|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$270.20 |
| Rate for Payer: Aetna Commercial |
$161.34
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.38
|
| Rate for Payer: Priority Health Narrow Network |
$185.38
|
| Rate for Payer: Priority Health SBD |
$185.38
|
| Rate for Payer: UMR Bronson Commercial |
$177.56
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Aetna Commercial |
$201.25
|
| Rate for Payer: BCBS Complete |
$127.48
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Meridian Medicaid |
$127.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.82
|
| Rate for Payer: Priority Health Narrow Network |
$231.82
|
| Rate for Payer: Priority Health SBD |
$231.82
|
| Rate for Payer: UMR Bronson Commercial |
$226.78
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Aetna Commercial |
$201.25
|
| Rate for Payer: BCBS Complete |
$127.48
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Meridian Medicaid |
$127.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.82
|
| Rate for Payer: Priority Health Narrow Network |
$231.82
|
| Rate for Payer: Priority Health SBD |
$231.82
|
| Rate for Payer: UMR Bronson Commercial |
$226.78
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$216.92 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Aetna American Axle |
$320.45
|
| Rate for Payer: Aetna Commercial |
$419.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.45
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cofinity Commercial |
$345.10
|
| Rate for Payer: Cofinity Commercial |
$423.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.40
|
| Rate for Payer: Healthscope Commercial |
$443.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.05
|
| Rate for Payer: PHP Commercial |
$419.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.10
|
| Rate for Payer: Priority Health SBD |
$310.59
|
| Rate for Payer: UMR Bronson Commercial |
$216.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.75
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$182.41 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$320.45
|
| Rate for Payer: Aetna Commercial |
$419.05
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$534.63
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cofinity Commercial |
$345.10
|
| Rate for Payer: Cofinity Commercial |
$423.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$443.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.75
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.05
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$419.05
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$310.59
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$186.64
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$182.41
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.75
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$209.59 |
| Max. Negotiated Rate |
$1,594.65 |
| Rate for Payer: Aetna Commercial |
$356.47
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.65
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.35
|
| Rate for Payer: Priority Health Narrow Network |
$400.35
|
| Rate for Payer: Priority Health SBD |
$400.35
|
| Rate for Payer: UMR Bronson Commercial |
$341.78
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$408.20
|
| Rate for Payer: Aetna Commercial |
$533.80
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$534.99
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cofinity Commercial |
$540.08
|
| Rate for Payer: Cofinity Commercial |
$439.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$565.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$439.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.00
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$533.80
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$533.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$395.64
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$201.38
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$232.36
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.00
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$439.60 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: BCBS Complete |
$137.55
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Meridian Medicaid |
$137.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.73
|
| Rate for Payer: Priority Health Narrow Network |
$250.73
|
| Rate for Payer: Priority Health SBD |
$250.73
|
| Rate for Payer: UMR Bronson Commercial |
$288.88
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
12034
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$439.60 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: BCBS Complete |
$137.55
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Meridian Medicaid |
$137.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.73
|
| Rate for Payer: Priority Health Narrow Network |
$250.73
|
| Rate for Payer: Priority Health SBD |
$250.73
|
| Rate for Payer: UMR Bronson Commercial |
$288.88
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$276.32 |
| Max. Negotiated Rate |
$565.20 |
| Rate for Payer: Aetna American Axle |
$408.20
|
| Rate for Payer: Aetna Commercial |
$533.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.20
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cofinity Commercial |
$439.60
|
| Rate for Payer: Cofinity Commercial |
$540.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.40
|
| Rate for Payer: Healthscope Commercial |
$565.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$439.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$533.80
|
| Rate for Payer: PHP Commercial |
$533.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.60
|
| Rate for Payer: Priority Health SBD |
$395.64
|
| Rate for Payer: UMR Bronson Commercial |
$276.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.00
|
|
|
PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 26591
|
| Min. Negotiated Rate |
$232.45 |
| Max. Negotiated Rate |
$760.36 |
| Rate for Payer: Aetna Commercial |
$635.36
|
| Rate for Payer: BCBS Complete |
$333.46
|
| Rate for Payer: BCBS Trust/PPO |
$232.45
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Meridian Medicaid |
$333.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.36
|
| Rate for Payer: Priority Health Narrow Network |
$760.36
|
| Rate for Payer: Priority Health SBD |
$760.36
|
| Rate for Payer: UMR Bronson Commercial |
$343.62
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$4,639.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$544.22 |
| Max. Negotiated Rate |
$3,247.30 |
| Rate for Payer: Aetna Commercial |
$877.19
|
| Rate for Payer: BCBS Complete |
$571.43
|
| Rate for Payer: BCBS Trust/PPO |
$575.32
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Meridian Medicaid |
$571.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$544.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,247.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,344.26
|
| Rate for Payer: Priority Health SBD |
$1,344.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,133.94
|
|
|
PR REPAIR LACERATION PALATE </2 CM
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$363.47 |
| Rate for Payer: Aetna Commercial |
$243.08
|
| Rate for Payer: BCBS Complete |
$126.81
|
| Rate for Payer: BCBS Trust/PPO |
$363.47
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Meridian Medicaid |
$126.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.02
|
| Rate for Payer: Priority Health Narrow Network |
$331.02
|
| Rate for Payer: Priority Health SBD |
