|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
29823
|
| Min. Negotiated Rate |
$384.25 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Aetna Commercial |
$790.59
|
| Rate for Payer: BCBS Complete |
$403.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.32
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Meridian Medicaid |
$403.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$384.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.04
|
| Rate for Payer: Priority Health Narrow Network |
$913.04
|
| Rate for Payer: Priority Health SBD |
$913.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.50
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
29823
|
| Min. Negotiated Rate |
$1,089.00 |
| Max. Negotiated Rate |
$2,227.50 |
| Rate for Payer: Aetna American Axle |
$1,608.75
|
| Rate for Payer: Aetna Commercial |
$2,103.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,608.75
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$1,732.50
|
| Rate for Payer: Cofinity Commercial |
$2,128.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,980.00
|
| Rate for Payer: Healthscope Commercial |
$2,227.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,732.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,856.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,103.75
|
| Rate for Payer: PHP Commercial |
$2,103.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.50
|
| Rate for Payer: Priority Health SBD |
$1,559.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,089.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,856.25
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 29823
|
| Min. Negotiated Rate |
$384.25 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Aetna Commercial |
$790.59
|
| Rate for Payer: BCBS Complete |
$403.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.32
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Meridian Medicaid |
$403.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$384.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.04
|
| Rate for Payer: Priority Health Narrow Network |
$913.04
|
| Rate for Payer: Priority Health SBD |
$913.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.50
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
29823
|
| Min. Negotiated Rate |
$590.71 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna American Axle |
$1,608.75
|
| Rate for Payer: Aetna Commercial |
$2,103.75
|
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,608.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,534.12
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$1,732.50
|
| Rate for Payer: Cofinity Commercial |
$2,128.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,980.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$2,227.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,732.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,856.25
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,103.75
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$2,103.75
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Priority Health SBD |
$1,559.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$649.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$590.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: UMR Bronson Commercial |
$915.75
|
| Rate for Payer: VA VA |
$2,877.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,856.25
|
|
|
PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
29826
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$2,787.84 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,787.84
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.94
|
| Rate for Payer: Priority Health Narrow Network |
$260.94
|
| Rate for Payer: Priority Health SBD |
$260.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.50
|
|
|
PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 29826
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$2,787.84 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,787.84
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.94
|
| Rate for Payer: Priority Health Narrow Network |
$260.94
|
| Rate for Payer: Priority Health SBD |
$260.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.50
|
|
|
PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
29826
|
| Min. Negotiated Rate |
$1,089.00 |
| Max. Negotiated Rate |
$2,227.50 |
| Rate for Payer: Aetna American Axle |
$1,608.75
|
| Rate for Payer: Aetna Commercial |
$2,103.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,608.75
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$1,732.50
|
| Rate for Payer: Cofinity Commercial |
$2,128.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,980.00
|
| Rate for Payer: Healthscope Commercial |
$2,227.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,732.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,856.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,103.75
|
| Rate for Payer: PHP Commercial |
$2,103.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.50
|
| Rate for Payer: Priority Health SBD |
$1,559.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,089.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,856.25
|
|
|
PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
29826
|
| Min. Negotiated Rate |
$167.00 |
| Max. Negotiated Rate |
$3,045.53 |
| Rate for Payer: Aetna American Axle |
$1,608.75
|
| Rate for Payer: Aetna Commercial |
$2,103.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,608.75
|
| Rate for Payer: BCBS Complete |
$990.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,045.53
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$1,732.50
|
| Rate for Payer: Cofinity Commercial |
$2,128.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,980.00
