|
PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
HCPCS 37243
|
| Min. Negotiated Rate |
$346.34 |
| Max. Negotiated Rate |
$1,206.64 |
| Rate for Payer: Aetna Commercial |
$745.17
|
| Rate for Payer: BCBS Complete |
$363.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.64
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Meridian Medicaid |
$363.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$867.62
|
| Rate for Payer: Priority Health Narrow Network |
$867.62
|
| Rate for Payer: Priority Health SBD |
$867.62
|
| Rate for Payer: UMR Bronson Commercial |
$548.78
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
55250
|
| Min. Negotiated Rate |
$147.61 |
| Max. Negotiated Rate |
$1,543.69 |
| Rate for Payer: Aetna Commercial |
$290.03
|
| Rate for Payer: BCBS Complete |
$154.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.69
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Meridian Medicaid |
$154.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.44
|
| Rate for Payer: Priority Health Narrow Network |
$367.44
|
| Rate for Payer: Priority Health SBD |
$367.44
|
| Rate for Payer: UMR Bronson Commercial |
$402.50
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 55250
|
| Min. Negotiated Rate |
$147.61 |
| Max. Negotiated Rate |
$1,543.69 |
| Rate for Payer: Aetna Commercial |
$290.03
|
| Rate for Payer: BCBS Complete |
$154.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.69
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Meridian Medicaid |
$154.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.44
|
| Rate for Payer: Priority Health Narrow Network |
$367.44
|
| Rate for Payer: Priority Health SBD |
$367.44
|
| Rate for Payer: UMR Bronson Commercial |
$402.50
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna American Axle |
$568.75
|
| Rate for Payer: Aetna Commercial |
$743.75
|
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,306.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$752.50
|
| Rate for Payer: Cofinity Commercial |
$612.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Healthscope Commercial |
$787.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.25
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.75
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Commercial |
$743.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Priority Health SBD |
$551.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$226.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: UMR Bronson Commercial |
$323.75
|
| Rate for Payer: VA VA |
$1,810.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.25
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Aetna American Axle |
$568.75
|
| Rate for Payer: Aetna Commercial |
$743.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.75
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$612.50
|
| Rate for Payer: Cofinity Commercial |
$752.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Healthscope Commercial |
$787.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.75
|
| Rate for Payer: PHP Commercial |
$743.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health SBD |
$551.25
|
| Rate for Payer: UMR Bronson Commercial |
$385.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.25
|
|
|
PR VASOVASOSTOMY VASOVASORRHAPHY
|
Professional
|
Both
|
$933.00
|
|
|
Service Code
|
HCPCS 55400
|
| Min. Negotiated Rate |
$373.20 |
| Max. Negotiated Rate |
$2,224.67 |
| Rate for Payer: Aetna Commercial |
$641.17
|
| Rate for Payer: BCBS Complete |
$373.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,224.67
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$798.64
|
| Rate for Payer: Priority Health Narrow Network |
$798.64
|
| Rate for Payer: Priority Health SBD |
$798.64
|
| Rate for Payer: UMR Bronson Commercial |
$429.18
|
|
|
PR VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG
|
Professional
|
Both
|
$2,716.00
|
|
|
Service Code
|
HCPCS 63103
|
| Min. Negotiated Rate |
$187.01 |
| Max. Negotiated Rate |
$4,342.63 |
| Rate for Payer: Aetna Commercial |
$381.03
|
| Rate for Payer: BCBS Complete |
$196.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,342.63
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: Meridian Medicaid |
$196.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.14
|
| Rate for Payer: Priority Health Narrow Network |
$497.14
|
| Rate for Payer: Priority Health SBD |
$497.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,249.36
|
|
|
PR VCRPEC LES 1 SGM XDRL CERVICAL
|
Professional
|
Both
|
$4,613.00
|
|
|
Service Code
|
HCPCS 63300
|
| Min. Negotiated Rate |
$519.85 |
| Max. Negotiated Rate |
$3,229.10 |
| Rate for Payer: Aetna Commercial |
$2,360.58
|
| Rate for Payer: BCBS Complete |
$1,228.96
|
| Rate for Payer: BCBS Trust/PPO |
$519.85
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Meridian Medicaid |
$1,228.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,170.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,094.97
|
| Rate for Payer: Priority Health Narrow Network |
$3,094.97
|
| Rate for Payer: Priority Health SBD |
$3,094.97
|
| Rate for Payer: UMR Bronson Commercial |
$2,121.98
|
|
|
PR VCRPEC LES 1 SGM XDRL THORACIC TTHRC
|
Professional
|
Both
|
$4,564.00
|
|
|
Service Code
|
HCPCS 63301
|
| Min. Negotiated Rate |
$1,431.79 |
| Max. Negotiated Rate |
$3,772.74 |
| Rate for Payer: Aetna Commercial |
$2,850.87
