|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$476.27 |
| Max. Negotiated Rate |
$1,039.07 |
| Rate for Payer: Aetna Commercial |
$932.51
|
| Rate for Payer: BCBS Complete |
$500.08
|
| Rate for Payer: BCBS Trust/PPO |
$614.94
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Meridian Medicaid |
$500.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,039.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,039.07
|
| Rate for Payer: Priority Health SBD |
$1,039.07
|
| Rate for Payer: UMR Bronson Commercial |
$553.38
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$176.36 |
| Max. Negotiated Rate |
$1,139.30 |
| Rate for Payer: Aetna Commercial |
$299.73
|
| Rate for Payer: BCBS Complete |
$185.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.30
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Meridian Medicaid |
$185.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.11
|
| Rate for Payer: Priority Health Narrow Network |
$339.11
|
| Rate for Payer: Priority Health SBD |
$339.11
|
| Rate for Payer: UMR Bronson Commercial |
$418.60
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,208.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$212.57 |
| Max. Negotiated Rate |
$2,272.50 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.50
|
| Rate for Payer: Cash Price |
$966.40
|
| Rate for Payer: Cash Price |
$966.40
|
| Rate for Payer: Meridian Medicaid |
$223.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.57
|
| Rate for Payer: Priority Health Narrow Network |
$408.57
|
| Rate for Payer: Priority Health SBD |
$408.57
|
| Rate for Payer: UMR Bronson Commercial |
$555.68
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$415.10 |
| Rate for Payer: Aetna Commercial |
$260.73
|
| Rate for Payer: BCBS Complete |
$161.25
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Meridian Medicaid |
$161.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.30
|
| Rate for Payer: Priority Health Narrow Network |
$294.30
|
| Rate for Payer: Priority Health SBD |
$294.30
|
| Rate for Payer: UMR Bronson Commercial |
$272.78
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$191.70 |
| Max. Negotiated Rate |
$896.00 |
| Rate for Payer: Aetna Commercial |
$324.96
|
| Rate for Payer: BCBS Complete |
$201.28
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Meridian Medicaid |
$201.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.70
|
| Rate for Payer: Priority Health Narrow Network |
$368.70
|
| Rate for Payer: Priority Health SBD |
$368.70
|
| Rate for Payer: UMR Bronson Commercial |
$588.80
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$136.49
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Meridian Medicaid |
$83.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.67
|
| Rate for Payer: Priority Health Narrow Network |
$151.67
|
| Rate for Payer: Priority Health SBD |
$151.67
|
| Rate for Payer: UMR Bronson Commercial |
$184.00
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$375.20 |
| Rate for Payer: Aetna Commercial |
$250.47
|
| Rate for Payer: BCBS Complete |
$154.54
|
| Rate for Payer: BCBS Trust/PPO |
$84.02
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Meridian Medicaid |
$154.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.20
|
| Rate for Payer: Priority Health Narrow Network |
$283.20
|
| Rate for Payer: Priority Health SBD |
$283.20
|
| Rate for Payer: UMR Bronson Commercial |
$246.56
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$277.38
|
| Rate for Payer: BCBS Complete |
$171.76
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Meridian Medicaid |
$171.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.21
|
| Rate for Payer: Priority Health Narrow Network |
$313.21
|
| Rate for Payer: Priority Health SBD |
$313.21
|
| Rate for Payer: UMR Bronson Commercial |
$404.80
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna American Axle |
$572.00
|
| Rate for Payer: Aetna Commercial |
$748.00
|
| Rate for Payer: Aetna Medicare |
$580.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$572.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$621.27
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cofinity Commercial |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$756.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Healthscope Commercial |
$792.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$616.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$660.00
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$748.00
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Commercial |
$748.00
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$554.40
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.26
|
| Rate for Payer: UHC Exchange |
$251.48
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: UMR Bronson Commercial |
$325.60
|
| Rate for Payer: VA VA |
$558.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$660.00
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$387.20 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna American Axle |
$572.00
|
| Rate for Payer: Aetna Commercial |
$748.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$572.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cofinity Commercial |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$756.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.00
|
| Rate for Payer: Healthscope Commercial |
$792.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$616.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$660.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$748.00
|
| Rate for Payer: PHP Commercial |
$748.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.00
|
| Rate for Payer: Priority Health SBD |
$554.40
|
| Rate for Payer: UMR Bronson Commercial |
$387.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$660.00
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$277.38
|
| Rate for Payer: BCBS Complete |
$171.76
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Meridian Medicaid |
$171.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.21
|
| Rate for Payer: Priority Health Narrow Network |
$313.21
|
| Rate for Payer: Priority Health SBD |
