|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS
|
Professional
|
Both
|
$3,875.00
|
|
|
Service Code
|
HCPCS 64856
|
| Min. Negotiated Rate |
$183.32 |
| Max. Negotiated Rate |
$2,712.50 |
| Rate for Payer: Aetna Commercial |
$1,297.52
|
| Rate for Payer: BCBS Complete |
$677.66
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Meridian Medicaid |
$677.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,712.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,715.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,715.09
|
| Rate for Payer: Priority Health SBD |
$1,715.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,782.50
|
|
|
PR SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ
|
Professional
|
Both
|
$2,296.00
|
|
|
Service Code
|
HCPCS 27386
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$1,607.20 |
| Rate for Payer: Aetna Commercial |
$1,142.85
|
| Rate for Payer: BCBS Complete |
$581.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.54
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Meridian Medicaid |
$581.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,607.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,317.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,317.99
|
| Rate for Payer: Priority Health SBD |
$1,317.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,056.16
|
|
|
PR SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP
|
Professional
|
Both
|
$2,160.00
|
|
|
Service Code
|
HCPCS 33320
|
| Min. Negotiated Rate |
$375.26 |
| Max. Negotiated Rate |
$1,675.14 |
| Rate for Payer: Aetna Commercial |
$1,417.73
|
| Rate for Payer: BCBS Complete |
$707.41
|
| Rate for Payer: BCBS Trust/PPO |
$375.26
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Meridian Medicaid |
$707.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,675.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,675.14
|
| Rate for Payer: Priority Health SBD |
$1,675.14
|
| Rate for Payer: UMR Bronson Commercial |
$993.60
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK
|
Professional
|
Both
|
$1,128.00
|
|
|
Service Code
|
HCPCS 67935
|
| Min. Negotiated Rate |
$276.90 |
| Max. Negotiated Rate |
$2,017.58 |
| Rate for Payer: Aetna Commercial |
$573.82
|
| Rate for Payer: BCBS Complete |
$290.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,017.58
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Meridian Medicaid |
$290.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.77
|
| Rate for Payer: Priority Health Narrow Network |
$755.77
|
| Rate for Payer: Priority Health SBD |
$755.77
|
| Rate for Payer: UMR Bronson Commercial |
$518.88
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 67930
|
| Min. Negotiated Rate |
$148.89 |
| Max. Negotiated Rate |
$668.30 |
| Rate for Payer: Aetna Commercial |
$309.73
|
| Rate for Payer: BCBS Complete |
$156.33
|
| Rate for Payer: BCBS Trust/PPO |
$668.30
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Meridian Medicaid |
$156.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.70
|
| Rate for Payer: Priority Health Narrow Network |
$405.70
|
| Rate for Payer: Priority Health SBD |
$405.70
|
| Rate for Payer: UMR Bronson Commercial |
$345.00
|
|
|
PR SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE
|
Professional
|
Both
|
$2,108.00
|
|
|
Service Code
|
HCPCS 64834
|
| Min. Negotiated Rate |
$404.68 |
| Max. Negotiated Rate |
$1,475.60 |
| Rate for Payer: Aetna Commercial |
$952.43
|
| Rate for Payer: BCBS Complete |
$503.43
|
| Rate for Payer: BCBS Trust/PPO |
$404.68
|
| Rate for Payer: Cash Price |
$1,686.40
|
| Rate for Payer: Cash Price |
$1,686.40
|
| Rate for Payer: Meridian Medicaid |
$503.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,248.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,248.52
|
| Rate for Payer: Priority Health SBD |
$1,248.52
|
| Rate for Payer: UMR Bronson Commercial |
$969.68
|
|
|
PR SUTURE 1 NERVE MEDIAN MOTOR THENAR
|
Professional
|
Both
|
$2,242.00
|
|
|
Service Code
|
HCPCS 64835
|
| Min. Negotiated Rate |
$302.72 |
| Max. Negotiated Rate |
$1,569.40 |
| Rate for Payer: Aetna Commercial |
$1,049.59
|
| Rate for Payer: BCBS Complete |
$552.20
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Meridian Medicaid |
$552.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,569.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,387.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,387.25