|
| Rate for Payer: BCBS Complete |
$1,503.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.88
|
| Rate for Payer: Cash Price |
$3,651.20
|
| Rate for Payer: Cash Price |
$3,651.20
|
| Rate for Payer: Meridian Medicaid |
$1,503.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,431.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,194.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,772.74
|
| Rate for Payer: Priority Health Narrow Network |
$3,772.74
|
| Rate for Payer: Priority Health SBD |
$3,772.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,099.44
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG
|
Professional
|
Both
|
$9,042.00
|
|
|
Service Code
|
HCPCS 63087
|
| Min. Negotiated Rate |
$232.45 |
| Max. Negotiated Rate |
$6,329.40 |
| Rate for Payer: Aetna Commercial |
$3,114.02
|
| Rate for Payer: BCBS Complete |
$1,635.10
|
| Rate for Payer: BCBS Trust/PPO |
$232.45
|
| Rate for Payer: Cash Price |
$7,233.60
|
| Rate for Payer: Cash Price |
$7,233.60
|
| Rate for Payer: Meridian Medicaid |
$1,635.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,557.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,329.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,095.49
|
| Rate for Payer: Priority Health Narrow Network |
$4,095.49
|
| Rate for Payer: Priority Health SBD |
$4,095.49
|
| Rate for Payer: UMR Bronson Commercial |
$4,159.32
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 63088
|
| Min. Negotiated Rate |
$165.08 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: Aetna Commercial |
$335.33
|
| Rate for Payer: BCBS Complete |
$173.33
|
| Rate for Payer: BCBS Trust/PPO |
$342.34
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Meridian Medicaid |
$173.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.42
|
| Rate for Payer: Priority Health Narrow Network |
$435.42
|
| Rate for Payer: Priority Health SBD |
$435.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,426.00
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG
|
Professional
|
Both
|
$7,131.00
|
|
|
Service Code
|
HCPCS 63090
|
| Min. Negotiated Rate |
$1,249.46 |
| Max. Negotiated Rate |
$4,991.70 |
| Rate for Payer: Aetna Commercial |
$2,534.05
|
| Rate for Payer: BCBS Complete |
$1,311.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,683.69
|
| Rate for Payer: Cash Price |
$5,704.80
|
| Rate for Payer: Cash Price |
$5,704.80
|
| Rate for Payer: Meridian Medicaid |
$1,311.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,249.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,991.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,297.12
|
| Rate for Payer: Priority Health Narrow Network |
$3,297.12
|
| Rate for Payer: Priority Health SBD |
$3,297.12
|
| Rate for Payer: UMR Bronson Commercial |
$3,280.26
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG
|
Professional
|
Both
|
$2,429.00
|
|
|
Service Code
|
HCPCS 63091
|
| Min. Negotiated Rate |
$111.40 |
| Max. Negotiated Rate |
$2,079.39 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: BCBS Complete |
$116.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,079.39
|
| Rate for Payer: Cash Price |
$1,943.20
|
| Rate for Payer: Cash Price |
$1,943.20
|
| Rate for Payer: Meridian Medicaid |
$116.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,700.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.13
|
| Rate for Payer: Priority Health Narrow Network |
$296.13
|
| Rate for Payer: Priority Health SBD |
$296.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,117.34
|
|
|
PR VEIN SCREEN
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 00515
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR VEN CATHJ SLCTV ORGAN BLD SAMPLING
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 36500
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$244.57
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS Trust/PPO |
$428.45
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Meridian Medicaid |
$119.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.47
|
| Rate for Payer: Priority Health Narrow Network |
$282.47
|
| Rate for Payer: Priority Health SBD |
$282.47
|
| Rate for Payer: UMR Bronson Commercial |
$157.32
|
|
|
PR VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL
|
Professional
|
Both
|
$4,281.00
|
|
|
Service Code
|
HCPCS 37180
|
| Min. Negotiated Rate |
$1,352.34 |
| Max. Negotiated Rate |
$3,361.97 |
| Rate for Payer: Aetna Commercial |
$2,874.90
|
| Rate for Payer: BCBS Complete |
$1,419.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,647.77
|
| Rate for Payer: Cash Price |
$3,424.80
|
| Rate for Payer: Cash Price |
$3,424.80
|
| Rate for Payer: Meridian Medicaid |
$1,419.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,352.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,996.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,361.97
|
| Rate for Payer: Priority Health Narrow Network |
$3,361.97
|
| Rate for Payer: Priority Health SBD |
$3,361.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,969.26
|
|
|
PR VENTILATING TUBE RMVL REQUIRING GENERAL ANES
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
HCPCS 69424
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$2,176.60 |
| Rate for Payer: Aetna Commercial |
$67.67
|
| Rate for Payer: BCBS Complete |
$40.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,176.60
