|
PR THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM IN
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 34490
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$2,309.73 |
| Rate for Payer: Aetna Commercial |
$865.10
|
| Rate for Payer: BCBS Complete |
$378.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,309.73
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Meridian Medicaid |
$378.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$882.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,016.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,016.56
|
| Rate for Payer: Priority Health SBD |
$1,016.56
|
| Rate for Payer: UMR Bronson Commercial |
$579.60
|
|
|
PR THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF
|
Professional
|
Both
|
$2,074.00
|
|
|
Service Code
|
HCPCS 36831
|
| Min. Negotiated Rate |
$386.38 |
| Max. Negotiated Rate |
$1,521.50 |
| Rate for Payer: Aetna Commercial |
$824.83
|
| Rate for Payer: BCBS Complete |
$405.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,521.50
|
| Rate for Payer: Cash Price |
$1,659.20
|
| Rate for Payer: Cash Price |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$405.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$960.18
|
| Rate for Payer: Priority Health Narrow Network |
$960.18
|
| Rate for Payer: Priority Health SBD |
$960.18
|
| Rate for Payer: UMR Bronson Commercial |
$954.04
|
|
|
PR THROMBECTOMY,ARTERIOVENOUS FISTULA
|
Professional
|
Both
|
$1,873.00
|
|
|
Service Code
|
HCPCS 36870
|
| Min. Negotiated Rate |
$749.20 |
| Max. Negotiated Rate |
$1,311.10 |
| Rate for Payer: BCBS Complete |
$749.20
|
| Rate for Payer: Cash Price |
$1,498.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,311.10
|
| Rate for Payer: UMR Bronson Commercial |
$861.58
|
|
|
PR THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 37211
|
| Min. Negotiated Rate |
$240.26 |
| Max. Negotiated Rate |
$1,423.24 |
| Rate for Payer: Aetna Commercial |
$517.91
|
| Rate for Payer: BCBS Complete |
$252.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,423.24
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Meridian Medicaid |
$252.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$597.92
|
| Rate for Payer: Priority Health Narrow Network |
$597.92
|
| Rate for Payer: Priority Health SBD |
$597.92
|
| Rate for Payer: UMR Bronson Commercial |
$280.60
|
|
|
PR THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 37213
|
| Min. Negotiated Rate |
$143.14 |
| Max. Negotiated Rate |
$749.00 |
| Rate for Payer: Aetna Commercial |
$311.52
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCBS Trust/PPO |
$399.45
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.47
|
| Rate for Payer: Priority Health Narrow Network |
$357.47
|
| Rate for Payer: Priority Health SBD |
$357.47
|
| Rate for Payer: UMR Bronson Commercial |
$492.20
|
|
|
PR THROMBOLYSIS CEREBRAL IV INFUSION
|
Professional
|
Both
|
$1,381.00
|
|
|
Service Code
|
HCPCS 37195
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$1,330.43 |
| Rate for Payer: Aetna Commercial |
$1,244.65
|
| Rate for Payer: BCBS Complete |
$253.65
|
| Rate for Payer: BCBS Trust/PPO |
$789.81
|
| Rate for Payer: Cash Price |
$1,104.80
|
| Rate for Payer: Cash Price |
$1,104.80
|
| Rate for Payer: Meridian Medicaid |
$253.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,330.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,330.43
|
| Rate for Payer: Priority Health SBD |
$1,330.43
|
| Rate for Payer: UMR Bronson Commercial |
$635.26
|
|
|
PR THROMBOLYSIS CORONARY INTRAVENOUS INFUSION
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 92977
|
| Min. Negotiated Rate |
$68.22 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$68.22
|
| Rate for Payer: BCBS Complete |
$250.00
|
| Rate for Payer: BCBS Trust/PPO |
$294.26
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.71
|
| Rate for Payer: Priority Health Narrow Network |
$74.71
|
| Rate for Payer: Priority Health SBD |
$74.71
|
| Rate for Payer: UMR Bronson Commercial |
$287.50
|
|
|
PR THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 92975
|
| Min. Negotiated Rate |
$233.87 |
| Max. Negotiated Rate |
$543.90 |
| Rate for Payer: Aetna Commercial |
$505.09
|
| Rate for Payer: BCBS Complete |
$245.56
|
| Rate for Payer: BCBS Trust/PPO |
$392.00
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Meridian Medicaid |
$245.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$517.78
|
| Rate for Payer: Priority Health Narrow Network |
$517.78
|
| Rate for Payer: Priority Health SBD |
$517.78
|
| Rate for Payer: UMR Bronson Commercial |
$357.42
|
|
|
PR THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX
|
Professional
|
Both
|
$1,579.00
|
|
|
Service Code
|
HCPCS 37212
|
| Min. Negotiated Rate |
$209.38 |
| Max. Negotiated Rate |
$1,739.86 |
| Rate for Payer: Aetna Commercial |
$452.62
|
| Rate for Payer: BCBS Complete |
$219.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,739.86
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Meridian Medicaid |
$219.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.91
|
| Rate for Payer: Priority Health Narrow Network |
$522.91
|
| Rate for Payer: Priority Health SBD |
$522.91
|
| Rate for Payer: UMR Bronson Commercial |
$726.34
|
|
|
PR THRSC CRTJ PRCRD WINDOW/PRTL RESCJ PRCRD SAC
|
Professional
|
Both
|
$3,635.00
|
|
|
Service Code
|
HCPCS 32659
|
| Min. Negotiated Rate |
$465.19 |
| Max. Negotiated Rate |
$2,544.50 |
| Rate for Payer: Aetna Commercial |
$942.23
|
| Rate for Payer: BCBS Complete |
$488.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.62
|
| Rate for Payer: Cash Price |
$2,908.00
|