$313.21
|
| Rate for Payer: UMR Bronson Commercial |
$404.80
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$90.06
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.70
|
| Rate for Payer: Priority Health Narrow Network |
$100.70
|
| Rate for Payer: Priority Health SBD |
$100.70
|
| Rate for Payer: UMR Bronson Commercial |
$126.50
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.22 |
| Max. Negotiated Rate |
$1,329.80 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,329.80
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.24
|
| Rate for Payer: UHC Exchange |
$80.22
|
| Rate for Payer: UMR Bronson Commercial |
$101.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$90.06
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.70
|
| Rate for Payer: Priority Health Narrow Network |
$100.70
|
| Rate for Payer: Priority Health SBD |
$100.70
|
| Rate for Payer: UMR Bronson Commercial |
$126.50
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$127.37 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Aetna Commercial |
$215.74
|
| Rate for Payer: BCBS Complete |
$133.74
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Meridian Medicaid |
$133.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.57
|
| Rate for Payer: Priority Health Narrow Network |
$244.57
|
| Rate for Payer: Priority Health SBD |
$244.57
|
| Rate for Payer: UMR Bronson Commercial |
$248.86
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$457.10 |
| Rate for Payer: Aetna Commercial |
$267.18
|
| Rate for Payer: BCBS Complete |
$164.61
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Meridian Medicaid |
$164.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.70
|
| Rate for Payer: Priority Health Narrow Network |
$301.70
|
| Rate for Payer: Priority Health SBD |
$301.70
|
| Rate for Payer: UMR Bronson Commercial |
$300.38
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Aetna Commercial |
$78.51
|
| Rate for Payer: BCBS Complete |
$47.64
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Meridian Medicaid |
$47.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.14
|
| Rate for Payer: Priority Health Narrow Network |
$87.14
|
| Rate for Payer: Priority Health SBD |
$87.14
|
| Rate for Payer: UMR Bronson Commercial |
$94.30
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$324.80 |
| Rate for Payer: Aetna Commercial |
$148.88
|
| Rate for Payer: BCBS Complete |
$90.58
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Meridian Medicaid |
$90.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.47
|
| Rate for Payer: Priority Health Narrow Network |
$166.47
|
| Rate for Payer: Priority Health SBD |
$166.47
|
| Rate for Payer: UMR Bronson Commercial |
$213.44
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$1,913.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$517.47 |
| Max. Negotiated Rate |
$1,479.35 |
| Rate for Payer: Aetna Commercial |
$1,288.90
|
| Rate for Payer: BCBS Complete |
$652.61
|
| Rate for Payer: BCBS Trust/PPO |
$517.47
|
| Rate for Payer: Cash Price |
$1,530.40
|
| Rate for Payer: Cash Price |
$1,530.40
|
| Rate for Payer: Meridian Medicaid |
$652.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,479.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.35
|
| Rate for Payer: Priority Health SBD |
$1,479.35
|
| Rate for Payer: UMR Bronson Commercial |
$879.98
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,126.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$394.05 |
| Max. Negotiated Rate |
$3,872.44 |
| Rate for Payer: Aetna Commercial |
$797.98
|
| Rate for Payer: BCBS Complete |
$413.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,872.44
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Meridian Medicaid |
$413.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,488.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$929.90
|
| Rate for Payer: Priority Health Narrow Network |
$929.90
|
| Rate for Payer: Priority Health SBD |
$929.90
|
| Rate for Payer: UMR Bronson Commercial |
$977.96
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Aetna Commercial |
$590.68
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS Trust/PPO |
$744.37
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$785.64
|
| Rate for Payer: Priority Health Narrow Network |
$785.64
|
| Rate for Payer: Priority Health SBD |
$785.64
|
| Rate for Payer: UMR Bronson Commercial |
$563.50
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,023.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$522.28 |
| Max. Negotiated Rate |
$2,459.24 |
| Rate for Payer: Aetna Commercial |
$969.79
|
| Rate for Payer: BCBS Complete |
$548.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,459.24
|
| Rate for Payer: Cash Price |
$1,618.40
|
| Rate for Payer: Cash Price |
$1,618.40
|
| Rate for Payer: Meridian Medicaid |
$548.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,156.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,156.57
|
| Rate for Payer: Priority Health SBD |
$1,156.57
|
| Rate for Payer: UMR Bronson Commercial |
$930.58
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$326.53 |
| Max. Negotiated Rate |
$2,026.03 |
| Rate for Payer: Aetna Commercial |
$599.11
|
| Rate for Payer: BCBS Complete |
$342.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,026.03
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Meridian Medicaid |
$342.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.50
|
| Rate for Payer: Priority Health Narrow Network |
$721.50
|
| Rate for Payer: Priority Health SBD |
$721.50
|
| Rate for Payer: UMR Bronson Commercial |
$690.00
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$198.73 |
| Max. Negotiated Rate |
$584.83 |
| Rate for Payer: Aetna Commercial |
$400.74
|
| Rate for Payer: BCBS Complete |
$208.67
|
| Rate for Payer: BCBS Trust/PPO |
$584.83
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Meridian Medicaid |
$208.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.00
|
| Rate for Payer: Priority Health Narrow Network |
$538.00
|
| Rate for Payer: Priority Health SBD |
$538.00
|
| Rate for Payer: UMR Bronson Commercial |
$304.06
|
|
