|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$384.25 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$796.08
|
| Rate for Payer: BCBS Complete |
$403.46
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Meridian Medicaid |
$403.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$384.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$703.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.55
|
| Rate for Payer: Priority Health Narrow Network |
$913.55
|
| Rate for Payer: Priority Health SBD |
$913.55
|
| Rate for Payer: UMR Bronson Commercial |
$462.30
|
|
|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$1,768.00
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$580.95 |
| Max. Negotiated Rate |
$1,237.60 |
| Rate for Payer: Aetna Commercial |
$941.72
|
| Rate for Payer: BCBS Complete |
$707.20
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: Cash Price |
$1,414.40
|
| Rate for Payer: Cash Price |
$1,414.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,099.43
|
| Rate for Payer: Priority Health SBD |
$1,099.43
|
| Rate for Payer: UMR Bronson Commercial |
$813.28
|
|
|
PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$1,232.52 |
| Rate for Payer: Aetna Commercial |
$36.91
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.52
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Meridian Medicaid |
$17.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.34
|
| Rate for Payer: Priority Health Narrow Network |
$40.34
|
| Rate for Payer: Priority Health SBD |
$40.34
|
| Rate for Payer: UMR Bronson Commercial |
$87.86
|
|
|
PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 29583
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$37.26
|
|
|
PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$1,140.60 |
| Rate for Payer: Aetna Commercial |
$21.24
|
| Rate for Payer: BCBS Complete |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Meridian Medicaid |
$10.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.01
|
| Rate for Payer: Priority Health Narrow Network |
$24.01
|
| Rate for Payer: Priority Health SBD |
$24.01
|
| Rate for Payer: UMR Bronson Commercial |
$59.34
|
|
|
PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 29582
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$90.30 |
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: UMR Bronson Commercial |
$59.34
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$831.54 |
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$831.54
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: Priority Health SBD |
$75.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 97014
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$1,449.66 |
| Rate for Payer: Aetna Commercial |
$9.73
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,449.66
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: Priority Health SBD |
$75.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
|
|
PR APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$1,039.69 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,039.69
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: Priority Health SBD |
$75.00
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
|
|
PR APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$10.52
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.00
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: Priority Health SBD |
$75.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>/=100SCM ADL 100SQCM
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$49.31
|
| Rate for Payer: BCBS Complete |
$29.53
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Meridian Medicaid |
$29.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.67
|
| Rate for Payer: Priority Health Narrow Network |
$54.67
|
| Rate for Payer: Priority Health SBD |
$54.67
|
| Rate for Payer: UMR Bronson Commercial |
$63.48
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 15273
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$422.80 |
| Rate for Payer: Aetna Commercial |
$216.78
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS Trust/PPO |
$383.40
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Meridian Medicaid |
$129.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.41
|
| Rate for Payer: Priority Health Narrow Network |
$238.41
|
| Rate for Payer: Priority Health SBD |
$238.41
|
| Rate for Payer: UMR Bronson Commercial |
$277.84
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$1,661.55 |
| Rate for Payer: Aetna Commercial |
$91.37
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.55
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.52
|
| Rate for Payer: Priority Health Narrow Network |
$101.52
|
| Rate for Payer: Priority Health SBD |
$101.52
|
| Rate for Payer: UMR Bronson Commercial |
$125.58
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$1,661.55 |
| Rate for Payer: Aetna Commercial |
$91.37
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.55
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.52
|
| Rate for Payer: Priority Health Narrow Network |
$101.52
|
| Rate for Payer: Priority Health SBD |
$101.52
|
| Rate for Payer: UMR Bronson Commercial |
$125.58
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$81.86 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna American Axle |
$177.45
|
| Rate for Payer: Aetna Commercial |
$232.05
|
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,971.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$234.78
|
| Rate for Payer: Cofinity Commercial |
$191.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$245.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.75
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.05
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$232.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Priority Health SBD |
$171.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$81.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: UMR Bronson Commercial |
$101.01
|
| Rate for Payer: VA VA |
