Payer: Aetna Commercial |
$886.74
|
| Rate for Payer: Aetna Medicare |
$1,185.50
|
| Rate for Payer: BCBS Complete |
$412.41
|
| Rate for Payer: BCN Commercial |
$1,021.86
|
| Rate for Payer: Cash Price |
$1,896.80
|
| Rate for Payer: Cash Price |
$1,896.80
|
| Rate for Payer: Mclaren Medicaid |
$392.77
|
| Rate for Payer: Meridian Medicaid |
$412.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,778.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,092.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,092.34
|
| Rate for Payer: UHC Medicaid |
$392.77
|
| Rate for Payer: UHCCP Medicaid |
$392.77
|
|
|
PR RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$2,086.00
|
|
|
Service Code
|
HCPCS 25275
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$1,564.50 |
| Rate for Payer: Aetna Commercial |
$894.15
|
| Rate for Payer: Aetna Medicare |
$1,043.00
|
| Rate for Payer: BCBS Complete |
$417.77
|
| Rate for Payer: BCN Commercial |
$1,032.31
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Mclaren Medicaid |
$397.88
|
| Rate for Payer: Meridian Medicaid |
$417.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,564.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,103.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,103.51
|
| Rate for Payer: UHC Medicaid |
$397.88
|
| Rate for Payer: UHCCP Medicaid |
$397.88
|
|
|
PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 28210
|
| Min. Negotiated Rate |
$253.47 |
| Max. Negotiated Rate |
$731.25 |
| Rate for Payer: Aetna Commercial |
$564.04
|
| Rate for Payer: Aetna Medicare |
$487.50
|
| Rate for Payer: BCBS Complete |
$266.14
|
| Rate for Payer: BCN Commercial |
$638.41
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Mclaren Medicaid |
$253.47
|
| Rate for Payer: Meridian Medicaid |
$266.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$682.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$682.44
|
| Rate for Payer: UHC Medicaid |
$253.47
|
| Rate for Payer: UHCCP Medicaid |
$253.47
|
|
|
PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS
|
Professional
|
Both
|
$8,951.00
|
|
|
Service Code
|
HCPCS 33877
|
| Min. Negotiated Rate |
$2,099.54 |
| Max. Negotiated Rate |
$6,713.25 |
| Rate for Payer: Aetna Commercial |
$4,855.61
|
| Rate for Payer: Aetna Medicare |
$4,475.50
|
| Rate for Payer: BCBS Complete |
$2,204.52
|
| Rate for Payer: BCN Commercial |
$5,272.13
|
| Rate for Payer: Cash Price |
$7,160.80
|
| Rate for Payer: Cash Price |
$7,160.80
|
| Rate for Payer: Mclaren Medicaid |
$2,099.54
|
| Rate for Payer: Meridian Medicaid |
$2,204.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,713.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,099.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,669.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,669.50
|
| Rate for Payer: UHC Medicaid |
$2,099.54
|
| Rate for Payer: UHCCP Medicaid |
$2,099.54
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$624.91 |
| Rate for Payer: Aetna Commercial |
$486.63
|
| Rate for Payer: Aetna Medicare |
$324.50
|
| Rate for Payer: BCBS Complete |
$237.07
|
| Rate for Payer: BCN Commercial |
$573.68
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Mclaren Medicaid |
$225.78
|
| Rate for Payer: Meridian Medicaid |
$237.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$624.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$624.91
|
| Rate for Payer: UHC Medicaid |
$225.78
|
| Rate for Payer: UHCCP Medicaid |
$225.78
|
|
|
PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 36575
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$345.75 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: Aetna Medicare |
$230.50
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCN Commercial |
$49.30
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Mclaren Medicaid |
$18.96
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$53.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.01
|
| Rate for Payer: UHC Medicaid |
$18.96
|
| Rate for Payer: UHCCP Medicaid |
$18.96
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS INCARCERATED
|
Professional
|
Both
|
$1,507.00
|
|
|
Service Code
|
HCPCS 49582
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$1,130.25 |
| Rate for Payer: Aetna Medicare |
$753.50
|
| Rate for Payer: BCBS Complete |
$602.80
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.25
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 49580
|
| Min. Negotiated Rate |
$522.40 |
| Max. Negotiated Rate |
$979.50 |
| Rate for Payer: Aetna Medicare |
$653.00
|
| Rate for Payer: BCBS Complete |
$522.40
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$979.50
|
|
|
PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,736.00
|
|
|
Service Code
|
HCPCS 49587
|
| Min. Negotiated Rate |
$694.40 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna Medicare |
$868.00
|
| Rate for Payer: BCBS Complete |
$694.40
|
| Rate for Payer: Cash Price |
$1,388.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,302.00
|
|
|
PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,507.00
|
|
|
Service Code
|
HCPCS 49585
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$1,130.25 |
| Rate for Payer: Aetna Medicare |
$753.50
|
| Rate for Payer: BCBS Complete |
$602.80
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.25
|
|
