|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$244.95 |
| Max. Negotiated Rate |
$2,210.41 |
| Rate for Payer: Aetna Commercial |
$407.50
|
| Rate for Payer: BCBS Complete |
$257.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.41
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Meridian Medicaid |
$257.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.75
|
| Rate for Payer: Priority Health Narrow Network |
$538.75
|
| Rate for Payer: Priority Health SBD |
$538.75
|
| Rate for Payer: UMR Bronson Commercial |
$368.00
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$155.92 |
| Max. Negotiated Rate |
$1,182.86 |
| Rate for Payer: Aetna Commercial |
$316.96
|
| Rate for Payer: BCBS Complete |
$163.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.86
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Meridian Medicaid |
$163.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.62
|
| Rate for Payer: Priority Health Narrow Network |
$365.62
|
| Rate for Payer: Priority Health SBD |
$365.62
|
| Rate for Payer: UMR Bronson Commercial |
$286.58
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$609.00
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$183.82 |
| Max. Negotiated Rate |
$920.30 |
| Rate for Payer: Aetna Commercial |
$375.41
|
| Rate for Payer: BCBS Complete |
$193.01
|
| Rate for Payer: BCBS Trust/PPO |
$920.30
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Meridian Medicaid |
$193.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.05
|
| Rate for Payer: Priority Health Narrow Network |
$434.05
|
| Rate for Payer: Priority Health SBD |
$434.05
|
| Rate for Payer: UMR Bronson Commercial |
$280.14
|
|
|
PR TX SEPTIC ABORTION SURGICAL
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 59830
|
| Min. Negotiated Rate |
$300.54 |
| Max. Negotiated Rate |
$1,227.77 |
| Rate for Payer: Aetna Commercial |
$503.21
|
| Rate for Payer: BCBS Complete |
$315.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.77
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Meridian Medicaid |
$315.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$662.46
|
| Rate for Payer: Priority Health Narrow Network |
$662.46
|
| Rate for Payer: Priority Health SBD |
$662.46
|
| Rate for Payer: UMR Bronson Commercial |
$450.80
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$6,328.00
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$595.12 |
| Max. Negotiated Rate |
$4,429.60 |
| Rate for Payer: Aetna Commercial |
$1,230.99
|
| Rate for Payer: BCBS Complete |
$624.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,365.66
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Meridian Medicaid |
$624.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$595.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,429.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,416.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,416.03
|
| Rate for Payer: Priority Health SBD |
$1,416.03
|
| Rate for Payer: UMR Bronson Commercial |
$2,910.88
|
|
|
PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES
|
Professional
|
Both
|
$856.00
|
|
|
Service Code
|
HCPCS 27257
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$2,684.82 |
| Rate for Payer: Aetna Commercial |
$483.93
|
| Rate for Payer: BCBS Complete |
$244.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,684.82
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Meridian Medicaid |
$244.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$552.52
|
| Rate for Payer: Priority Health Narrow Network |
$552.52
|
| Rate for Payer: Priority Health SBD |
$552.52
|
| Rate for Payer: UMR Bronson Commercial |
$393.76
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
12020
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$322.70 |
| Rate for Payer: Aetna Commercial |
$203.61
|
| Rate for Payer: BCBS Complete |
$126.59
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Meridian Medicaid |
$126.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.01
|
| Rate for Payer: Priority Health Narrow Network |
$231.01
|
| Rate for Payer: Priority Health SBD |
$231.01
|
| Rate for Payer: UMR Bronson Commercial |
$212.06
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$322.70 |
| Rate for Payer: Aetna Commercial |
$203.61
|
| Rate for Payer: BCBS Complete |
$126.59
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Meridian Medicaid |
$126.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.01
|
| Rate for Payer: Priority Health Narrow Network |
$231.01
|
| Rate for Payer: Priority Health SBD |
$231.01
|
| Rate for Payer: UMR Bronson Commercial |
$212.06
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$170.57 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna American Axle |
$299.65
|
| Rate for Payer: Aetna Commercial |
$391.85
|
| Rate for Payer: Aetna Medicare |
$580.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$621.27
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$396.46
|
| Rate for Payer: Cofinity Commercial |