|
| Rate for Payer: Healthscope Commercial |
$2,227.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,732.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,856.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,103.75
|
| Rate for Payer: PHP Commercial |
$2,103.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.50
|
| Rate for Payer: Priority Health SBD |
$1,559.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.70
|
| Rate for Payer: UHC Exchange |
$167.00
|
| Rate for Payer: UMR Bronson Commercial |
$915.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,856.25
|
|
|
PR SURGICAL TRAYS
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS A4550
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Professional
|
Both
|
$5,562.00
|
|
|
Service Code
|
HCPCS 69706
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$3,893.40 |
| Rate for Payer: Aetna Commercial |
$274.21
|
| Rate for Payer: BCBS Complete |
$162.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,280.67
|
| Rate for Payer: Cash Price |
$4,449.60
|
| Rate for Payer: Cash Price |
$4,449.60
|
| Rate for Payer: Meridian Medicaid |
$162.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,893.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$340.86
|
| Rate for Payer: Priority Health Narrow Network |
$340.86
|
| Rate for Payer: Priority Health SBD |
$340.86
|
| Rate for Payer: UMR Bronson Commercial |
$2,558.52
|
|
|
PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Professional
|
Both
|
$5,380.54
|
|
|
Service Code
|
HCPCS 69705
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$3,766.38 |
| Rate for Payer: Aetna Commercial |
$196.86
|
| Rate for Payer: BCBS Complete |
$116.08
|
| Rate for Payer: BCBS Trust/PPO |
$3,634.18
|
| Rate for Payer: Cash Price |
$4,304.43
|
| Rate for Payer: Cash Price |
$4,304.43
|
| Rate for Payer: Meridian Medicaid |
$116.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.68
|
| Rate for Payer: Priority Health Narrow Network |
$244.68
|
| Rate for Payer: Priority Health SBD |
$244.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,475.05
|
|
|
PR SURG OPENING,ESOPHAGUS,ABD APPRCH
|
Professional
|
Both
|
$2,732.00
|
|
|
Service Code
|
HCPCS 43350
|
| Min. Negotiated Rate |
$1,092.80 |
| Max. Negotiated Rate |
$1,912.40 |
| Rate for Payer: BCBS Complete |
$1,092.80
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,256.72
|
|
|
PR SURG TX ANAL FISTULA 2ND STAGE
|
Professional
|
Both
|
$951.00
|
|
|
Service Code
|
HCPCS 46285
|
| Min. Negotiated Rate |
$273.28 |
| Max. Negotiated Rate |
$2,300.22 |
| Rate for Payer: Aetna Commercial |
$558.65
|
| Rate for Payer: BCBS Complete |
$286.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,300.22
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Meridian Medicaid |
$286.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.96
|
| Rate for Payer: Priority Health Narrow Network |
$744.96
|
| Rate for Payer: Priority Health SBD |
$744.96
|
| Rate for Payer: UMR Bronson Commercial |
$437.46
|
|
|
PR SURG TX ANAL FISTULA INTERSPHINCTERIC
|
Professional
|
Both
|
$1,289.00
|
|
|
Service Code
|
HCPCS 46275
|
| Min. Negotiated Rate |
$272.43 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Aetna Commercial |
$558.68
|
| Rate for Payer: BCBS Complete |
$286.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,730.40
|
| Rate for Payer: Cash Price |
$1,031.20
|
| Rate for Payer: Cash Price |
$1,031.20
|
| Rate for Payer: Meridian Medicaid |
$286.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.96
|
| Rate for Payer: Priority Health Narrow Network |
$744.96
|
| Rate for Payer: Priority Health SBD |
$744.96
|
| Rate for Payer: UMR Bronson Commercial |
$592.94
|
|
|
PR SURG TX ANAL FISTULA SUBQ
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 46270
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$2,437.58 |
| Rate for Payer: Aetna Commercial |
$530.44
|
| Rate for Payer: BCBS Complete |
$271.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,437.58
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Meridian Medicaid |
$271.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$708.51
|
| Rate for Payer: Priority Health Narrow Network |
$708.51
|
| Rate for Payer: Priority Health SBD |
$708.51
|
| Rate for Payer: UMR Bronson Commercial |
$388.70
|
|
|
PR SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD
|
Professional
|
Both
|
$11,112.00
|
|
|
Service Code
|
HCPCS 33548
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$7,778.40 |
| Rate for Payer: Aetna Commercial |
$3,982.60
|
| Rate for Payer: BCBS Complete |
$1,931.44
|
| Rate for Payer: BCBS Trust/PPO |
$624.98
|
| Rate for Payer: Cash Price |
$8,889.60
|
| Rate for Payer: Cash Price |
$8,889.60
|
| Rate for Payer: Meridian Medicaid |
$1,931.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,839.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,778.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,588.67
|
| Rate for Payer: Priority Health Narrow Network |
$4,588.67
|
| Rate for Payer: Priority Health SBD |
$4,588.67
|
| Rate for Payer: UMR Bronson Commercial |
$5,111.52
|
|
|
PR SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 64832
|
| Min. Negotiated Rate |
$210.23 |
| Max. Negotiated Rate |
$907.90 |
| Rate for Payer: Aetna Commercial |
$430.52
|
| Rate for Payer: BCBS Complete |
$220.74
|
| Rate for Payer: BCBS Trust/PPO |
$294.79
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Meridian Medicaid |
$220.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$907.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.73
|
| Rate for Payer: Priority Health Narrow Network |
$557.73
|
| Rate for Payer: Priority Health SBD |
$557.73
|
| Rate for Payer: UMR Bronson Commercial |
