|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Facility
|
IP
|
$2,051.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
49521
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$902.44 |
| Max. Negotiated Rate |
$1,845.90 |
| Rate for Payer: Aetna American Axle |
$1,333.15
|
| Rate for Payer: Aetna Commercial |
$1,743.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.15
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Cofinity Commercial |
$1,435.70
|
| Rate for Payer: Cofinity Commercial |
$1,763.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.80
|
| Rate for Payer: Healthscope Commercial |
$1,845.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,435.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,538.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,743.35
|
| Rate for Payer: PHP Commercial |
$1,743.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.70
|
| Rate for Payer: Priority Health SBD |
$1,292.13
|
| Rate for Payer: UMR Bronson Commercial |
$902.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,538.25
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Facility
|
OP
|
$2,051.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
49521
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$707.93 |
| Max. Negotiated Rate |
$21,170.20 |
| Rate for Payer: Aetna American Axle |
$1,333.15
|
| Rate for Payer: Aetna Commercial |
$1,743.35
|
| Rate for Payer: Aetna Medicare |
$6,993.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,406.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,406.09
|
| Rate for Payer: BCBS Complete |
$3,862.77
|
| Rate for Payer: BCBS MAPPO |
$6,724.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,519.12
|
| Rate for Payer: BCN Medicare Advantage |
$6,724.87
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Cofinity Commercial |
$1,435.70
|
| Rate for Payer: Cofinity Commercial |
$1,763.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,724.87
|
| Rate for Payer: Healthscope Commercial |
$1,845.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,435.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,538.25
|
| Rate for Payer: Mclaren Medicaid |
$3,678.50
|
| Rate for Payer: Mclaren Medicare |
$6,724.87
|
| Rate for Payer: Meridian Medicaid |
$3,862.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,061.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,733.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,743.35
|
| Rate for Payer: PACE Medicare |
$6,388.63
|
| Rate for Payer: PACE SWMI |
$6,724.87
|
| Rate for Payer: PHP Commercial |
$1,743.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,724.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,678.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,170.20
|
| Rate for Payer: Priority Health Medicare |
$6,724.87
|
| Rate for Payer: Priority Health Narrow Network |
$16,936.16
|
| Rate for Payer: Priority Health SBD |
$1,292.13
|
| Rate for Payer: Railroad Medicare Medicare |
$6,724.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$778.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,724.87
|
| Rate for Payer: UHC Exchange |
$707.93
|
| Rate for Payer: UHC Medicare Advantage |
$6,926.62
|
| Rate for Payer: UMR Bronson Commercial |
$758.87
|
| Rate for Payer: VA VA |
$6,724.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,538.25
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$2,051.00
|
|
|
Service Code
|
HCPCS 49521
|
| Min. Negotiated Rate |
$134.72 |
| Max. Negotiated Rate |
$1,435.70 |
| Rate for Payer: Aetna Commercial |
$967.53
|
| Rate for Payer: BCBS Complete |
$483.54
|
| Rate for Payer: BCBS Trust/PPO |
$134.72
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Meridian Medicaid |
$483.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,264.13
|
| Rate for Payer: Priority Health SBD |
$1,264.13
|
| Rate for Payer: UMR Bronson Commercial |
$943.46
|
|
|
PR RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT
|
Professional
|
Both
|
$4,381.00
|
|
|
Service Code
|
HCPCS 38115
|
| Min. Negotiated Rate |
$710.04 |
| Max. Negotiated Rate |
$3,066.70 |
| Rate for Payer: Aetna Commercial |
$1,592.12
|
| Rate for Payer: BCBS Complete |
$865.30
|
| Rate for Payer: BCBS Trust/PPO |
$710.04
|
| Rate for Payer: Cash Price |
$3,504.80
|
| Rate for Payer: Cash Price |
$3,504.80
|
| Rate for Payer: Meridian Medicaid |
$865.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$824.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,066.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,790.15
|
| Rate for Payer: Priority Health Narrow Network |
$2,790.15
|
| Rate for Payer: Priority Health SBD |
$2,790.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,015.26
|
|
|
PR RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE
|
Professional
|
Both
|
$1,932.00
|
|
|
Service Code
|
HCPCS 49600
|
| Min. Negotiated Rate |
$472.43 |
| Max. Negotiated Rate |
$2,035.01 |
| Rate for Payer: Aetna Commercial |
$991.65
|
| Rate for Payer: BCBS Complete |
$496.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,035.01
|
| Rate for Payer: Cash Price |
$1,545.60
|
| Rate for Payer: Cash Price |
$1,545.60
|
| Rate for Payer: Meridian Medicaid |
$496.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,352.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,296.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,296.48
|
| Rate for Payer: Priority Health SBD |
$1,296.48
|
| Rate for Payer: UMR Bronson Commercial |
$888.72
|
|
|
PR RPR SPIGELIAN HERNIA
|
Professional
|
Both
|
$1,594.00
|
|
|
Service Code
|
HCPCS 49590
|
| Min. Negotiated Rate |
$637.60 |
| Max. Negotiated Rate |
$1,115.80 |
| Rate for Payer: BCBS Complete |
