|
PR ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$4,186.00
|
|
|
Service Code
|
HCPCS 22846
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$2,930.20 |
| Rate for Payer: Aetna Commercial |
$1,018.33
|
| Rate for Payer: BCBS Complete |
$505.67
|
| Rate for Payer: BCBS Trust/PPO |
$62.83
|
| Rate for Payer: Cash Price |
$3,348.80
|
| Rate for Payer: Cash Price |
$3,348.80
|
| Rate for Payer: Meridian Medicaid |
$505.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,930.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,149.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,149.98
|
| Rate for Payer: Priority Health SBD |
$1,149.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,925.56
|
|
|
PR ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$3,705.00
|
|
|
Service Code
|
HCPCS 22847
|
| Min. Negotiated Rate |
$111.22 |
| Max. Negotiated Rate |
$2,593.50 |
| Rate for Payer: Aetna Commercial |
$1,078.87
|
| Rate for Payer: BCBS Complete |
$530.72
|
| Rate for Payer: BCBS Trust/PPO |
$111.22
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Meridian Medicaid |
$530.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,593.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,210.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,210.25
|
| Rate for Payer: Priority Health SBD |
$1,210.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,704.30
|
|
|
PR ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$2,526.00
|
|
|
Service Code
|
HCPCS 27418
|
| Min. Negotiated Rate |
$531.01 |
| Max. Negotiated Rate |
$1,768.20 |
| Rate for Payer: Aetna Commercial |
$1,109.69
|
| Rate for Payer: BCBS Complete |
$557.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,136.90
|
| Rate for Payer: Cash Price |
$2,020.80
|
| Rate for Payer: Cash Price |
$2,020.80
|
| Rate for Payer: Meridian Medicaid |
$557.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,768.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,275.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,275.09
|
| Rate for Payer: Priority Health SBD |
$1,275.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,161.96
|
|
|
PR ANTICOAG MGMT, EACH SUBSEQ 90 DAYS
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 99364
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
|
|
PR ANTICOAG MGMT, INITIAL 90 DAYS
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 99363
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$142.10 |
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.10
|
| Rate for Payer: UMR Bronson Commercial |
$93.38
|
|
|
PR ANTICOAGULANT MGMT FOR PT TAKING WARFARIN
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 93793
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$39.09 |
| Rate for Payer: Aetna Commercial |
$12.40
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$39.09
|
| 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 |
$16.08
|
| Rate for Payer: Priority Health Narrow Network |
$16.08
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
|
|
PR ANT VESICOURETHROPEXY/URETHROPEXY SMPL
|
Professional
|
Both
|
$2,411.00
|
|
|
Service Code
|
HCPCS 51840
|
| Min. Negotiated Rate |
$444.53 |
| Max. Negotiated Rate |
$5,391.30 |
| Rate for Payer: Aetna Commercial |
$888.00
|
| Rate for Payer: BCBS Complete |
$466.76
|
| Rate for Payer: BCBS Trust/PPO |
$5,391.30
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Meridian Medicaid |
$466.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,687.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,117.46
|
| Rate for Payer: Priority Health SBD |
$1,117.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,109.06
|
|
|
PR AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS
|
Professional
|
Both
|
$1,902.00
|
|
|
Service Code
|
HCPCS 33866
|
| Min. Negotiated Rate |
$572.54 |
| Max. Negotiated Rate |
$1,430.97 |
| Rate for Payer: Aetna Commercial |
$1,243.44
|
| Rate for Payer: BCBS Complete |
$601.17
|
| Rate for Payer: BCBS Trust/PPO |
$573.21
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Meridian Medicaid |
$601.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$572.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,430.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,430.97
|
| Rate for Payer: Priority Health SBD |
$1,430.97
|
| Rate for Payer: UMR Bronson Commercial |
$874.92
|
|
|
PR AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX
|
Professional
|
Both
|
$1,827.00
|
|
|
Service Code
|
HCPCS 33800
|
| Min. Negotiated Rate |
$621.11 |
| Max. Negotiated Rate |
$1,542.68 |
| Rate for Payer: Aetna Commercial |
$1,324.10
|
| Rate for Payer: BCBS Complete |
$652.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,416.90
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Meridian Medicaid |
$652.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,278.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,542.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,542.68
|
| Rate for Payer: Priority Health SBD |
$1,542.68
|
| Rate for Payer: UMR Bronson Commercial |
$840.42
|
|
|
PR AORTOPLASTY SUPRAVALVULAR STENOSIS
|
Professional
|
Both
|
$9,194.00
|
|
|
Service Code
|
HCPCS 33417
|
| Min. Negotiated Rate |
$918.19 |
| Max. Negotiated Rate |
$6,435.80 |
| Rate for Payer: Aetna Commercial |
$2,236.97
|
| Rate for Payer: BCBS Complete |
$1,103.27
|
| Rate for Payer: BCBS Trust/PPO |
$918.19
|
| Rate for Payer: Cash Price |