|
| Rate for Payer: Priority Health SBD |
$1,387.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.32
|
|
|
PR SUTURE 1 NERVE ULNAR MOTOR
|
Professional
|
Both
|
$1,770.00
|
|
|
Service Code
|
HCPCS 64836
|
| Min. Negotiated Rate |
$219.24 |
| Max. Negotiated Rate |
$1,387.25 |
| Rate for Payer: Aetna Commercial |
$1,049.59
|
| Rate for Payer: BCBS Complete |
$552.20
|
| Rate for Payer: BCBS Trust/PPO |
$219.24
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Meridian Medicaid |
$552.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,387.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,387.25
|
| Rate for Payer: Priority Health SBD |
$1,387.25
|
| Rate for Payer: UMR Bronson Commercial |
$814.20
|
|
|
PR SUTURE BRACHIAL PLEXUS
|
Professional
|
Both
|
$3,632.00
|
|
|
Service Code
|
HCPCS 64861
|
| Min. Negotiated Rate |
$244.60 |
| Max. Negotiated Rate |
$2,608.02 |
| Rate for Payer: Aetna Commercial |
$1,962.06
|
| Rate for Payer: BCBS Complete |
$1,039.75
|
| Rate for Payer: BCBS Trust/PPO |
$244.60
|
| Rate for Payer: Cash Price |
$2,905.60
|
| Rate for Payer: Cash Price |
$2,905.60
|
| Rate for Payer: Meridian Medicaid |
$1,039.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,542.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,608.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,608.02
|
| Rate for Payer: Priority Health SBD |
$2,608.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,670.72
|
|
|
PR SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
HCPCS 64831
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,362.20 |
| Rate for Payer: Aetna Commercial |
$883.33
|
| Rate for Payer: BCBS Complete |
$470.79
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: Cash Price |
$1,556.80
|
| Rate for Payer: Cash Price |
$1,556.80
|
| Rate for Payer: Meridian Medicaid |
$470.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,181.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,181.72
|
| Rate for Payer: Priority Health SBD |
$1,181.72
|
| Rate for Payer: UMR Bronson Commercial |
$895.16
|
|
|
PR SUTURE EACH ADDITIONAL NERVE HAND/FOOT
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 64837
|
| Min. Negotiated Rate |
$206.57 |
| Max. Negotiated Rate |
$899.50 |
| Rate for Payer: Aetna Commercial |
$471.67
|
| Rate for Payer: BCBS Complete |
$240.87
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Meridian Medicaid |
$240.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$608.69
|
| Rate for Payer: Priority Health Narrow Network |
$608.69
|
| Rate for Payer: Priority Health SBD |
$608.69
|
| Rate for Payer: UMR Bronson Commercial |
$591.10
|
|
|
PR SUTURE EACH ADDITIONAL PERIPHERAL NERVE
|
Professional
|
Both
|
$1,601.00
|
|
|
Service Code
|
HCPCS 64859
|
| Min. Negotiated Rate |
$155.92 |
| Max. Negotiated Rate |
$1,120.70 |
| Rate for Payer: Aetna Commercial |
$320.62
|
| Rate for Payer: BCBS Complete |
$163.72
|
| Rate for Payer: BCBS Trust/PPO |
$304.83
|
| Rate for Payer: Cash Price |
$1,280.80
|
| Rate for Payer: Cash Price |
$1,280.80
|
| Rate for Payer: Meridian Medicaid |
$163.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,120.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.92
|
| Rate for Payer: Priority Health Narrow Network |
$413.92
|
| Rate for Payer: Priority Health SBD |
$413.92
|
| Rate for Payer: UMR Bronson Commercial |
$736.46
|
|
|
PR SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY
|
Professional
|
Both
|
$2,988.00
|
|
|
Service Code
|
HCPCS 47900
|
| Min. Negotiated Rate |
$881.82 |
| Max. Negotiated Rate |
$3,830.18 |
| Rate for Payer: Aetna Commercial |
$1,836.31
|
| Rate for Payer: BCBS Complete |
$925.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,830.18
|
| Rate for Payer: Cash Price |
$2,390.40
|
| Rate for Payer: Cash Price |
$2,390.40
|
| Rate for Payer: Meridian Medicaid |
$925.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$881.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,091.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,425.39
|
| Rate for Payer: Priority Health Narrow Network |
$2,425.39
|
| Rate for Payer: Priority Health SBD |
$2,425.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,374.48
|
|
|
PR SUTURE FACIAL NERVE EXTRACRANIAL
|
Professional
|
Both
|
$2,381.00
|
|
|
Service Code
|
HCPCS 64864
|
| Min. Negotiated Rate |
$305.89 |
| Max. Negotiated Rate |
$1,666.70 |
| Rate for Payer: Aetna Commercial |
