|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 49525
|
| Hospital Charge Code |
49525
|
| Min. Negotiated Rate |
$369.34 |
| Max. Negotiated Rate |
$1,122.80 |
| Rate for Payer: Aetna Commercial |
$773.33
|
| Rate for Payer: BCBS Complete |
$387.81
|
| Rate for Payer: BCBS Trust/PPO |
$515.62
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Meridian Medicaid |
$387.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,122.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,013.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.67
|
| Rate for Payer: Priority Health SBD |
$1,013.67
|
| Rate for Payer: UMR Bronson Commercial |
$737.84
|
|
|
PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 12046
|
| Min. Negotiated Rate |
$204.05 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$343.64
|
| Rate for Payer: BCBS Complete |
$214.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.00
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Meridian Medicaid |
$214.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.08
|
| Rate for Payer: Priority Health Narrow Network |
$390.08
|
| Rate for Payer: Priority Health SBD |
$390.08
|
| Rate for Payer: UMR Bronson Commercial |
$418.60
|
|
|
PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 41250
|
| Min. Negotiated Rate |
$97.52 |
| Max. Negotiated Rate |
$1,744.97 |
| Rate for Payer: Aetna Commercial |
$203.77
|
| Rate for Payer: BCBS Complete |
$103.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.97
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Meridian Medicaid |
$103.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.06
|
| Rate for Payer: Priority Health Narrow Network |
$271.06
|
| Rate for Payer: Priority Health SBD |
$271.06
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX
|
Professional
|
Both
|
$1,063.00
|
|
|
Service Code
|
HCPCS 41252
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$744.10 |
| Rate for Payer: Aetna Commercial |
$276.83
|
| Rate for Payer: BCBS Complete |
$140.68
|
| Rate for Payer: BCBS Trust/PPO |
$370.34
|
| Rate for Payer: Cash Price |
$850.40
|
| Rate for Payer: Cash Price |
$850.40
|
| Rate for Payer: Meridian Medicaid |
$140.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.24
|
| Rate for Payer: Priority Health Narrow Network |
$369.24
|
| Rate for Payer: Priority Health SBD |
$369.24
|
| Rate for Payer: UMR Bronson Commercial |
$488.98
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH
|
Professional
|
Both
|
$3,342.00
|
|
|
Service Code
|
HCPCS 49606
|
| Min. Negotiated Rate |
$726.33 |
| Max. Negotiated Rate |
$2,339.40 |
| Rate for Payer: Aetna Commercial |
$1,535.48
|
| Rate for Payer: BCBS Complete |
$762.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.86
|
| Rate for Payer: Cash Price |
$2,673.60
|
| Rate for Payer: Cash Price |
$2,673.60
|
| Rate for Payer: Meridian Medicaid |
$762.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$726.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,339.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,996.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,996.17
|
| Rate for Payer: Priority Health SBD |
$1,996.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,537.32
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH
|
Professional
|
Both
|
$8,940.00
|
|
|
Service Code
|
HCPCS 49605
|
| Min. Negotiated Rate |
$2,106.86 |
| Max. Negotiated Rate |
$8,595.58 |
| Rate for Payer: Aetna Commercial |
$6,672.97
|
| Rate for Payer: BCBS Complete |
$3,280.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.86
|
| Rate for Payer: Cash Price |
$7,152.00
|
| Rate for Payer: Cash Price |
$7,152.00
|
| Rate for Payer: Meridian Medicaid |
$3,280.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,123.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,258.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,595.58
|
| Rate for Payer: Priority Health Narrow Network |
$8,595.58
|
| Rate for Payer: Priority Health SBD |
$8,595.58
|
| Rate for Payer: UMR Bronson Commercial |
$4,112.40
|
|
|
PR RPR LIP FULL THICKNESS HALF/< VERTICAL HEIGHT
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$233.45 |
| Max. Negotiated Rate |
$674.80 |
| Rate for Payer: Aetna Commercial |
$469.82
|
| Rate for Payer: BCBS Complete |
$245.12
|