$7,355.20
|
| Rate for Payer: Cash Price |
$7,355.20
|
| Rate for Payer: Meridian Medicaid |
$1,103.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,050.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,435.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,609.79
|
| Rate for Payer: Priority Health Narrow Network |
$2,609.79
|
| Rate for Payer: Priority Health SBD |
$2,609.79
|
| Rate for Payer: UMR Bronson Commercial |
$4,229.24
|
|
|
PR APNEALINK
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 00020
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 44955
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$593.60 |
| Rate for Payer: Aetna Commercial |
$112.58
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS Trust/PPO |
$566.34
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.82
|
| Rate for Payer: Priority Health Narrow Network |
$145.82
|
| Rate for Payer: Priority Health SBD |
$145.82
|
| Rate for Payer: UMR Bronson Commercial |
$390.08
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$593.60 |
| Rate for Payer: Aetna Commercial |
$112.58
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS Trust/PPO |
$566.34
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.82
|
| Rate for Payer: Priority Health Narrow Network |
$145.82
|
| Rate for Payer: Priority Health SBD |
$145.82
|
| Rate for Payer: UMR Bronson Commercial |
$390.08
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
IP
|
$848.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$373.12 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna American Axle |
$551.20
|
| Rate for Payer: Aetna Commercial |
$720.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$551.20
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$593.60
|
| Rate for Payer: Cofinity Commercial |
$729.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.40
|
| Rate for Payer: Healthscope Commercial |
$763.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$593.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$636.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$720.80
|
| Rate for Payer: PHP Commercial |
$720.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health SBD |
$534.24
|
| Rate for Payer: UMR Bronson Commercial |
$373.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$636.00
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
OP
|
$848.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$81.21 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna American Axle |
$551.20
|
| Rate for Payer: Aetna Commercial |
$720.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$551.20
|
| Rate for Payer: BCBS Complete |
$339.20
|
| Rate for Payer: BCBS Trust/PPO |
$293.94
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$729.28
|
| Rate for Payer: Cofinity Commercial |
$593.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.40
|
| Rate for Payer: Healthscope Commercial |
$763.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$593.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$636.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$720.80
|
| Rate for Payer: PHP Commercial |
$720.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health SBD |
$534.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.33
|
| Rate for Payer: UHC Exchange |
$81.21
|
| Rate for Payer: UMR Bronson Commercial |
$313.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$636.00
|
|
|
PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$2,095.00
|
|
|
Service Code
|
HCPCS 44960
|
| Min. Negotiated Rate |
$561.26 |
| Max. Negotiated Rate |
$1,541.66 |
| Rate for Payer: Aetna Commercial |
$1,185.47
|
| Rate for Payer: BCBS Complete |
$589.32
|
| Rate for Payer: BCBS Trust/PPO |
$857.96
|
| Rate for Payer: Cash Price |
$1,676.00
|
| Rate for Payer: Cash Price |
$1,676.00
|
| Rate for Payer: Meridian Medicaid |
$589.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,541.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,541.66
|
| Rate for Payer: Priority Health SBD |
$1,541.66
|
| Rate for Payer: UMR Bronson Commercial |
$963.70
|
|
|
PR APPENDECTOMY
|
Facility
|
OP
|
$1,704.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$630.48 |
| Max. Negotiated Rate |
$21,170.20 |
| Rate for Payer: Aetna American Axle |
$1,107.60
|
| Rate for Payer: Aetna Commercial |
$1,448.40
|
| Rate for Payer: Aetna Medicare |
$6,993.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,107.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,406.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,406.09
|
| Rate for Payer: BCBS Complete |
$3,862.77
|
| Rate for Payer: BCBS MAPPO |
$6,724.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,559.34
|
| Rate for Payer: BCN Medicare Advantage |
$6,724.87
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cofinity Commercial |
$1,192.80
|
| Rate for Payer: Cofinity Commercial |
$1,465.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,363.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,724.87
|
| Rate for Payer: Healthscope Commercial |
$1,533.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,192.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,278.00
|
| Rate for Payer: Mclaren Medicaid |
$3,678.50
|
| Rate for Payer: Mclaren Medicare |
$6,724.87
|
| Rate for Payer: Meridian Medicaid |
$3,862.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,061.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,733.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,448.40