$1,100.43
|
| Rate for Payer: BCBS Complete |
$576.80
|
| Rate for Payer: BCBS Trust/PPO |
$305.89
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Meridian Medicaid |
$576.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,666.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,460.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,460.86
|
| Rate for Payer: Priority Health SBD |
$1,460.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,095.26
|
|
|
PR SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT
|
Professional
|
Both
|
$2,977.00
|
|
|
Service Code
|
HCPCS 64865
|
| Min. Negotiated Rate |
$354.49 |
| Max. Negotiated Rate |
$2,083.90 |
| Rate for Payer: Aetna Commercial |
$1,394.17
|
| Rate for Payer: BCBS Complete |
$728.88
|
| Rate for Payer: BCBS Trust/PPO |
$354.49
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Meridian Medicaid |
$728.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$694.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,083.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,844.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,844.75
|
| Rate for Payer: Priority Health SBD |
$1,844.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,369.42
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Facility
|
OP
|
$1,521.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$562.77 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna American Axle |
$988.65
|
| Rate for Payer: Aetna Commercial |
$1,292.85
|
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,719.25
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Cofinity Commercial |
$1,064.70
|
| Rate for Payer: Cofinity Commercial |
$1,308.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,216.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$1,368.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,064.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,140.75
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,292.85
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$1,292.85
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,064.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Priority Health SBD |
$958.23
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$621.81
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: UMR Bronson Commercial |
$562.77
|
| Rate for Payer: VA VA |
$6,359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,140.75
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Facility
|
IP
|
$1,521.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$669.24 |
| Max. Negotiated Rate |
$1,368.90 |
| Rate for Payer: Aetna American Axle |
$988.65
|
| Rate for Payer: Aetna Commercial |
$1,292.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.65
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Cofinity Commercial |
$1,064.70
|
| Rate for Payer: Cofinity Commercial |
$1,308.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,216.80
|
| Rate for Payer: Healthscope Commercial |
$1,368.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,064.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,140.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,292.85
|
| Rate for Payer: PHP Commercial |
$1,292.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,064.70
|
| Rate for Payer: Priority Health SBD |
$958.23
|
| Rate for Payer: UMR Bronson Commercial |
$669.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,140.75
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Professional
|
Both
|
$1,521.00
|
|
|
Service Code
|
HCPCS 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$404.49 |
| Max. Negotiated Rate |
$2,533.73 |
| Rate for Payer: Aetna Commercial |
$824.66
|
| Rate for Payer: BCBS Complete |
$424.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,533.73
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Meridian Medicaid |
$424.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$404.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,064.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$964.62
|
| Rate for Payer: Priority Health Narrow Network |
$964.62
|
| Rate for Payer: Priority Health SBD |
$964.62
|
| Rate for Payer: UMR Bronson Commercial |
$699.66
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Professional
|
Both
|
$1,521.00
|
|
|
Service Code
|
HCPCS 27380
|
| Min. Negotiated Rate |
$404.49 |
| Max. Negotiated Rate |
$2,533.73 |
