|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 28020
|
| Min. Negotiated Rate |
$236.00 |
| Max. Negotiated Rate |
$1,710.64 |
| Rate for Payer: Aetna Commercial |
$485.15
|
| Rate for Payer: BCBS Complete |
$247.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,710.64
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$563.75
|
| Rate for Payer: Priority Health Narrow Network |
$563.75
|
| Rate for Payer: Priority Health SBD |
$563.75
|
| Rate for Payer: UMR Bronson Commercial |
$414.46
|
|
|
PR ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 25101
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna Commercial |
$537.23
|
| Rate for Payer: BCBS Complete |
$279.56
|
| Rate for Payer: BCBS Trust/PPO |
$107.77
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Meridian Medicaid |
$279.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.10
|
| Rate for Payer: Priority Health Narrow Network |
$628.10
|
| Rate for Payer: Priority Health SBD |
$628.10
|
| Rate for Payer: UMR Bronson Commercial |
$621.00
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$2,726.00
|
|
|
Service Code
|
HCPCS 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$496.29 |
| Max. Negotiated Rate |
$1,908.20 |
| Rate for Payer: Aetna Commercial |
$1,022.94
|
| Rate for Payer: BCBS Complete |
$521.10
|
| Rate for Payer: BCBS Trust/PPO |
$901.28
|
| Rate for Payer: Cash Price |
$2,180.80
|
| Rate for Payer: Cash Price |
$2,180.80
|
| Rate for Payer: Meridian Medicaid |
$521.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$496.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,178.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.07
|
| Rate for Payer: Priority Health SBD |
$1,178.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,253.96
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Facility
|
IP
|
$2,726.00
|
|
|
Service Code
|
CPT 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$1,199.44 |
| Max. Negotiated Rate |
$2,453.40 |
| Rate for Payer: Aetna American Axle |
$1,771.90
|
| Rate for Payer: Aetna Commercial |
$2,317.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,771.90
|
| Rate for Payer: Cash Price |
$2,180.80
|
| Rate for Payer: Cofinity Commercial |
$1,908.20
|
| Rate for Payer: Cofinity Commercial |
$2,344.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,180.80
|
| Rate for Payer: Healthscope Commercial |
$2,453.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,908.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,044.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,317.10
|
| Rate for Payer: PHP Commercial |
$2,317.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.20
|
| Rate for Payer: Priority Health SBD |
$1,717.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,199.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,044.50
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$2,726.00
|
|
|
Service Code
|
HCPCS 27335
|
| Min. Negotiated Rate |
$496.29 |
| Max. Negotiated Rate |
$1,908.20 |
| Rate for Payer: Aetna Commercial |
$1,022.94
|
| Rate for Payer: BCBS Complete |
$521.10
|
| Rate for Payer: BCBS Trust/PPO |
$901.28
|
| Rate for Payer: Cash Price |
$2,180.80
|
| Rate for Payer: Cash Price |
$2,180.80
|
| Rate for Payer: Meridian Medicaid |
$521.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$496.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,178.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.07
|
| Rate for Payer: Priority Health SBD |
$1,178.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,253.96
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Facility
|
OP
|
$2,726.00
|
|
|
Service Code
|
CPT 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$762.94 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna American Axle |
$1,771.90
|
| Rate for Payer: Aetna Commercial |
$2,317.10
|
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,771.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.75
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$2,180.80
|
| Rate for Payer: Cash Price |
$2,180.80
|
| Rate for Payer: Cofinity Commercial |
$1,908.20
|
| Rate for Payer: Cofinity Commercial |
$2,344.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,180.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$2,453.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,908.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,044.50
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,317.10
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$2,317.10
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Priority Health SBD |
$1,717.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$762.94
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,008.62
|
| Rate for Payer: VA VA |
$6,359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,044.50
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-CERVICAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 58321
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: Aetna Commercial |
$58.02
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS Trust/PPO |
$80.30
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.65
|
| Rate for Payer: Priority Health Narrow Network |
$68.65
|
| Rate for Payer: Priority Health SBD |
$68.65
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-UTERINE
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 58322
|
| Min. Negotiated Rate |
$69.05 |
| Max. Negotiated Rate |
$307.47 |
| Rate for Payer: Aetna Commercial |
$69.05
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS Trust/PPO |
$307.47
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.43
|
| Rate for Payer: Priority Health Narrow Network |
$81.43
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 36625
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$664.07 |