$331.02
|
| Rate for Payer: UMR Bronson Commercial |
$156.86
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$166.14 |
| Max. Negotiated Rate |
$622.34 |
| Rate for Payer: Aetna Commercial |
$339.34
|
| Rate for Payer: BCBS Complete |
$174.45
|
| Rate for Payer: BCBS Trust/PPO |
$622.34
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Meridian Medicaid |
$174.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.69
|
| Rate for Payer: Priority Health Narrow Network |
$455.69
|
| Rate for Payer: Priority Health SBD |
$455.69
|
| Rate for Payer: UMR Bronson Commercial |
$332.58
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,253.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,577.10 |
| Rate for Payer: Aetna Commercial |
$948.56
|
| Rate for Payer: BCBS Complete |
$487.78
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Meridian Medicaid |
$487.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,102.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,102.49
|
| Rate for Payer: Priority Health SBD |
$1,102.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,036.38
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$431.54 |
| Max. Negotiated Rate |
$3,768.36 |
| Rate for Payer: Aetna Commercial |
$918.82
|
| Rate for Payer: BCBS Complete |
$453.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,768.36
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Meridian Medicaid |
$453.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,198.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,198.88
|
| Rate for Payer: Priority Health SBD |
$1,198.88
|
| Rate for Payer: UMR Bronson Commercial |
$542.34
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$2,310.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$595.76 |
| Max. Negotiated Rate |
$1,617.00 |
| Rate for Payer: Aetna Commercial |
$1,220.47
|
| Rate for Payer: BCBS Complete |
$625.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,195.01
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Meridian Medicaid |
$625.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$595.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,296.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,296.06
|
| Rate for Payer: Priority Health SBD |
$1,296.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,062.60
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,253.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$241.43 |
| Max. Negotiated Rate |
$1,577.10 |
| Rate for Payer: Aetna Commercial |
$942.95
|
| Rate for Payer: BCBS Complete |
$485.54
|
| Rate for Payer: BCBS Trust/PPO |
$241.43
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Meridian Medicaid |
$485.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,096.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,096.37
|
| Rate for Payer: Priority Health SBD |
$1,096.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,036.38
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,371.00
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$856.47 |
| Max. Negotiated Rate |
$3,059.70 |
| Rate for Payer: Aetna Commercial |
$1,689.72
|
| Rate for Payer: BCBS Complete |
$899.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,561.65
|
| Rate for Payer: Cash Price |
$3,496.80
|
| Rate for Payer: Cash Price |
$3,496.80
|
| Rate for Payer: Meridian Medicaid |
$899.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$856.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,059.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,253.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,253.57
|
| Rate for Payer: Priority Health SBD |
$2,253.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,010.66
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,992.00
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,087.15 |
| Max. Negotiated Rate |
$3,494.40 |
| Rate for Payer: Aetna Commercial |
$2,146.84
|
| Rate for Payer: BCBS Complete |
$1,141.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,441.73
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Meridian Medicaid |
$1,141.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,087.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,494.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,860.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,860.56
|
| Rate for Payer: Priority Health SBD |
$2,860.56
|
| Rate for Payer: UMR Bronson Commercial |
$2,296.32
|
|
|
PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$5,256.00
|
|
|
Service Code
|
HCPCS 63706
|
| Min. Negotiated Rate |
$1,205.37 |
| Max. Negotiated Rate |
$3,679.20 |
| Rate for Payer: Aetna Commercial |
$2,385.55
|
| Rate for Payer: BCBS Complete |
$1,265.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.41
|
| Rate for Payer: Cash Price |
$4,204.80
|
| Rate for Payer: Cash Price |
$4,204.80
|
| Rate for Payer: Meridian Medicaid |
$1,265.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,205.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,679.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,173.12
|
| Rate for Payer: Priority Health Narrow Network |
$3,173.12
|
| Rate for Payer: Priority Health SBD |
$3,173.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,417.76
|
|
|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$511.72 |
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: BCBS Complete |
$73.58
|
| Rate for Payer: BCBS Trust/PPO |
$511.72
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Meridian Medicaid |
$73.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.23
|
| Rate for Payer: Priority Health Narrow Network |
$135.23
|
| Rate for Payer: Priority Health SBD |
$135.23
|
| Rate for Payer: UMR Bronson Commercial |
$178.48
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$431.11 |
| Max. Negotiated Rate |
$1,246.00 |
| Rate for Payer: Aetna Commercial |
$847.07
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCBS Trust/PPO |
$953.05
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,246.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$943.22
|
| Rate for Payer: Priority Health Narrow Network |
$943.22
|
| Rate for Payer: Priority Health SBD |
$943.22
|
| Rate for Payer: UMR Bronson Commercial |
$818.80
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$1,654.00
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$522.49 |
| Max. Negotiated Rate |
$1,440.07 |
| Rate for Payer: Aetna Commercial |
$1,304.87
|
| Rate for Payer: BCBS Complete |
$693.32
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Meridian Medicaid |
$693.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$660.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,440.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,440.07
|
| Rate for Payer: Priority Health SBD |
$1,440.07
|
| Rate for Payer: UMR Bronson Commercial |
$760.84
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,512.00
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$432.68 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$1,440.34
|
| Rate for Payer: BCBS Complete |
$732.23
|
| Rate for Payer: BCBS Trust/PPO |
$432.68
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Meridian Medicaid |
$732.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$697.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,158.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,655.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,655.01
|
| Rate for Payer: Priority Health SBD |
$1,655.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,075.52
|
|