| Rate for Payer: Aetna Commercial |
$824.66
|
| Rate for Payer: BCBS Complete |
$424.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,533.73
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Meridian Medicaid |
$424.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$404.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,064.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$964.62
|
| Rate for Payer: Priority Health Narrow Network |
$964.62
|
| Rate for Payer: Priority Health SBD |
$964.62
|
| Rate for Payer: UMR Bronson Commercial |
$699.66
|
|
|
PR SUTURE MESENTERY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,940.00
|
|
|
Service Code
|
HCPCS 44850
|
| Min. Negotiated Rate |
$330.19 |
| Max. Negotiated Rate |
$1,358.00 |
| Rate for Payer: Aetna Commercial |
$1,006.64
|
| Rate for Payer: BCBS Complete |
$503.43
|
| Rate for Payer: BCBS Trust/PPO |
$330.19
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Meridian Medicaid |
$503.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,358.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,312.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,312.35
|
| Rate for Payer: Priority Health SBD |
$1,312.35
|
| Rate for Payer: UMR Bronson Commercial |
$892.40
|
|
|
PR SUTURE NERVE REQ SECONDARY/DELAYED SUTURE
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 64872
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$213.43 |
| Rate for Payer: Aetna Commercial |
$150.63
|
| Rate for Payer: BCBS Complete |
$76.49
|
| Rate for Payer: BCBS Trust/PPO |
$213.43
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Meridian Medicaid |
$76.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.64
|
| Rate for Payer: Priority Health Narrow Network |
$193.64
|
| Rate for Payer: Priority Health SBD |
$193.64
|
| Rate for Payer: UMR Bronson Commercial |
$91.08
|
|
|
PR SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 64874
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$303.24 |
| Rate for Payer: Aetna Commercial |
$225.49
|
| Rate for Payer: BCBS Complete |
$114.73
|
| Rate for Payer: BCBS Trust/PPO |
$303.24
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Meridian Medicaid |
$114.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.33
|
| Rate for Payer: Priority Health Narrow Network |
$289.33
|
| Rate for Payer: Priority Health SBD |
$289.33
|
| Rate for Payer: UMR Bronson Commercial |
$139.84
|
|
|
PR SUTURE PHARYNX WOUND/INJURY
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
HCPCS 42900
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$1,110.49 |
| Rate for Payer: Aetna Commercial |
$440.38
|
| Rate for Payer: BCBS Complete |
$223.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,110.49
|
| Rate for Payer: Cash Price |
$488.80
|
| Rate for Payer: Cash Price |
$488.80
|
| Rate for Payer: Meridian Medicaid |
$223.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$584.45
|
| Rate for Payer: Priority Health Narrow Network |
$584.45
|
| Rate for Payer: Priority Health SBD |
$584.45
|
| Rate for Payer: UMR Bronson Commercial |
$281.06
|
|
|
PR SUTURE POSTERIOR TIBIAL NERVE
|
Professional
|
Both
|
$1,940.00
|
|
|
Service Code
|
HCPCS 64840
|
| Min. Negotiated Rate |
$247.24 |
| Max. Negotiated Rate |
$1,632.99 |
| Rate for Payer: Aetna Commercial |
$1,237.15
|
| Rate for Payer: BCBS Complete |
$649.48
|
| Rate for Payer: BCBS Trust/PPO |
$247.24
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Meridian Medicaid |
$649.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$618.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,358.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,632.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,632.99
|
| Rate for Payer: Priority Health SBD |
$1,632.99
|
| Rate for Payer: UMR Bronson Commercial |
$892.40
|
|
|
PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$1,866.00
|
|
|
Service Code
|
HCPCS 27385
|
| Min. Negotiated Rate |
$394.69 |
| Max. Negotiated Rate |
$1,306.20 |
| Rate for Payer: Aetna Commercial |
$800.67
|
| Rate for Payer: BCBS Complete |
$414.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.92
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Meridian Medicaid |
$414.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$939.09
|
| Rate for Payer: Priority Health Narrow Network |
$939.09
|
| Rate for Payer: Priority Health SBD |
$939.09
|
| Rate for Payer: UMR Bronson Commercial |
$858.36
|
|
