|
PR TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,854.00
|
|
|
Service Code
|
HCPCS 69641
|
| Min. Negotiated Rate |
$669.46 |
| Max. Negotiated Rate |
$2,697.80 |
| Rate for Payer: Aetna Commercial |
$1,185.92
|
| Rate for Payer: BCBS Complete |
$702.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.56
|
| Rate for Payer: Cash Price |
$3,083.20
|
| Rate for Payer: Cash Price |
$3,083.20
|
| Rate for Payer: Meridian Medicaid |
$702.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$669.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,697.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,486.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,486.98
|
| Rate for Payer: Priority Health SBD |
$1,486.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,772.84
|
|
|
PR TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$2,631.00
|
|
|
Service Code
|
HCPCS 69642
|
| Min. Negotiated Rate |
$859.24 |
| Max. Negotiated Rate |
$1,906.11 |
| Rate for Payer: Aetna Commercial |
$1,523.27
|
| Rate for Payer: BCBS Complete |
$902.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,237.81
|
| Rate for Payer: Cash Price |
$2,104.80
|
| Rate for Payer: Cash Price |
$2,104.80
|
| Rate for Payer: Meridian Medicaid |
$902.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$859.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,906.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,906.11
|
| Rate for Payer: Priority Health SBD |
$1,906.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,210.26
|
|
|
PR TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH
|
Professional
|
Both
|
$3,685.00
|
|
|
Service Code
|
HCPCS 0483T
|
| Min. Negotiated Rate |
$131.11 |
| Max. Negotiated Rate |
$2,579.50 |
| Rate for Payer: Aetna Commercial |
$1,415.73
|
| Rate for Payer: BCBS Complete |
$1,474.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.11
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,579.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,695.10
|
|
|
PR TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 27681
|
| Min. Negotiated Rate |
$328.87 |
| Max. Negotiated Rate |
$1,190.70 |
| Rate for Payer: Aetna Commercial |
$686.91
|
| Rate for Payer: BCBS Complete |
$345.31
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Meridian Medicaid |
$345.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$775.68
|
| Rate for Payer: Priority Health Narrow Network |
$775.68
|
| Rate for Payer: Priority Health SBD |
$775.68
|
| Rate for Payer: UMR Bronson Commercial |
$782.46
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 25295
|
| Min. Negotiated Rate |
$343.78 |
| Max. Negotiated Rate |
$1,011.50 |
| Rate for Payer: Aetna Commercial |
$701.07
|
| Rate for Payer: BCBS Complete |
$360.97
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Meridian Medicaid |
$360.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$816.53
|
| Rate for Payer: Priority Health Narrow Network |
$816.53
|
| Rate for Payer: Priority Health SBD |
$816.53
|
| Rate for Payer: UMR Bronson Commercial |
$664.70
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$635.80 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna American Axle |
$939.25
|
| Rate for Payer: Aetna Commercial |
$1,228.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.25
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cofinity Commercial |
$1,242.70
|
| Rate for Payer: Cofinity Commercial |
$1,011.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.00
|
| Rate for Payer: Healthscope Commercial |
$1,300.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,011.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,083.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,228.25
|
| Rate for Payer: PHP Commercial |
$1,228.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.50
|
| Rate for Payer: Priority Health SBD |
$910.35
|
| Rate for Payer: UMR Bronson Commercial |
$635.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,083.75
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$343.78 |
| Max. Negotiated Rate |
$1,011.50 |
| Rate for Payer: Aetna Commercial |
$701.07
|
| Rate for Payer: BCBS Complete |
$360.97
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Meridian Medicaid |
$360.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$816.53
|
| Rate for Payer: Priority Health Narrow Network |
$816.53
|
| Rate for Payer: Priority Health SBD |
$816.53
|
| Rate for Payer: UMR Bronson Commercial |
$664.70
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$528.49 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna American Axle |
$939.25
|
| Rate for Payer: Aetna Commercial |
$1,228.25
|
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.25
|
| 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 |
$2,157.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cofinity Commercial |
$1,011.50
|
| Rate for Payer: Cofinity Commercial |
$1,242.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$1,300.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,011.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,083.75
|
| 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 |
$1,228.25
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$1,228.25
|
