|
PR REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV
|
Professional
|
Both
|
$2,186.00
|
|
|
Service Code
|
HCPCS 64569
|
| Min. Negotiated Rate |
$484.98 |
| Max. Negotiated Rate |
$1,530.20 |
| Rate for Payer: Aetna Commercial |
$983.52
|
| Rate for Payer: BCBS Complete |
$525.13
|
| Rate for Payer: BCBS Trust/PPO |
$484.98
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Meridian Medicaid |
$525.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,311.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,311.95
|
| Rate for Payer: Priority Health SBD |
$1,311.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,005.56
|
|
|
PR REVISION/RMVL PERIPHERAL/GASTRIC NPGR
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 64595
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$2,181.88 |
| Rate for Payer: Aetna Commercial |
$161.68
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,181.88
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.59
|
| Rate for Payer: Priority Health Narrow Network |
$214.59
|
| Rate for Payer: Priority Health SBD |
$214.59
|
| Rate for Payer: UMR Bronson Commercial |
$313.72
|
|
|
PR REVISION STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$3,840.00
|
|
|
Service Code
|
HCPCS 69662
|
| Min. Negotiated Rate |
$742.94 |
| Max. Negotiated Rate |
$3,121.20 |
| Rate for Payer: Aetna Commercial |
$1,316.73
|
| Rate for Payer: BCBS Complete |
$780.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,121.20
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Meridian Medicaid |
$780.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$742.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,688.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,644.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,644.46
|
| Rate for Payer: Priority Health SBD |
$1,644.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,766.40
|
|
|
PR REVISION TRACHEOSTOMY SCAR
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
HCPCS 31830
|
| Min. Negotiated Rate |
$237.50 |
| Max. Negotiated Rate |
$982.11 |
| Rate for Payer: Aetna Commercial |
$454.84
|
| Rate for Payer: BCBS Complete |
$249.38
|
| Rate for Payer: BCBS Trust/PPO |
$982.11
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Meridian Medicaid |
$249.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.52
|
| Rate for Payer: Priority Health Narrow Network |
$513.52
|
| Rate for Payer: Priority Health SBD |
$513.52
|
| Rate for Payer: UMR Bronson Commercial |
$314.18
|
|
|
PR REVIS PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
HCPCS 49426
|
| Min. Negotiated Rate |
$430.90 |
| Max. Negotiated Rate |
$1,414.00 |
| Rate for Payer: Aetna Commercial |
$903.18
|
| Rate for Payer: BCBS Complete |
$452.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,314.94
|
| Rate for Payer: Cash Price |
$1,616.00
|
| Rate for Payer: Cash Price |
$1,616.00
|
| Rate for Payer: Meridian Medicaid |
$452.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,182.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,182.41
|
| Rate for Payer: Priority Health SBD |
$1,182.41
|
| Rate for Payer: UMR Bronson Commercial |
$929.20
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$4,110.00
|
|
|
Service Code
|
HCPCS 23474
|
| Min. Negotiated Rate |
$341.30 |
| Max. Negotiated Rate |
$2,877.00 |
| Rate for Payer: Aetna Commercial |
$2,333.04
|
| Rate for Payer: BCBS Complete |
$1,165.67
|
| Rate for Payer: BCBS Trust/PPO |
$341.30
|
| Rate for Payer: Cash Price |
$3,288.00
|
| Rate for Payer: Cash Price |
$3,288.00
|
| Rate for Payer: Meridian Medicaid |
$1,165.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,110.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,877.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,649.77
|
| Rate for Payer: Priority Health Narrow Network |
$2,649.77
|
| Rate for Payer: Priority Health SBD |
$2,649.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,890.60
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
Both
|
$3,516.00
|
|
|
Service Code
|
HCPCS 23473
|
| Min. Negotiated Rate |
$225.83 |
| Max. Negotiated Rate |
$2,461.20 |
| Rate for Payer: Aetna Commercial |
$2,162.95
|
| Rate for Payer: BCBS Complete |
$1,080.01
|
| Rate for Payer: BCBS Trust/PPO |
$225.83
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Meridian Medicaid |
$1,080.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,028.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,461.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,454.70
|
| Rate for Payer: Priority Health Narrow Network |
$2,454.70
|
| Rate for Payer: Priority Health SBD |
$2,454.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,617.36
|
|
|
PR REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT
|
Professional
|
Both
|
$2,042.00
|
|
|
Service Code
|
HCPCS 25449
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$3,253.04 |
| Rate for Payer: Aetna Commercial |
$1,378.02
|
| Rate for Payer: BCBS Complete |
$698.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.04
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Meridian Medicaid |
$698.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$665.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,429.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,584.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,584.55
|
| Rate for Payer: Priority Health SBD |
$1,584.55
|
| Rate for Payer: UMR Bronson Commercial |
$939.32
|
|
|
PR REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 44345
|
| Min. Negotiated Rate |
$670.52 |
| Max. Negotiated Rate |
$1,841.54 |