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Meridian Medicaid |
$40.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.87
|
| Rate for Payer: Priority Health Narrow Network |
$84.87
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UMR Bronson Commercial |
$276.46
|
|
|
PR VENTILATION ASSIST & MGMT INPATIENT 1ST DAY
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 94002
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$1,687.92 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,687.92
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.27
|
| Rate for Payer: Priority Health Narrow Network |
$121.27
|
| Rate for Payer: Priority Health SBD |
$121.27
|
| Rate for Payer: UMR Bronson Commercial |
$77.74
|
|
|
PR VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 94003
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$1,092.52 |
| Rate for Payer: Aetna Commercial |
$72.70
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.52
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.89
|
| Rate for Payer: Priority Health Narrow Network |
$84.89
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| Rate for Payer: UMR Bronson Commercial |
$57.04
|
|
|
PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 61026
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$593.81 |
| Rate for Payer: Aetna Commercial |
$135.98
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS Trust/PPO |
$593.81
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Meridian Medicaid |
$74.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.63
|
| Rate for Payer: Priority Health Narrow Network |
$180.63
|
| Rate for Payer: Priority Health SBD |
$180.63
|
| Rate for Payer: UMR Bronson Commercial |
$253.92
|
|
|
PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 61020
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$330.19 |
| Rate for Payer: Aetna Commercial |
$134.44
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$330.19
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.06
|
| Rate for Payer: Priority Health Narrow Network |
$180.06
|
| Rate for Payer: Priority Health SBD |
$180.06
|
| Rate for Payer: UMR Bronson Commercial |
$206.54
|
|
|
PR VENTRICULOCISTERNOSTOMY
|
Professional
|
Both
|
$4,660.00
|
|
|
Service Code
|
HCPCS 62180
|
| Min. Negotiated Rate |
$1,040.08 |
| Max. Negotiated Rate |
$3,262.00 |
| Rate for Payer: Aetna Commercial |
$2,066.64
|
| Rate for Payer: BCBS Complete |
$1,092.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,771.92
|
| Rate for Payer: Cash Price |
$3,728.00
|
| Rate for Payer: Cash Price |
$3,728.00
|
| Rate for Payer: Meridian Medicaid |
$1,092.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,040.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,262.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,738.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,738.25
|
| Rate for Payer: Priority Health SBD |
$2,738.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,143.60
|
|
|
PR VENTRICULOCISTERNOSTOMY 3RD VENTRICLE
|
Professional
|
Both
|
$6,420.00
|
|
|
Service Code
|
HCPCS 62200
|
| Min. Negotiated Rate |
$895.67 |
| Max. Negotiated Rate |
$4,494.00 |
| Rate for Payer: Aetna Commercial |
$1,779.36
|
| Rate for Payer: BCBS Complete |
$940.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.01
|
| Rate for Payer: Cash Price |
$5,136.00
|
| Rate for Payer: Cash Price |
$5,136.00
|
| Rate for Payer: Meridian Medicaid |
$940.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$895.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,494.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,358.89
|
| Rate for Payer: Priority Health Narrow Network |
$2,358.89
|
| Rate for Payer: Priority Health SBD |
$2,358.89
|
| Rate for Payer: UMR Bronson Commercial |
$2,953.20
|
|
|
PR VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC
|
Professional
|
Both
|
$5,833.00
|
|
|
Service Code
|
HCPCS 62201
|
| Min. Negotiated Rate |
$792.36 |
| Max. Negotiated Rate |
$9,012.27 |
| Rate for Payer: Aetna Commercial |
$1,562.86
|
| Rate for Payer: BCBS Complete |
$831.98
|
| Rate for Payer: BCBS Trust/PPO |
$9,012.27
|
| Rate for Payer: Cash Price |
$4,666.40
|
| Rate for Payer: Cash Price |
$4,666.40
|
| Rate for Payer: Meridian Medicaid |
$831.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$792.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,083.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,088.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,088.80
|
| Rate for Payer: Priority Health SBD |
$2,088.80
|
| Rate for Payer: UMR Bronson Commercial |
$2,683.18
|
|
|
PR VENTRICULOMYOTOMY-MYECTOMY
|
Professional
|
Both
|
$8,920.00
|
|
|
Service Code
|
HCPCS 33416
|
| Min. Negotiated Rate |
$718.49 |
| Max. Negotiated Rate |
$6,244.00 |
| Rate for Payer: Aetna Commercial |
$2,713.83
|
| Rate for Payer: BCBS Complete |
$1,331.84
|
| Rate for Payer: BCBS Trust/PPO |
$718.49
|
| Rate for Payer: Cash Price |
$7,136.00
|
| Rate for Payer: Cash Price |
$7,136.00
|
| Rate for Payer: Meridian Medicaid |
$1,331.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,268.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,244.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,156.64
|
| Rate for Payer: Priority Health Narrow Network |
$3,156.64
|
| Rate for Payer: Priority Health SBD |
$3,156.64
|
| Rate for Payer: UMR Bronson Commercial |
$4,103.20
|
|