| Rate for Payer: Cash Price |
$2,908.00
|
| Rate for Payer: Meridian Medicaid |
$488.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,544.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,003.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,003.42
|
| Rate for Payer: Priority Health SBD |
$1,003.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,672.10
|
|
|
PR THRSC TOT PULM DCRTCTJ INTRAPLEURAL PNEUMONOLSS
|
Professional
|
Both
|
$4,372.00
|
|
|
Service Code
|
HCPCS 32652
|
| Min. Negotiated Rate |
$1,005.88 |
| Max. Negotiated Rate |
$3,060.40 |
| Rate for Payer: Aetna Commercial |
$2,144.89
|
| Rate for Payer: BCBS Complete |
$1,098.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,005.88
|
| Rate for Payer: Cash Price |
$3,497.60
|
| Rate for Payer: Cash Price |
$3,497.60
|
| Rate for Payer: Meridian Medicaid |
$1,098.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,060.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,264.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,264.75
|
| Rate for Payer: Priority Health SBD |
$2,264.75
|
| Rate for Payer: UMR Bronson Commercial |
$2,011.12
|
|
|
PR THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 60522
|
| Min. Negotiated Rate |
$603.85 |
| Max. Negotiated Rate |
$1,906.30 |
| Rate for Payer: Aetna Commercial |
$1,766.25
|
| Rate for Payer: BCBS Complete |
$904.89
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Meridian Medicaid |
$904.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$861.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,756.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,906.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,906.30
|
| Rate for Payer: Priority Health SBD |
$1,906.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,154.14
|
|
|
PR THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX
|
Professional
|
Both
|
$3,462.00
|
|
|
Service Code
|
HCPCS 60520
|
| Min. Negotiated Rate |
$250.94 |
| Max. Negotiated Rate |
$2,423.40 |
| Rate for Payer: Aetna Commercial |
$1,354.31
|
| Rate for Payer: BCBS Complete |
$704.95
|
| Rate for Payer: BCBS Trust/PPO |
$250.94
|
| Rate for Payer: Cash Price |
$2,769.60
|
| Rate for Payer: Cash Price |
$2,769.60
|
| Rate for Payer: Meridian Medicaid |
$704.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$671.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,423.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,482.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,482.82
|
| Rate for Payer: Priority Health SBD |
$1,482.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,592.52
|
|
|
PR THYMECTOMY PRTL/TOT W/O RAD MEDSTNL DSJ SPX
|
Professional
|
Both
|
$3,870.00
|
|
|
Service Code
|
HCPCS 60521
|
| Min. Negotiated Rate |
$373.51 |
| Max. Negotiated Rate |
$2,709.00 |
| Rate for Payer: Aetna Commercial |
$1,448.43
|
| Rate for Payer: BCBS Complete |
$747.66
|
| Rate for Payer: BCBS Trust/PPO |
$373.51
|
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Meridian Medicaid |
$747.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$712.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,709.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,573.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,573.67
|
| Rate for Payer: Priority Health SBD |
$1,573.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,780.20
|
|
|
PR THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL
|
Professional
|
Both
|
$3,128.00
|
|
|
Service Code
|
HCPCS 60260
|
| Min. Negotiated Rate |
$317.51 |
| Max. Negotiated Rate |
$2,189.60 |
| Rate for Payer: Aetna Commercial |
$1,402.16
|
| Rate for Payer: BCBS Complete |
$731.12
|
| Rate for Payer: BCBS Trust/PPO |
$317.51
|
| Rate for Payer: Cash Price |
$2,502.40
|
| Rate for Payer: Cash Price |
$2,502.40
|
| Rate for Payer: Meridian Medicaid |
$731.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$696.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,540.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,540.56
|
| Rate for Payer: Priority Health SBD |
$1,540.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,438.88
|
|
|
PR THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH
|
Professional
|
Both
|
$2,143.36
|
|
|
Service Code
|
HCPCS 60271
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$3,645.80 |
| Rate for Payer: Aetna Commercial |
$1,358.54
|
| Rate for Payer: BCBS Complete |
$708.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,645.80
|
| Rate for Payer: Cash Price |
$1,714.69
|
| Rate for Payer: Cash Price |
$1,714.69
|
| Rate for Payer: Meridian Medicaid |
$708.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$675.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,500.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,493.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,493.24
|
| Rate for Payer: Priority Health SBD |
$1,493.24
|
| Rate for Payer: UMR Bronson Commercial |
$985.95
|
|
|
PR THYROIDECTOMY TOTAL/COMPLETE
|
Professional
|
Both
|
$3,049.00
|
|
|
Service Code
|
HCPCS 60240
|
| Min. Negotiated Rate |
$587.67 |
| Max. Negotiated Rate |
$2,134.30 |
| Rate for Payer: Aetna Commercial |
$1,181.69
|
| Rate for Payer: BCBS Complete |
$617.05
|
| Rate for Payer: BCBS Trust/PPO |
$681.51
|
| Rate for Payer: Cash Price |
$2,439.20
|
| Rate for Payer: Cash Price |
$2,439.20
|
| Rate for Payer: Meridian Medicaid |
$617.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$587.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,134.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,299.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,299.25
|
| Rate for Payer: Priority Health SBD |