| Rate for Payer: BCBS Trust/PPO |
$649.28
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Meridian Medicaid |
$245.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.96
|
| Rate for Payer: Priority Health Narrow Network |
$637.96
|
| Rate for Payer: Priority Health SBD |
$637.96
|
| Rate for Payer: UMR Bronson Commercial |
$443.44
|
|
|
PR RPR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$204.91 |
| Max. Negotiated Rate |
$555.63 |
| Rate for Payer: Aetna Commercial |
$408.20
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: BCBS Trust/PPO |
$462.26
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Meridian Medicaid |
$215.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.63
|
| Rate for Payer: Priority Health Narrow Network |
$555.63
|
| Rate for Payer: Priority Health SBD |
$555.63
|
| Rate for Payer: UMR Bronson Commercial |
$312.34
|
|
|
PR RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 40654
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$842.64 |
| Rate for Payer: Aetna Commercial |
$555.88
|
| Rate for Payer: BCBS Complete |
$288.96
|
| Rate for Payer: BCBS Trust/PPO |
$842.64
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Meridian Medicaid |
$288.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$751.43
|
| Rate for Payer: Priority Health Narrow Network |
$751.43
|
| Rate for Payer: Priority Health SBD |
$751.43
|
| Rate for Payer: UMR Bronson Commercial |
$341.78
|
|
|
PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 46715
|
| Min. Negotiated Rate |
$231.40 |
| Max. Negotiated Rate |
$982.51 |
| Rate for Payer: Aetna Commercial |
$747.32
|
| Rate for Payer: BCBS Complete |
$375.28
|
| Rate for Payer: BCBS Trust/PPO |
$231.40
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Meridian Medicaid |
$375.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$982.51
|
| Rate for Payer: Priority Health Narrow Network |
$982.51
|
| Rate for Payer: Priority Health SBD |
$982.51
|
| Rate for Payer: UMR Bronson Commercial |
$535.90
|
|
|
PR RPR LW IMPERFORATE ANUS W/TRPOS FISTULA
|
Professional
|
Both
|
$2,933.00
|
|
|
Service Code
|
HCPCS 46716
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$2,174.92 |
| Rate for Payer: Aetna Commercial |
$1,651.96
|
| Rate for Payer: BCBS Complete |
$833.32
|
| Rate for Payer: BCBS Trust/PPO |
$117.81
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Meridian Medicaid |
$833.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$793.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,053.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,174.92
|
| Rate for Payer: Priority Health Narrow Network |
$2,174.92
|
| Rate for Payer: Priority Health SBD |
$2,174.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,349.18
|
|
|
PR RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ
|
Professional
|
Both
|
$10,076.00
|
|
|
Service Code
|
HCPCS 39503
|
| Min. Negotiated Rate |
$516.15 |
| Max. Negotiated Rate |
$9,074.67 |
| Rate for Payer: Aetna Commercial |
$5,982.65
|
| Rate for Payer: BCBS Complete |
$3,824.42
|
| Rate for Payer: BCBS Trust/PPO |
$516.15
|
| Rate for Payer: Cash Price |
$8,060.80
|
| Rate for Payer: Cash Price |
$8,060.80
|
| Rate for Payer: Meridian Medicaid |
$3,824.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,642.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,053.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,074.67
|
| Rate for Payer: Priority Health Narrow Network |
$9,074.67
|
| Rate for Payer: Priority Health SBD |
$9,074.67
|
| Rate for Payer: UMR Bronson Commercial |
$4,634.96
|
|
|
PR RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 53449
|
| Min. Negotiated Rate |
$319.62 |
| Max. Negotiated Rate |
$981.29 |
| Rate for Payer: Aetna Commercial |
$786.57
|
| Rate for Payer: BCBS Complete |
$410.62
|
| Rate for Payer: BCBS Trust/PPO |
$319.62
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Meridian Medicaid |
$410.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$391.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$799.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$981.29
|
| Rate for Payer: Priority Health Narrow Network |
$981.29
|
| Rate for Payer: Priority Health SBD |
$981.29
|
| Rate for Payer: UMR Bronson Commercial |
$525.32
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE
|
Professional
|
Both
|
$3,789.00
|
|
|
Service Code
|
HCPCS 27472
|
| Min. Negotiated Rate |
$522.49 |
| Max. Negotiated Rate |
$2,652.30 |
| Rate for Payer: Aetna Commercial |
$1,690.24
|
| Rate for Payer: BCBS Complete |
$852.78
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Meridian Medicaid |
$852.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,933.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,933.83
|
| Rate for Payer: Priority Health SBD |
$1,933.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,742.94
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/O GRF
|
Professional
|
Both
|
$2,870.00
|
|
|
Service Code
|
HCPCS 27470
|
| Min. Negotiated Rate |
$266.79 |
| Max. Negotiated Rate |
$2,009.00 |
| Rate for Payer: Aetna Commercial |
$1,574.91
|
| Rate for Payer: BCBS Complete |
$797.54
|
| Rate for Payer: BCBS Trust/PPO |
$266.79
|
| Rate for Payer: Cash Price |
$2,296.00
|
| Rate for Payer: Cash Price |
$2,296.00
|
| Rate for Payer: Meridian Medicaid |
$797.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$759.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,009.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,806.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,806.68
|
| Rate for Payer: Priority Health SBD |
$1,806.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,320.20
|
|
|
PR RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH
|
Professional
|
Both
|
$5,315.00
|
|
|
Service Code
|
HCPCS 27725
|
| Min. Negotiated Rate |
$782.78 |
| Max. Negotiated Rate |
$3,720.50 |
| Rate for Payer: Aetna Commercial |
$1,621.26
|
| Rate for Payer: BCBS Complete |
$821.92
|
| Rate for Payer: BCBS Trust/PPO |
$800.37
|
| Rate for Payer: Cash Price |
$4,252.00
|
| Rate for Payer: Cash Price |
$4,252.00
|
| Rate for Payer: Meridian Medicaid |
$821.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$782.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,720.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,859.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,859.78
|
| Rate for Payer: Priority Health SBD |
$1,859.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,444.90
|
|
|
PR RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,677.00
|
|
|
Service Code
|
HCPCS 27724
|
| Min. Negotiated Rate |
$322.79 |
| Max. Negotiated Rate |
$3,273.90 |
| Rate for Payer: Aetna Commercial |
$1,683.13
|
| Rate for Payer: BCBS Complete |
$844.05
|
| Rate for Payer: BCBS Trust/PPO |
$322.79
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Meridian Medicaid |
$844.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$803.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,273.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,916.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,916.99
|
| Rate for Payer: Priority Health SBD |
$1,916.99
|
| Rate for Payer: UMR Bronson Commercial |
$2,151.42
|
|
|
PR RPR NON/MALUNION METARSAL W/WO BONE GRAFT
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 28322
|
| Min. Negotiated Rate |
$373.39 |
| Max. Negotiated Rate |
$2,539.54 |
| Rate for Payer: Aetna Commercial |
$766.29
|
| Rate for Payer: BCBS Complete |
$392.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.54
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Meridian Medicaid |
$392.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$885.46
|
| Rate for Payer: Priority Health Narrow Network |
$885.46
|
| Rate for Payer: Priority Health SBD |
$885.46
|
| Rate for Payer: UMR Bronson Commercial |
$593.40
|
|
|
PR RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS
|
Professional
|
Both
|
$6,887.00
|
|
|
Service Code
|
HCPCS 33496
|
| Min. Negotiated Rate |
$807.24 |
| Max. Negotiated Rate |
$4,820.90 |
| Rate for Payer: Aetna Commercial |
$2,234.49
|
| Rate for Payer: BCBS Complete |
$1,092.98
|
| Rate for Payer: BCBS Trust/PPO |
$807.24
|
| Rate for Payer: Cash Price |
$5,509.60
|
| Rate for Payer: Cash Price |
$5,509.60
|
| Rate for Payer: Meridian Medicaid |
$1,092.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,040.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,820.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,594.89
|
| Rate for Payer: Priority Health Narrow Network |
$2,594.89
|
| Rate for Payer: Priority Health SBD |
$2,594.89
|