|
| Rate for Payer: PACE Medicare |
$6,388.63
|
| Rate for Payer: PACE SWMI |
$6,724.87
|
| Rate for Payer: PHP Commercial |
$1,448.40
|
| Rate for Payer: PHP Medicare Advantage |
$6,724.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,678.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,170.20
|
| Rate for Payer: Priority Health Medicare |
$6,724.87
|
| Rate for Payer: Priority Health Narrow Network |
$16,936.16
|
| Rate for Payer: Priority Health SBD |
$1,073.52
|
| Rate for Payer: Railroad Medicare Medicare |
$6,724.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,724.87
|
| Rate for Payer: UHC Exchange |
$632.62
|
| Rate for Payer: UHC Medicare Advantage |
$6,926.62
|
| Rate for Payer: UMR Bronson Commercial |
$630.48
|
| Rate for Payer: VA VA |
$6,724.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,278.00
|
|
|
PR APPENDECTOMY
|
Facility
|
IP
|
$1,704.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$749.76 |
| Max. Negotiated Rate |
$1,533.60 |
| Rate for Payer: Aetna American Axle |
$1,107.60
|
| Rate for Payer: Aetna Commercial |
$1,448.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,107.60
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cofinity Commercial |
$1,192.80
|
| Rate for Payer: Cofinity Commercial |
$1,465.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,363.20
|
| Rate for Payer: Healthscope Commercial |
$1,533.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,192.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,278.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,448.40
|
| Rate for Payer: PHP Commercial |
$1,448.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.80
|
| Rate for Payer: Priority Health SBD |
$1,073.52
|
| Rate for Payer: UMR Bronson Commercial |
$749.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,278.00
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 44950
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$1,192.80 |
| Rate for Payer: Aetna Commercial |
$868.66
|
| Rate for Payer: BCBS Complete |
$432.10
|
| Rate for Payer: BCBS Trust/PPO |
$413.13
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Meridian Medicaid |
$432.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,129.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,129.49
|
| Rate for Payer: Priority Health SBD |
$1,129.49
|
| Rate for Payer: UMR Bronson Commercial |
$783.84
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$1,192.80 |
| Rate for Payer: Aetna Commercial |
$868.66
|
| Rate for Payer: BCBS Complete |
$432.10
|
| Rate for Payer: BCBS Trust/PPO |
$413.13
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Meridian Medicaid |
$432.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,129.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,129.49
|
| Rate for Payer: Priority Health SBD |
$1,129.49
|
| Rate for Payer: UMR Bronson Commercial |
$783.84
|
|
|
PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 20660
|
| Min. Negotiated Rate |
$153.36 |
| Max. Negotiated Rate |
$6,925.56 |
| Rate for Payer: Aetna Commercial |
$326.16
|
| Rate for Payer: BCBS Complete |
$161.03
|
| Rate for Payer: BCBS Trust/PPO |
$6,925.56
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Meridian Medicaid |
$161.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.70
|
| Rate for Payer: Priority Health Narrow Network |
$368.70
|
| Rate for Payer: Priority Health SBD |
$368.70
|
| Rate for Payer: UMR Bronson Commercial |
$389.62
|
|
|
PR APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 29325
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$1,154.34 |
| Rate for Payer: Aetna Commercial |
$232.63
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.34
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.62
|
| Rate for Payer: Priority Health Narrow Network |
$269.62
|
| Rate for Payer: Priority Health SBD |
$269.62
|
| Rate for Payer: UMR Bronson Commercial |
$297.62
|
|
|
PR APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 29075
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$1,010.64 |
| Rate for Payer: Aetna Commercial |
$81.81
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,010.64
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.01
|
| Rate for Payer: Priority Health Narrow Network |
$96.01
|
| Rate for Payer: Priority Health SBD |
$96.01
|
| Rate for Payer: UMR Bronson Commercial |
$90.62
|
|
|
PR APPLICATION CAST FIGURE-OF-8
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 29049
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$822.03 |
| Rate for Payer: Aetna Commercial |
$90.96
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$822.03
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.71
|
| Rate for Payer: Priority Health Narrow Network |
$105.71
|
| Rate for Payer: Priority Health SBD |
$105.71
|
| Rate for Payer: UMR Bronson Commercial |
$107.64
|
|
|
PR APPLICATION CAST FINGER
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 29086
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$1,122.64 |
| Rate for Payer: Aetna Commercial |
$62.87
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.64
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.06
|
| Rate for Payer: Priority Health Narrow Network |
$75.06
|
| Rate for Payer: Priority Health SBD |
$75.06
|
| Rate for Payer: UMR Bronson Commercial |
$58.88
|
|