$322.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Healthscope Commercial |
$414.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$322.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.75
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$391.85
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Commercial |
$391.85
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$290.43
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.26
|
| Rate for Payer: UHC Exchange |
$185.33
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: UMR Bronson Commercial |
$170.57
|
| Rate for Payer: VA VA |
$558.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.75
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$414.90 |
| Rate for Payer: Aetna American Axle |
$299.65
|
| Rate for Payer: Aetna Commercial |
$391.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.65
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$322.70
|
| Rate for Payer: Cofinity Commercial |
$396.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.80
|
| Rate for Payer: Healthscope Commercial |
$414.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$322.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$391.85
|
| Rate for Payer: PHP Commercial |
$391.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health SBD |
$290.43
|
| Rate for Payer: UMR Bronson Commercial |
$202.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.75
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna Commercial |
$150.60
|
| Rate for Payer: BCBS Complete |
$95.06
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Meridian Medicaid |
$95.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.05
|
| Rate for Payer: Priority Health Narrow Network |
$173.05
|
| Rate for Payer: Priority Health SBD |
$173.05
|
| Rate for Payer: UMR Bronson Commercial |
$157.32
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$149.53 |
| Max. Negotiated Rate |
$1,001.66 |
| Rate for Payer: Aetna Commercial |
$340.48
|
| Rate for Payer: BCBS Complete |
$157.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.66
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Meridian Medicaid |
$157.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.44
|
| Rate for Payer: Priority Health Narrow Network |
$404.44
|
| Rate for Payer: Priority Health SBD |
$404.44
|
| Rate for Payer: UMR Bronson Commercial |
$364.32
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$921.88 |
| Rate for Payer: Aetna Commercial |
$250.09
|
| Rate for Payer: BCBS Complete |
$132.85
|
| Rate for Payer: BCBS Trust/PPO |
$921.88
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Meridian Medicaid |
$132.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.18
|
| Rate for Payer: Priority Health Narrow Network |
$296.18
|
| Rate for Payer: Priority Health SBD |
$296.18
|
| Rate for Payer: UMR Bronson Commercial |
$263.12
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,181.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$641.77 |
| Max. Negotiated Rate |
$2,926.70 |
| Rate for Payer: Aetna Commercial |
$1,333.51
|
| Rate for Payer: BCBS Complete |
$673.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.30
|
| Rate for Payer: Cash Price |
$3,344.80
|
| Rate for Payer: Cash Price |
$3,344.80
|
| Rate for Payer: Meridian Medicaid |
$673.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$641.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,926.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,527.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,527.36
|
| Rate for Payer: Priority Health SBD |
$1,527.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,923.26
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$184.67 |
| Max. Negotiated Rate |
$4,016.66 |
| Rate for Payer: Aetna Commercial |
$323.65
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,016.66
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Meridian Medicaid |
$193.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.87
|
| Rate for Payer: Priority Health Narrow Network |
$406.87
|
| Rate for Payer: Priority Health SBD |
$406.87
|
| Rate for Payer: UMR Bronson Commercial |
$301.30
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$1,875.47 |
| Rate for Payer: Aetna Commercial |
$11.76
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.47
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Narrow Network |
$14.37
|
| Rate for Payer: Priority Health SBD |
$14.37
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$1,749.20 |
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.20
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.65
|
| Rate for Payer: Priority Health Narrow Network |
$29.65
|
| Rate for Payer: Priority Health SBD |
$29.65
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR
|
Professional
|
Both
|
$2,738.00
|
|
|
Service Code
|
HCPCS 69646
|
| Min. Negotiated Rate |
$1,007.28 |
| Max. Negotiated Rate |
$2,237.55 |
| Rate for Payer: Aetna Commercial |
$1,770.52
|
| Rate for Payer: BCBS Complete |
$1,057.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.35