| Rate for Payer: UMR Bronson Commercial |
$3,168.02
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$3,177.00
|
|
|
Service Code
|
HCPCS 25405
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$2,223.90 |
| Rate for Payer: Aetna Commercial |
$1,384.02
|
| Rate for Payer: BCBS Complete |
$700.92
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: Cash Price |
$2,541.60
|
| Rate for Payer: Cash Price |
$2,541.60
|
| Rate for Payer: Meridian Medicaid |
$700.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$667.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,223.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,589.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,589.14
|
| Rate for Payer: Priority Health SBD |
$1,589.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,461.42
|
|
|
PR RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF
|
Professional
|
Both
|
$3,211.00
|
|
|
Service Code
|
HCPCS 25415
|
| Min. Negotiated Rate |
$272.95 |
| Max. Negotiated Rate |
$2,247.70 |
| Rate for Payer: Aetna Commercial |
$1,294.84
|
| Rate for Payer: BCBS Complete |
$655.52
|
| Rate for Payer: BCBS Trust/PPO |
$272.95
|
| Rate for Payer: Cash Price |
$2,568.80
|
| Rate for Payer: Cash Price |
$2,568.80
|
| Rate for Payer: Meridian Medicaid |
$655.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,486.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,486.00
|
| Rate for Payer: Priority Health SBD |
$1,486.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,477.06
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 25400
|
| Min. Negotiated Rate |
$211.32 |
| Max. Negotiated Rate |
$1,806.70 |
| Rate for Payer: Aetna Commercial |
$1,071.92
|
| Rate for Payer: BCBS Complete |
$544.59
|
| Rate for Payer: BCBS Trust/PPO |
$211.32
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Meridian Medicaid |
$544.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$518.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,235.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,235.77
|
| Rate for Payer: Priority Health SBD |
$1,235.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,187.26
|
|
|
PR RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$2,068.00
|
|
|
Service Code
|
HCPCS 26546
|
| Min. Negotiated Rate |
$243.55 |
| Max. Negotiated Rate |
$1,608.04 |
| Rate for Payer: Aetna Commercial |
$1,364.30
|
| Rate for Payer: BCBS Complete |
$704.95
|
| Rate for Payer: BCBS Trust/PPO |
$243.55
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Meridian Medicaid |
$704.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$671.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,447.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,608.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,608.04
|
| Rate for Payer: Priority Health SBD |
$1,608.04
|
| Rate for Payer: UMR Bronson Commercial |
$951.28
|
|
|
PR RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC
|
Professional
|
Both
|
$1,349.00
|
|
|
Service Code
|
HCPCS 25440
|
| Min. Negotiated Rate |
$497.78 |
| Max. Negotiated Rate |
$1,264.75 |
| Rate for Payer: Aetna Commercial |
$1,024.99
|
| Rate for Payer: BCBS Complete |
$522.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,264.75
|
| Rate for Payer: Cash Price |
$1,079.20
|
| Rate for Payer: Cash Price |
$1,079.20
|
| Rate for Payer: Meridian Medicaid |
$522.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$497.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,182.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,182.67
|
| Rate for Payer: Priority Health SBD |
$1,182.67
|
| Rate for Payer: UMR Bronson Commercial |
$620.54
|
|
|
PR RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT
|
Professional
|
Both
|
$411.23
|
|
|
Service Code
|
HCPCS 30468
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$627.09 |
| Rate for Payer: Aetna Commercial |
$213.72
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS Trust/PPO |
$627.09
|
| Rate for Payer: Cash Price |
$328.98
|
| Rate for Payer: Cash Price |
$328.98
|
| Rate for Payer: Meridian Medicaid |
$113.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.84
|
| Rate for Payer: Priority Health Narrow Network |
$233.84
|
| Rate for Payer: Priority Health SBD |
$233.84
|
| Rate for Payer: UMR Bronson Commercial |
$189.17
|
|