$637.60
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,115.80
|
| Rate for Payer: UMR Bronson Commercial |
$733.24
|
|
|
PR RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL
|
Professional
|
Both
|
$7,731.00
|
|
|
Service Code
|
HCPCS 38780
|
| Min. Negotiated Rate |
$672.02 |
| Max. Negotiated Rate |
$5,411.70 |
| Rate for Payer: Aetna Commercial |
$1,285.27
|
| Rate for Payer: BCBS Complete |
$705.62
|
| Rate for Payer: BCBS Trust/PPO |
$957.28
|
| Rate for Payer: Cash Price |
$6,184.80
|
| Rate for Payer: Cash Price |
$6,184.80
|
| Rate for Payer: Meridian Medicaid |
$705.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$672.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,411.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,243.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,243.29
|
| Rate for Payer: Priority Health SBD |
$2,243.29
|
| Rate for Payer: UMR Bronson Commercial |
$3,556.26
|
|
|
PR RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
HCPCS 28200
|
| Min. Negotiated Rate |
$211.08 |
| Max. Negotiated Rate |
$1,084.07 |
| Rate for Payer: Aetna Commercial |
$428.78
|
| Rate for Payer: BCBS Complete |
$221.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.07
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Meridian Medicaid |
$221.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$498.91
|
| Rate for Payer: Priority Health Narrow Network |
$498.91
|
| Rate for Payer: Priority Health SBD |
$498.91
|
| Rate for Payer: UMR Bronson Commercial |
$564.88
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 25263
|
| Min. Negotiated Rate |
$413.22 |
| Max. Negotiated Rate |
$3,601.42 |
| Rate for Payer: Aetna Commercial |
$843.92
|
| Rate for Payer: BCBS Complete |
$433.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,601.42
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Meridian Medicaid |
$433.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$860.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$980.44
|
| Rate for Payer: Priority Health Narrow Network |
$980.44
|
| Rate for Payer: Priority Health SBD |
$980.44
|
| Rate for Payer: UMR Bronson Commercial |
$565.34
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 25260
|
| Min. Negotiated Rate |
$413.22 |
| Max. Negotiated Rate |
$1,459.69 |
| Rate for Payer: Aetna Commercial |
$841.29
|
| Rate for Payer: BCBS Complete |
$433.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,459.69
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Meridian Medicaid |
$433.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$982.49
|
| Rate for Payer: Priority Health Narrow Network |
$982.49
|
| Rate for Payer: Priority Health SBD |
$982.49
|
| Rate for Payer: UMR Bronson Commercial |
$767.28
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25270
|
| Min. Negotiated Rate |
$322.91 |
| Max. Negotiated Rate |
$3,579.76 |
| Rate for Payer: Aetna Commercial |
$656.88
|
| Rate for Payer: BCBS Complete |
$339.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,579.76
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Meridian Medicaid |
$339.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$765.98
|
| Rate for Payer: Priority Health Narrow Network |
$765.98
|
| Rate for Payer: Priority Health SBD |
$765.98
|
| Rate for Payer: UMR Bronson Commercial |
$639.40
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 25272
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$3,566.55 |
| Rate for Payer: Aetna Commercial |
$747.23
|
| Rate for Payer: BCBS Complete |
$383.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,566.55
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Meridian Medicaid |
$383.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$866.58
|
| Rate for Payer: Priority Health Narrow Network |
$866.58
|
| Rate for Payer: Priority Health SBD |
$866.58
|
| Rate for Payer: UMR Bronson Commercial |
$730.94
|
|
|
PR RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 25275
|
| Min. Negotiated Rate |
$436.86 |
| Max. Negotiated Rate |
$1,389.50 |
| Rate for Payer: Aetna Commercial |
$894.15
|
| Rate for Payer: BCBS Complete |
$458.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.56
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Meridian Medicaid |
$458.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,037.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,037.64
|
| Rate for Payer: Priority Health SBD |
$1,037.64
|
| Rate for Payer: UMR Bronson Commercial |
$913.10
|
|
|
PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 28210
|
| Min. Negotiated Rate |
$273.49 |
| Max. Negotiated Rate |
$912.90 |
| Rate for Payer: Aetna Commercial |
$564.04
|
| Rate for Payer: BCBS Complete |
$287.16
|
| Rate for Payer: BCBS Trust/PPO |
$912.90
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Meridian Medicaid |
$287.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$649.04
|
| Rate for Payer: Priority Health Narrow Network |
$649.04
|
| Rate for Payer: Priority Health SBD |
$649.04
|
| Rate for Payer: UMR Bronson Commercial |
$426.88
|
|
|
PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS
|
Professional
|
Both
|
$8,520.00
|
|
|
Service Code
|
HCPCS 33877
|
| Min. Negotiated Rate |
$2,114.78 |
| Max. Negotiated Rate |
$5,964.00 |
| Rate for Payer: Aetna Commercial |
$4,855.61
|
| Rate for Payer: BCBS Complete |
$2,362.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,114.78
|
| Rate for Payer: Cash Price |
$6,816.00
|
| Rate for Payer: Cash Price |
$6,816.00
|
| Rate for Payer: Meridian Medicaid |
$2,362.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,249.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,964.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,602.04