| Rate for Payer: Aetna Commercial |
$1,408.79
|
| Rate for Payer: BCBS Complete |
$704.05
|
| Rate for Payer: BCBS Trust/PPO |
$697.88
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Meridian Medicaid |
$704.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$670.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,841.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,841.54
|
| Rate for Payer: Priority Health SBD |
$1,841.54
|
| Rate for Payer: UMR Bronson Commercial |
$958.18
|
|
|
PR REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 44340
|
| Min. Negotiated Rate |
$249.89 |
| Max. Negotiated Rate |
$1,104.80 |
| Rate for Payer: Aetna Commercial |
$833.87
|
| Rate for Payer: BCBS Complete |
$424.94
|
| Rate for Payer: BCBS Trust/PPO |
$249.89
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Meridian Medicaid |
$424.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$404.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,104.80
|
| Rate for Payer: Priority Health SBD |
$1,104.80
|
| Rate for Payer: UMR Bronson Commercial |
$502.32
|
|
|
PR REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 44346
|
| Min. Negotiated Rate |
$754.02 |
| Max. Negotiated Rate |
$2,070.26 |
| Rate for Payer: Aetna Commercial |
$1,590.78
|
| Rate for Payer: BCBS Complete |
$791.72
|
| Rate for Payer: BCBS Trust/PPO |
$785.58
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Meridian Medicaid |
$791.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$754.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,963.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,070.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,070.26
|
| Rate for Payer: Priority Health SBD |
$2,070.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,290.30
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/AUTOG VN PATCH GRF
|
Professional
|
Both
|
$2,568.00
|
|
|
Service Code
|
HCPCS 35884
|
| Min. Negotiated Rate |
$772.98 |
| Max. Negotiated Rate |
$1,921.96 |
| Rate for Payer: Aetna Commercial |
$1,667.74
|
| Rate for Payer: BCBS Complete |
$811.63
|
| Rate for Payer: BCBS Trust/PPO |
$926.64
|
| Rate for Payer: Cash Price |
$2,054.40
|
| Rate for Payer: Cash Price |
$2,054.40
|
| Rate for Payer: Meridian Medicaid |
$811.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,921.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,921.96
|
| Rate for Payer: Priority Health SBD |
$1,921.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,181.28
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF
|
Professional
|
Both
|
$2,316.00
|
|
|
Service Code
|
HCPCS 35883
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$1,858.66 |
| Rate for Payer: Aetna Commercial |
$1,617.26
|
| Rate for Payer: BCBS Complete |
$782.78
|
| Rate for Payer: BCBS Trust/PPO |
$876.98
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Meridian Medicaid |
$782.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,621.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,858.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,858.66
|
| Rate for Payer: Priority Health SBD |
$1,858.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,065.36
|
|
|
PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY
|
Professional
|
Both
|
$5,278.00
|
|
|
Service Code
|
HCPCS 43860
|
| Min. Negotiated Rate |
$163.77 |
| Max. Negotiated Rate |
$3,694.60 |
| Rate for Payer: Aetna Commercial |
$2,208.98
|
| Rate for Payer: BCBS Complete |
$1,096.11
|
| Rate for Payer: BCBS Trust/PPO |
$163.77
|
| Rate for Payer: Cash Price |
$4,222.40
|
| Rate for Payer: Cash Price |
$4,222.40
|
| Rate for Payer: Meridian Medicaid |
$1,096.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,043.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,694.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,869.89
|
| Rate for Payer: Priority Health Narrow Network |
$2,869.89
|
| Rate for Payer: Priority Health SBD |
$2,869.89
|
| Rate for Payer: UMR Bronson Commercial |
$2,427.88
|
|
|
PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,536.00
|
|
|
Service Code
|
HCPCS 44314
|
| Min. Negotiated Rate |
$249.89 |
| Max. Negotiated Rate |
$1,775.20 |
| Rate for Payer: Aetna Commercial |
$1,349.17
|
| Rate for Payer: BCBS Complete |
$672.74
|
| Rate for Payer: BCBS Trust/PPO |
$249.89
|
| Rate for Payer: Cash Price |
$2,028.80
|
| Rate for Payer: Cash Price |
$2,028.80
|
| Rate for Payer: Meridian Medicaid |
$672.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,759.22
|
| Rate for Payer: Priority Health SBD |
$1,759.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,166.56
|
|
|
PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX
|
Professional
|
Both
|
$1,214.00
|
|
|
Service Code
|
HCPCS 44312
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$1,047.18 |
| Rate for Payer: Aetna Commercial |
$799.15
|
| Rate for Payer: BCBS Complete |
$402.12
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Meridian Medicaid |
$402.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,047.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,047.18
|
| Rate for Payer: Priority Health SBD |
$1,047.18
|
| Rate for Payer: UMR Bronson Commercial |
$558.44
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR
|
Professional
|
Both
|
$4,047.00
|
|
|
Service Code
|
HCPCS 63664
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$2,832.90 |
| Rate for Payer: Aetna Commercial |
$1,132.94
|
| Rate for Payer: BCBS Complete |
$604.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Meridian Medicaid |