$1,620.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.75
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Aetna American Axle |
$177.45
|
| Rate for Payer: Aetna Commercial |
$232.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.45
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$191.10
|
| Rate for Payer: Cofinity Commercial |
$234.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
| Rate for Payer: Healthscope Commercial |
$245.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.05
|
| Rate for Payer: PHP Commercial |
$232.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health SBD |
$171.99
|
| Rate for Payer: UMR Bronson Commercial |
$120.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.75
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 15272
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Meridian Medicaid |
$11.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.14
|
| Rate for Payer: Priority Health Narrow Network |
$20.14
|
| Rate for Payer: Priority Health SBD |
$20.14
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
PR ARREST EPIPHYSEAL DISTAL FEMUR
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 27475
|
| Min. Negotiated Rate |
$430.69 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Aetna Commercial |
$885.07
|
| Rate for Payer: BCBS Complete |
$452.22
|
| Rate for Payer: BCBS Trust/PPO |
$925.58
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Meridian Medicaid |
$452.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.50
|
| 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 |
$765.90
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL FIBULA
|
Professional
|
Both
|
$1,492.00
|
|
|
Service Code
|
HCPCS 27732
|
| Min. Negotiated Rate |
$296.92 |
| Max. Negotiated Rate |
$1,044.40 |
| Rate for Payer: Aetna Commercial |
$602.74
|
| Rate for Payer: BCBS Complete |
$311.77
|
| Rate for Payer: BCBS Trust/PPO |
$512.98
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Meridian Medicaid |
$311.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.68
|
| Rate for Payer: Priority Health Narrow Network |
$703.68
|
| Rate for Payer: Priority Health SBD |
$703.68
|
| Rate for Payer: UMR Bronson Commercial |
$686.32
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA
|
Professional
|
Both
|
$1,402.00
|
|
|
Service Code
|
HCPCS 27730
|
| Min. Negotiated Rate |
$341.28 |
| Max. Negotiated Rate |
$981.40 |
| Rate for Payer: Aetna Commercial |
$784.73
|
| Rate for Payer: BCBS Complete |
$402.12
|
| Rate for Payer: BCBS Trust/PPO |
$341.28
|
| Rate for Payer: Cash Price |
$1,121.60
|
| Rate for Payer: Cash Price |
$1,121.60
|
| Rate for Payer: Meridian Medicaid |
$402.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$908.44
|
| Rate for Payer: Priority Health Narrow Network |
$908.44
|
| Rate for Payer: Priority Health SBD |
$908.44
|
| Rate for Payer: UMR Bronson Commercial |
$644.92
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA
|
Professional
|
Both
|
$2,899.00
|
|
|
Service Code
|
HCPCS 27734
|
| Min. Negotiated Rate |
$237.21 |
| Max. Negotiated Rate |
$2,029.30 |
| Rate for Payer: Aetna Commercial |
$878.18
|
| Rate for Payer: BCBS Complete |
$448.64
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: Cash Price |
$2,319.20
|
| Rate for Payer: Cash Price |
$2,319.20
|
| Rate for Payer: Meridian Medicaid |
$448.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,029.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,014.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,014.66
|
| Rate for Payer: Priority Health SBD |
$1,014.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,333.54
|
|
|
PR ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 27742
|
| Min. Negotiated Rate |
$503.53 |
| Max. Negotiated Rate |
$2,852.82 |
| Rate for Payer: Aetna Commercial |
$1,037.50
|
| Rate for Payer: BCBS Complete |
$528.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,852.82
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Meridian Medicaid |
$528.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$503.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,195.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,195.94
|
| Rate for Payer: Priority Health SBD |
$1,195.94
|
| Rate for Payer: UMR Bronson Commercial |
$609.96
|
|
|
PR ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB
|
Professional
|
Both
|
$3,038.00
|
|
|
Service Code
|
HCPCS 27479
|
| Min. Negotiated Rate |
$592.35 |
| Max. Negotiated Rate |
$2,126.60 |
| Rate for Payer: Aetna Commercial |
$1,228.23
|
| Rate for Payer: BCBS Complete |
$621.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.73
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Meridian Medicaid |
$621.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$592.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,409.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,409.40
|
| Rate for Payer: Priority Health SBD |
$1,409.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,397.48
|
|
|
PR ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 36600
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$789.28 |
| Rate for Payer: Aetna Commercial |
$21.21
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS Trust/PPO |
$789.28
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.41
|
| Rate for Payer: Priority Health Narrow Network |
$23.41
|
| Rate for Payer: Priority Health SBD |
$23.41
|
| Rate for Payer: UMR Bronson Commercial |
$63.02
|
|
|
PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
HCPCS 36821
|
| Min. Negotiated Rate |
$413.01 |
| Max. Negotiated Rate |
$1,535.80 |
| Rate for Payer: Aetna Commercial |
$889.36
|
| Rate for Payer: BCBS Complete |
$433.66
|
| Rate for Payer: BCBS Trust/PPO |
$869.05
|
| Rate for Payer: Cash Price |
$1,755.20
|
| Rate for Payer: Cash Price |
$1,755.20
|
| Rate for Payer: Meridian Medicaid |
$433.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.88
|
| Rate for Payer: Priority Health SBD |
$1,029.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,009.24
|
|