|
| Rate for Payer: Priority Health Narrow Network |
$5,602.04
|
| Rate for Payer: Priority Health SBD |
$5,602.04
|
| Rate for Payer: UMR Bronson Commercial |
$3,919.20
|
|
|
PR RPR/TRAUMATIC AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$1,511.00
|
|
|
Service Code
|
HCPCS 35190
|
| Min. Negotiated Rate |
$474.78 |
| Max. Negotiated Rate |
$1,192.11 |
| Rate for Payer: Aetna Commercial |
$1,022.68
|
| Rate for Payer: BCBS Complete |
$498.52
|
| Rate for Payer: BCBS Trust/PPO |
$706.87
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Meridian Medicaid |
$498.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$474.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,057.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,192.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,192.11
|
| Rate for Payer: Priority Health SBD |
$1,192.11
|
| Rate for Payer: UMR Bronson Commercial |
$695.06
|
|
|
PR RPR/TRAUMATIC AV FISTULA HEAD & NECK
|
Professional
|
Both
|
$4,157.00
|
|
|
Service Code
|
HCPCS 35188
|
| Min. Negotiated Rate |
$833.26 |
| Max. Negotiated Rate |
$2,909.90 |
| Rate for Payer: Aetna Commercial |
$1,718.98
|
| Rate for Payer: BCBS Complete |
$874.92
|
| Rate for Payer: BCBS Trust/PPO |
$933.51
|
| Rate for Payer: Cash Price |
$3,325.60
|
| Rate for Payer: Cash Price |
$3,325.60
|
| Rate for Payer: Meridian Medicaid |
$874.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$833.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,909.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,060.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,060.80
|
| Rate for Payer: Priority Health SBD |
$2,060.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,912.22
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$243.67 |
| Max. Negotiated Rate |
$1,220.90 |
| Rate for Payer: Aetna Commercial |
$486.63
|
| Rate for Payer: BCBS Complete |
$255.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.90
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Meridian Medicaid |
$255.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$243.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.53
|
| Rate for Payer: Priority Health Narrow Network |
$609.53
|
| Rate for Payer: Priority Health SBD |
$609.53
|
| Rate for Payer: UMR Bronson Commercial |
$284.28
|
|
|
PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 36575
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$1,177.58 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: BCBS Complete |
$21.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,177.58
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Meridian Medicaid |
$21.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.13
|
| Rate for Payer: Priority Health Narrow Network |
$52.13
|
| Rate for Payer: Priority Health SBD |
$52.13
|
| Rate for Payer: UMR Bronson Commercial |
$201.94
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS INCARCERATED
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 49582
|
| Min. Negotiated Rate |
$573.60 |
| Max. Negotiated Rate |
$1,003.80 |
| Rate for Payer: BCBS Complete |
$573.60
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,003.80
|
| Rate for Payer: UMR Bronson Commercial |
$659.64
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 49580
|
| Min. Negotiated Rate |
$497.20 |
| Max. Negotiated Rate |
$870.10 |
| Rate for Payer: BCBS Complete |
$497.20
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.10
|
| Rate for Payer: UMR Bronson Commercial |
$571.78
|
|
|
PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,652.00
|
|
|
Service Code
|
HCPCS 49587
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$1,156.40 |
| Rate for Payer: BCBS Complete |
$660.80
|
| Rate for Payer: Cash Price |
$1,321.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.40
|
| Rate for Payer: UMR Bronson Commercial |
$759.92
|
|
|
PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 49585
|
| Min. Negotiated Rate |
$573.60 |
| Max. Negotiated Rate |
$1,003.80 |
| Rate for Payer: BCBS Complete |
$573.60
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,003.80
|
| Rate for Payer: UMR Bronson Commercial |
$659.64
|
|
|
PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC
|
Professional
|
Both
|
$7,883.00
|
|
|
Service Code
|
HCPCS 33414
|
| Min. Negotiated Rate |
$509.28 |
| Max. Negotiated Rate |
$5,518.10 |
| Rate for Payer: Aetna Commercial |
$2,886.79
|
| Rate for Payer: BCBS Complete |
$1,413.69
|
| Rate for Payer: BCBS Trust/PPO |
$509.28
|
| Rate for Payer: Cash Price |
$6,306.40
|
| Rate for Payer: Cash Price |
$6,306.40
|
| Rate for Payer: Meridian Medicaid |
$1,413.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,346.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,518.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,348.67
|
| Rate for Payer: Priority Health Narrow Network |
$3,348.67
|
| Rate for Payer: Priority Health SBD |
$3,348.67
|
| Rate for Payer: UMR Bronson Commercial |
$3,626.18
|
|
|
PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER
|
Professional
|
Both
|
$2,768.00
|
|
|
Service Code
|
HCPCS 26428
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,937.60 |
| Rate for Payer: Aetna Commercial |
$1,057.07
|
| Rate for Payer: BCBS Complete |
$541.68
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Meridian Medicaid |
$541.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,937.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,239.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,239.34
|
| Rate for Payer: Priority Health SBD |
$1,239.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,273.28
|
|