$596.62
|
|
|
PR SUTR ESOPHGL WND/INJ CRV APPR
|
Professional
|
Both
|
$2,799.00
|
|
|
Service Code
|
HCPCS 43410
|
| Min. Negotiated Rate |
$663.50 |
| Max. Negotiated Rate |
$1,959.30 |
| Rate for Payer: Aetna Commercial |
$1,357.86
|
| Rate for Payer: BCBS Complete |
$696.68
|
| Rate for Payer: BCBS Trust/PPO |
$949.92
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Meridian Medicaid |
$696.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$663.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,959.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,820.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,820.96
|
| Rate for Payer: Priority Health SBD |
$1,820.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,287.54
|
|
|
PR SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR
|
Professional
|
Both
|
$3,996.00
|
|
|
Service Code
|
HCPCS 43415
|
| Min. Negotiated Rate |
$1,207.03 |
| Max. Negotiated Rate |
$4,470.35 |
| Rate for Payer: Aetna Commercial |
$3,436.27
|
| Rate for Payer: BCBS Complete |
$1,711.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.03
|
| Rate for Payer: Cash Price |
$3,196.80
|
| Rate for Payer: Cash Price |
$3,196.80
|
| Rate for Payer: Meridian Medicaid |
$1,711.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,630.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,470.35
|
| Rate for Payer: Priority Health Narrow Network |
$4,470.35
|
| Rate for Payer: Priority Health SBD |
$4,470.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,838.16
|
|
|
PR SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF
|
Professional
|
Both
|
$1,555.00
|
|
|
Service Code
|
HCPCS 27381
|
| Min. Negotiated Rate |
$530.58 |
| Max. Negotiated Rate |
$3,176.14 |
| Rate for Payer: Aetna Commercial |
$1,093.37
|
| Rate for Payer: BCBS Complete |
$557.11
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.14
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Meridian Medicaid |
$557.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$530.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,088.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,264.37
|
| Rate for Payer: Priority Health SBD |
$1,264.37
|
| Rate for Payer: UMR Bronson Commercial |
$715.30
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY
|
Professional
|
Both
|
$2,880.00
|
|
|
Service Code
|
HCPCS 44605
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$2,268.40 |
| Rate for Payer: Aetna Commercial |
$1,748.55
|
| Rate for Payer: BCBS Complete |
$860.38
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Meridian Medicaid |
$860.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,268.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,268.40
|
| Rate for Payer: Priority Health SBD |
$2,268.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,324.80
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$3,021.00
|
|
|
Service Code
|
HCPCS 44604
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$2,114.70 |
| Rate for Payer: Aetna Commercial |
$1,425.76
|
| Rate for Payer: BCBS Complete |
$705.17
|
| Rate for Payer: BCBS Trust/PPO |
$54.94
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Meridian Medicaid |
$705.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$671.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,114.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,846.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,846.83
|
| Rate for Payer: Priority Health SBD |
$1,846.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,389.66
|
|
|
PR SUTR&/LIG THORACIC DUCT THORACIC APPROACH
|
Professional
|
Both
|
$5,811.00
|
|
|
Service Code
|
HCPCS 38381
|
| Min. Negotiated Rate |
$510.77 |
| Max. Negotiated Rate |
$4,067.70 |
| Rate for Payer: Aetna Commercial |
$994.35
|
| Rate for Payer: BCBS Complete |
$536.31
|
| Rate for Payer: BCBS Trust/PPO |
$540.98
|
| Rate for Payer: Cash Price |
$4,648.80
|
| Rate for Payer: Cash Price |
$4,648.80
|
| Rate for Payer: Meridian Medicaid |
$536.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,067.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,723.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,723.94
|
| Rate for Payer: Priority Health SBD |
$1,723.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,673.06
|
|
|
PR SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 69740
|
| Min. Negotiated Rate |
$744.22 |
| Max. Negotiated Rate |
$1,902.94 |
| Rate for Payer: Aetna Commercial |
$1,318.76
|
| Rate for Payer: BCBS Complete |
$781.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,902.94
|
| Rate for Payer: Cash Price |
$1,612.00
|
| Rate for Payer: Cash Price |
$1,612.00
|
| Rate for Payer: Meridian Medicaid |
$781.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$744.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,649.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,649.16
|
| Rate for Payer: Priority Health SBD |
$1,649.16
|
| Rate for Payer: UMR Bronson Commercial |
$926.90
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS
|
Professional
|
Both
|
$3,113.00
|
|
|
Service Code
|
HCPCS 64857
|
| Min. Negotiated Rate |
$202.87 |
| Max. Negotiated Rate |
$2,179.10 |
| Rate for Payer: Aetna Commercial |
$1,356.55
|
| Rate for Payer: BCBS Complete |
$708.30
|
| Rate for Payer: BCBS Trust/PPO |
$202.87
|
| Rate for Payer: Cash Price |
$2,490.40
|
| Rate for Payer: Cash Price |
$2,490.40
|
| Rate for Payer: Meridian Medicaid |
$708.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,179.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,784.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,784.18
|
| Rate for Payer: Priority Health SBD |
$1,784.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,431.98
|
|