|
| Rate for Payer: Cash Price |
$2,190.40
|
| Rate for Payer: Cash Price |
$2,190.40
|
| Rate for Payer: Meridian Medicaid |
$1,057.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,007.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,916.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,237.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,237.55
|
| Rate for Payer: Priority Health SBD |
$2,237.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,259.48
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 69645
|
| Min. Negotiated Rate |
$946.79 |
| Max. Negotiated Rate |
$2,107.43 |
| Rate for Payer: Aetna Commercial |
$1,673.47
|
| Rate for Payer: BCBS Complete |
$994.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,502.49
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Meridian Medicaid |
$994.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$946.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,820.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,107.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,107.43
|
| Rate for Payer: Priority Health SBD |
$2,107.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,196.00
|
|
|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$1,851.00
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$134.72 |
| Max. Negotiated Rate |
$1,499.24 |
| Rate for Payer: Aetna Commercial |
$1,193.27
|
| Rate for Payer: BCBS Complete |
$710.54
|
| Rate for Payer: BCBS Trust/PPO |
$134.72
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Meridian Medicaid |
$710.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$676.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,499.24
|
| Rate for Payer: Priority Health SBD |
$1,499.24
|
| Rate for Payer: UMR Bronson Commercial |
$851.46
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$3,083.00
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$572.76 |
| Max. Negotiated Rate |
$2,248.97 |
| Rate for Payer: Aetna Commercial |
$1,012.12
|
| Rate for Payer: BCBS Complete |
$601.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,248.97
|
| Rate for Payer: Cash Price |
$2,466.40
|
| Rate for Payer: Cash Price |
$2,466.40
|
| Rate for Payer: Meridian Medicaid |
$601.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$572.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,158.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,850.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,850.00
|
| Rate for Payer: Priority Health SBD |
$1,270.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,418.18
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$2,059.84 |
| Rate for Payer: Aetna Commercial |
$176.44
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,059.84
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.30
|
| Rate for Payer: Priority Health Narrow Network |
$226.30
|
| Rate for Payer: Priority Health SBD |
$226.30
|
| Rate for Payer: UMR Bronson Commercial |
$170.20
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$2,182.94 |
| Rate for Payer: Aetna Commercial |
$145.46
|
| Rate for Payer: BCBS Complete |
$89.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,182.94
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Meridian Medicaid |
$89.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.64
|
| Rate for Payer: Priority Health Narrow Network |
$187.64
|
| Rate for Payer: Priority Health SBD |
$187.64
|
| Rate for Payer: UMR Bronson Commercial |
$148.58
|
|
|
PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ
|
Professional
|
Both
|
$1,916.00
|
|
|
Service Code
|
HCPCS 69632
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$1,544.97 |
| Rate for Payer: Aetna Commercial |
$1,230.77
|
| Rate for Payer: BCBS Complete |
$729.32
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: Cash Price |
$1,532.80
|
| Rate for Payer: Cash Price |
$1,532.80
|
| Rate for Payer: Meridian Medicaid |
$729.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$694.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,341.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,544.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.97
|
| Rate for Payer: Priority Health SBD |
$1,544.97
|
| Rate for Payer: UMR Bronson Commercial |
$881.36
|
|
|
PR TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,565.00
|
|
|
Service Code
|
HCPCS 69635
|
| Min. Negotiated Rate |
$329.13 |
| Max. Negotiated Rate |
$2,495.50 |
| Rate for Payer: Aetna Commercial |
$1,428.81
|
| Rate for Payer: BCBS Complete |
$862.62
|
| Rate for Payer: BCBS Trust/PPO |
$329.13
|
| Rate for Payer: Cash Price |
$2,852.00
|
| Rate for Payer: Cash Price |
$2,852.00
|
| Rate for Payer: Meridian Medicaid |
$862.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$821.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,495.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,826.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,826.43
|
| Rate for Payer: Priority Health SBD |
$1,826.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,639.90
|
|