| 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 |
$1,011.50
|
| 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 |
$910.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$528.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: UMR Bronson Commercial |
$534.65
|
| Rate for Payer: VA VA |
$2,877.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,083.75
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN
|
Professional
|
Both
|
$1,526.00
|
|
|
Service Code
|
HCPCS 24358
|
| Min. Negotiated Rate |
$222.41 |
| Max. Negotiated Rate |
$1,068.20 |
| Rate for Payer: Aetna Commercial |
$702.23
|
| Rate for Payer: BCBS Complete |
$362.98
|
| Rate for Payer: BCBS Trust/PPO |
$222.41
|
| Rate for Payer: Cash Price |
$1,220.80
|
| Rate for Payer: Cash Price |
$1,220.80
|
| Rate for Payer: Meridian Medicaid |
$362.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,068.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$818.57
|
| Rate for Payer: Priority Health Narrow Network |
$818.57
|
| Rate for Payer: Priority Health SBD |
$818.57
|
| Rate for Payer: UMR Bronson Commercial |
$701.96
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Facility
|
OP
|
$1,817.00
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$662.74 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna American Axle |
$1,181.05
|
| Rate for Payer: Aetna Commercial |
$1,544.45
|
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,181.05
|
| 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 |
$3,238.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$1,562.62
|
| Rate for Payer: Cofinity Commercial |
$1,271.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,453.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$1,635.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,271.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,362.75
|
| 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 |
$1,544.45
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$1,544.45
|
| 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 |
$1,271.90
|
| 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 |
$1,144.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$662.74
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: UMR Bronson Commercial |
$672.29
|
| Rate for Payer: VA VA |
$2,877.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,362.75
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Facility
|
IP
|
$1,817.00
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$1,635.30 |
| Rate for Payer: Aetna American Axle |
$1,181.05
|
| Rate for Payer: Aetna Commercial |
$1,544.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,181.05
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$1,271.90
|
| Rate for Payer: Cofinity Commercial |
$1,562.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,453.60
|
| Rate for Payer: Healthscope Commercial |
$1,635.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,271.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,362.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,544.45
|
| Rate for Payer: PHP Commercial |
$1,544.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.90
|
| Rate for Payer: Priority Health SBD |
$1,144.71
|
| Rate for Payer: UMR Bronson Commercial |
$799.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,362.75
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$191.45 |
| Max. Negotiated Rate |
$1,271.90 |
| Rate for Payer: Aetna Commercial |
$883.30
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCBS Trust/PPO |
$191.45
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,022.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,022.83
|
| Rate for Payer: Priority Health SBD |
$1,022.83
|
| Rate for Payer: UMR Bronson Commercial |
$835.82
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 24359
|
| Min. Negotiated Rate |
$191.45 |
| Max. Negotiated Rate |
$1,271.90 |
| Rate for Payer: Aetna Commercial |
$883.30
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCBS Trust/PPO |
$191.45
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,022.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,022.83
|
| Rate for Payer: Priority Health SBD |
$1,022.83
|
| Rate for Payer: UMR Bronson Commercial |
$835.82
|
|
|
PR TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,251.00
|
|
|
Service Code
|
HCPCS 25290
|
| Min. Negotiated Rate |
$285.42 |
| Max. Negotiated Rate |
$1,061.88 |
| Rate for Payer: Aetna Commercial |
$579.85
|
| Rate for Payer: BCBS Complete |
$299.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Meridian Medicaid |
$299.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$285.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$875.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$675.59
|
| Rate for Payer: Priority Health Narrow Network |
$675.59
|
| Rate for Payer: Priority Health SBD |
$675.59
|
| Rate for Payer: UMR Bronson Commercial |
$575.46
|
|
|
PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 99407
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$1,526.79 |
| Rate for Payer: Aetna Commercial |
$26.18
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.79
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.70
|