$1,299.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,402.54
|
|
|
PR THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 60252
|
| Min. Negotiated Rate |
$785.58 |
| Max. Negotiated Rate |
$1,869.38 |
| Rate for Payer: Aetna Commercial |
$1,701.55
|
| Rate for Payer: BCBS Complete |
$886.55
|
| Rate for Payer: BCBS Trust/PPO |
$785.58
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Meridian Medicaid |
$886.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$844.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,645.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,869.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,869.38
|
| Rate for Payer: Priority Health SBD |
$1,869.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,081.00
|
|
|
PR THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT
|
Professional
|
Both
|
$3,099.00
|
|
|
Service Code
|
HCPCS 60254
|
| Min. Negotiated Rate |
$225.06 |
| Max. Negotiated Rate |
$2,360.98 |
| Rate for Payer: Aetna Commercial |
$2,140.95
|
| Rate for Payer: BCBS Complete |
$1,118.47
|
| Rate for Payer: BCBS Trust/PPO |
$225.06
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Meridian Medicaid |
$1,118.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,065.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,169.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,360.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,360.98
|
| Rate for Payer: Priority Health SBD |
$2,360.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,425.54
|
|
|
PR THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC
|
Professional
|
Both
|
$5,346.00
|
|
|
Service Code
|
HCPCS 60270
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$3,742.20 |
| Rate for Payer: Aetna Commercial |
$1,762.15
|
| Rate for Payer: BCBS Complete |
$914.28
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Meridian Medicaid |
$914.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$870.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,742.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,928.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,928.05
|
| Rate for Payer: Priority Health SBD |
$1,928.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,459.16
|
|
|
PR TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 19357
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,253.56
|
| Rate for Payer: BCBS Complete |
$780.76
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Meridian Medicaid |
$780.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$743.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,427.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,427.12
|
| Rate for Payer: Priority Health SBD |
$1,427.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,104.00
|
|
|
PR TIXAGEV AND CILGAV INJ - ADMIN
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS M0220
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$2,507.84 |
| Rate for Payer: Aetna Commercial |
$150.50
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,507.84
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.93
|
| Rate for Payer: Priority Health Narrow Network |
$144.93
|
| Rate for Payer: Priority Health SBD |
$144.93
|
| Rate for Payer: UMR Bronson Commercial |
$92.00
|
|
|
PR TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP
|
Professional
|
Both
|
$3,534.00
|
|
|
Service Code
|
HCPCS 69637
|
| Min. Negotiated Rate |
$899.07 |
| Max. Negotiated Rate |
$2,473.80 |
| Rate for Payer: Aetna Commercial |
$1,624.04
|
| Rate for Payer: BCBS Complete |
$944.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.93
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Meridian Medicaid |
$944.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$899.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,473.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,999.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,999.94
|
| Rate for Payer: Priority Health SBD |
$1,999.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,625.64
|
|
|
PR TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR
|
Professional
|
Both
|
$4,225.00
|
|
|
Service Code
|
HCPCS 69644
|
| Min. Negotiated Rate |
$964.89 |
| Max. Negotiated Rate |
$2,957.50 |
| Rate for Payer: Aetna Commercial |
$1,699.51
|
| Rate for Payer: BCBS Complete |
$1,013.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,406.93
|
| Rate for Payer: Cash Price |
$3,380.00
|
| Rate for Payer: Cash Price |
$3,380.00
|
| Rate for Payer: Meridian Medicaid |
$1,013.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$964.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,957.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,147.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,147.97
|
| Rate for Payer: Priority Health SBD |
$2,147.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,943.50
|
|
|
PR TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR
|
Professional
|
Both
|
$3,996.00
|
|
|
Service Code
|
HCPCS 69643
|
| Min. Negotiated Rate |
$785.12 |
| Max. Negotiated Rate |
$2,797.20 |
| Rate for Payer: Aetna Commercial |
$1,396.70
|
| Rate for Payer: BCBS Complete |
$824.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,123.77
|
| Rate for Payer: Cash Price |
$3,196.80
|
| Rate for Payer: Cash Price |
$3,196.80
|
| Rate for Payer: Meridian Medicaid |
$824.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$785.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,744.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,744.88
|
| Rate for Payer: Priority Health SBD |
$1,744.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,838.16
|
|