$604.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$576.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,832.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,512.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,512.96
|
| Rate for Payer: Priority Health SBD |
$1,512.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,861.62
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
|
Professional
|
Both
|
$4,723.00
|
|
|
Service Code
|
HCPCS 63663
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$3,306.10 |
| Rate for Payer: Aetna Commercial |
$582.45
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.26
|
| Rate for Payer: Cash Price |
$3,778.40
|
| Rate for Payer: Cash Price |
$3,778.40
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,306.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$759.31
|
| Rate for Payer: Priority Health Narrow Network |
$759.31
|
| Rate for Payer: Priority Health SBD |
$759.31
|
| Rate for Payer: UMR Bronson Commercial |
$2,172.58
|
|
|
PR REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP
|
Professional
|
Both
|
$1,789.00
|
|
|
Service Code
|
HCPCS 35879
|
| Min. Negotiated Rate |
$574.89 |
| Max. Negotiated Rate |
$1,898.71 |
| Rate for Payer: Aetna Commercial |
$1,239.03
|
| Rate for Payer: BCBS Complete |
$603.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.71
|
| Rate for Payer: Cash Price |
$1,431.20
|
| Rate for Payer: Cash Price |
$1,431.20
|
| Rate for Payer: Meridian Medicaid |
$603.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,252.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,432.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,432.56
|
| Rate for Payer: Priority Health SBD |
$1,432.56
|
| Rate for Payer: UMR Bronson Commercial |
$822.94
|
|
|
PR REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS
|
Professional
|
Both
|
$2,077.00
|
|
|
Service Code
|
HCPCS 35881
|
| Min. Negotiated Rate |
$642.62 |
| Max. Negotiated Rate |
$1,789.35 |
| Rate for Payer: Aetna Commercial |
$1,373.12
|
| Rate for Payer: BCBS Complete |
$674.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.35
|
| Rate for Payer: Cash Price |
$1,661.60
|
| Rate for Payer: Cash Price |
$1,661.60
|
| Rate for Payer: Meridian Medicaid |
$674.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,590.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,590.02
|
| Rate for Payer: Priority Health SBD |
$1,590.02
|
| Rate for Payer: UMR Bronson Commercial |
$955.42
|
|
|
PR REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY
|
Professional
|
Both
|
$2,046.00
|
|
|
Service Code
|
HCPCS 69601
|
| Min. Negotiated Rate |
$653.91 |
| Max. Negotiated Rate |
$2,276.44 |
| Rate for Payer: Aetna Commercial |
$1,166.54
|
| Rate for Payer: BCBS Complete |
$686.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,276.44
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Meridian Medicaid |
$686.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$653.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,450.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,450.21
|
| Rate for Payer: Priority Health SBD |
$1,450.21
|
| Rate for Payer: UMR Bronson Commercial |
$941.16
|
|
|
PR REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY
|
Professional
|
Both
|
$2,195.00
|
|
|
Service Code
|
HCPCS 69604
|
| Min. Negotiated Rate |
$714.62 |
| Max. Negotiated Rate |
$1,636.15 |
| Rate for Payer: Aetna Commercial |
$1,264.88
|
| Rate for Payer: BCBS Complete |
$750.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.15
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Meridian Medicaid |
$750.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$714.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,584.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,584.58
|
| Rate for Payer: Priority Health SBD |
$1,584.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,009.70
|
|
|
PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 36832
|
| Min. Negotiated Rate |
$473.50 |
| Max. Negotiated Rate |
$1,757.65 |
| Rate for Payer: Aetna Commercial |
$1,014.04
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.65
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,177.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,177.22
|
| Rate for Payer: Priority Health SBD |
$1,177.22
|
| Rate for Payer: UMR Bronson Commercial |
$552.00
|
|
|
PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 36833
|
| Min. Negotiated Rate |
$505.02 |
| Max. Negotiated Rate |
$1,600.90 |
| Rate for Payer: Aetna Commercial |
$1,085.98
|
| Rate for Payer: BCBS Complete |
$530.27
|
| Rate for Payer: BCBS Trust/PPO |
$902.86
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Meridian Medicaid |
$530.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,600.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,257.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,257.54
|
| Rate for Payer: Priority Health SBD |
$1,257.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,052.02
|
|
|
PR REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR
|
Professional
|
Both
|
$1,783.00
|
|
|
Service Code
|
HCPCS 63688
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$1,248.10 |
| Rate for Payer: Aetna Commercial |
$478.21
|
| Rate for Payer: BCBS Complete |
$203.30
|
| Rate for Payer: BCBS Trust/PPO |
$917.66
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Meridian Medicaid |
$203.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,248.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$634.74
|
| Rate for Payer: Priority Health Narrow Network |
$634.74
|
| Rate for Payer: Priority Health SBD |
$634.74
|
| Rate for Payer: UMR Bronson Commercial |
$820.18
|
|