| Rate for Payer: Priority Health Narrow Network |
$31.70
|
| Rate for Payer: Priority Health SBD |
$31.70
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 99406
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$1,290.64 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.64
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Meridian Medicaid |
$7.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.99
|
| Rate for Payer: Priority Health Narrow Network |
$14.99
|
| Rate for Payer: Priority Health SBD |
$14.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR TOBACCO-USE COUNSEL>10MIN
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS G0437
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.16
|
| Rate for Payer: Priority Health Narrow Network |
$32.16
|
| Rate for Payer: Priority Health SBD |
$32.16
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR TOBACCO-USE COUNSEL 3-10 MIN
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS G0436
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.42
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
|
|
PR TONE DECAY TEST
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 92563
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$1,190.79 |
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,190.79
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.47
|
| Rate for Payer: Priority Health Narrow Network |
$44.47
|
| Rate for Payer: Priority Health SBD |
$44.47
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12
|
Professional
|
Both
|
$891.00
|
|
|
Service Code
|
HCPCS 42820
|
| Min. Negotiated Rate |
$188.51 |
| Max. Negotiated Rate |
$652.98 |
| Rate for Payer: Aetna Commercial |
$381.77
|
| Rate for Payer: BCBS Complete |
$197.94
|
| Rate for Payer: BCBS Trust/PPO |
$652.98
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Meridian Medicaid |
$197.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$515.06
|
| Rate for Payer: Priority Health Narrow Network |
$515.06
|
| Rate for Payer: Priority Health SBD |
$515.06
|
| Rate for Payer: UMR Bronson Commercial |
$409.86
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 42821
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$1,924.07 |
| Rate for Payer: Aetna Commercial |
$398.73
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.07
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.75
|
| Rate for Payer: Priority Health Narrow Network |
$539.75
|
| Rate for Payer: Priority Health SBD |
$539.75
|
| Rate for Payer: UMR Bronson Commercial |
$261.28
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 42825
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$1,488.22 |
| Rate for Payer: Aetna Commercial |
$347.97
|
| Rate for Payer: BCBS Complete |
$182.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,488.22
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Meridian Medicaid |
$182.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.26
|
| Rate for Payer: Priority Health Narrow Network |
$476.26
|
| Rate for Payer: Priority Health SBD |
$476.26
|
| Rate for Payer: UMR Bronson Commercial |
$218.50
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 42826
|
| Min. Negotiated Rate |
$165.71 |
| Max. Negotiated Rate |
$1,230.94 |
| Rate for Payer: Aetna Commercial |
$332.24
|
| Rate for Payer: BCBS Complete |
$174.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.94
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Meridian Medicaid |
$174.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$453.33
|
| Rate for Payer: Priority Health Narrow Network |
$453.33
|
| Rate for Payer: Priority Health SBD |
$453.33
|
| Rate for Payer: UMR Bronson Commercial |
$213.44
|
|
|
PR TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM
|
Professional
|
Both
|
$2,363.00
|
|
|
Service Code
|
HCPCS 58200
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$1,903.63 |
| Rate for Payer: Aetna Commercial |
$1,612.51
|
| Rate for Payer: BCBS Complete |
$908.02
|
| Rate for Payer: BCBS Trust/PPO |
$82.02
|
| Rate for Payer: Cash Price |
$1,890.40
|
| Rate for Payer: Cash Price |
$1,890.40
|
| Rate for Payer: Meridian Medicaid |
$908.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$864.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,903.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,903.63
|
| Rate for Payer: Priority Health SBD |
$1,903.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,086.98
|
|
|
PR TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY
|
Professional
|
Both
|
$3,291.00
|
|
|
Service Code
|
HCPCS 58152
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$2,303.70 |
| Rate for Payer: Aetna Commercial |
$1,487.05
|
| Rate for Payer: BCBS Complete |
$832.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.46
|
| Rate for Payer: Cash Price |
$2,632.80
|
| Rate for Payer: Cash Price |
$2,632.80
|
| Rate for Payer: Meridian Medicaid |
$832.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$793.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,303.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,756.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,756.41
|
| Rate for Payer: Priority Health SBD |
$1,756.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,513.86
|
|