| Rate for Payer: Aetna Commercial |
$142.11
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.44
|
| Rate for Payer: Priority Health Narrow Network |
$165.44
|
| Rate for Payer: Priority Health SBD |
$165.44
|
| Rate for Payer: UMR Bronson Commercial |
$144.44
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 36620
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$962.03 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: BCBS Complete |
$29.07
|
| Rate for Payer: BCBS Trust/PPO |
$962.03
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Meridian Medicaid |
$29.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.68
|
| Rate for Payer: Priority Health Narrow Network |
$69.68
|
| Rate for Payer: Priority Health SBD |
$69.68
|
| Rate for Payer: UMR Bronson Commercial |
$142.60
|
|
|
PR ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 36640
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$802.49 |
| Rate for Payer: Aetna Commercial |
$154.82
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS Trust/PPO |
$802.49
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Meridian Medicaid |
$78.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.99
|
| Rate for Payer: Priority Health Narrow Network |
$182.99
|
| Rate for Payer: Priority Health SBD |
$182.99
|
| Rate for Payer: UMR Bronson Commercial |
$251.62
|
|
|
PR ARVEN ANAST OPN F/ARM VEIN TRPOS
|
Professional
|
Both
|
$1,494.00
|
|
|
Service Code
|
HCPCS 36820
|
| Min. Negotiated Rate |
$454.54 |
| Max. Negotiated Rate |
$1,126.68 |
| Rate for Payer: Aetna Commercial |
$967.99
|
| Rate for Payer: BCBS Complete |
$477.27
|
| Rate for Payer: BCBS Trust/PPO |
$769.73
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Meridian Medicaid |
$477.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,045.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,126.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.68
|
| Rate for Payer: Priority Health SBD |
$1,126.68
|
| Rate for Payer: UMR Bronson Commercial |
$687.24
|
|
|
PR ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS
|
Professional
|
Both
|
$2,387.00
|
|
|
Service Code
|
HCPCS 36819
|
| Min. Negotiated Rate |
$156.91 |
| Max. Negotiated Rate |
$1,670.90 |
| Rate for Payer: Aetna Commercial |
$981.67
|
| Rate for Payer: BCBS Complete |
$479.73
|
| Rate for Payer: BCBS Trust/PPO |
$156.91
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Meridian Medicaid |
$479.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.79
|
| Rate for Payer: Priority Health SBD |
$1,136.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,098.02
|
|
|
PR ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS
|
Professional
|
Both
|
$1,970.00
|
|
|
Service Code
|
HCPCS 36818
|
| Min. Negotiated Rate |
$431.54 |
| Max. Negotiated Rate |
$1,379.00 |
| Rate for Payer: Aetna Commercial |
$926.10
|
| Rate for Payer: BCBS Complete |
$453.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.17
|
| Rate for Payer: Cash Price |
$1,576.00
|
| Rate for Payer: Cash Price |
$1,576.00
|
| Rate for Payer: Meridian Medicaid |
$453.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,379.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,074.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,074.02
|
| Rate for Payer: Priority Health SBD |
$1,074.02
|
| Rate for Payer: UMR Bronson Commercial |
$906.20
|
|
|
PR ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART
|
Professional
|
Both
|
$8,262.00
|
|
|
Service Code
|
HCPCS 61705
|
| Min. Negotiated Rate |
$404.15 |
| Max. Negotiated Rate |
$5,783.40 |
| Rate for Payer: Aetna Commercial |
$3,364.49
|
| Rate for Payer: BCBS Complete |
$1,767.73
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: Cash Price |
$6,609.60
|
| Rate for Payer: Cash Price |
$6,609.60
|
| Rate for Payer: Meridian Medicaid |
$1,767.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,783.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,440.32
|
| Rate for Payer: Priority Health Narrow Network |
$4,440.32
|
| Rate for Payer: Priority Health SBD |
$4,440.32
|
| Rate for Payer: UMR Bronson Commercial |
$3,800.52
|
|
|
PR ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH
|
Professional
|
Both
|
$2,046.00
|
|
|
Service Code
|
HCPCS 31400
|
| Min. Negotiated Rate |
$649.44 |
| Max. Negotiated Rate |
$1,845.88 |
| Rate for Payer: Aetna Commercial |
$1,275.34
|
| Rate for Payer: BCBS Complete |
$681.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.88
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Meridian Medicaid |
$681.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$649.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,413.68
|
| Rate for Payer: Priority Health SBD |
$1,413.68
|
| Rate for Payer: UMR Bronson Commercial |
$941.16
|
|
|
PR AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT
|
Professional
|
Both
|
$6,492.28
|
|
|
Service Code
|
HCPCS 33863
|
| Min. Negotiated Rate |
$745.43 |
| Max. Negotiated Rate |
$4,892.42 |
| Rate for Payer: Aetna Commercial |
$4,233.55
|
| Rate for Payer: BCBS Complete |
$2,061.60
|
| Rate for Payer: BCBS Trust/PPO |
$745.43
|
| Rate for Payer: Cash Price |
$5,193.82
|
| Rate for Payer: Cash Price |
$5,193.82
|
| Rate for Payer: Meridian Medicaid |
$2,061.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,963.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,544.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,892.42
|
| Rate for Payer: Priority Health Narrow Network |
$4,892.42
|
| Rate for Payer: Priority Health SBD |
$4,892.42
|
| Rate for Payer: UMR Bronson Commercial |
$2,986.45
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DISSECTION
|
Professional
|
Both
|
$6,985.00
|
|
|
Service Code
|
HCPCS 33858
|
| Min. Negotiated Rate |
$313.81 |
| Max. Negotiated Rate |
$5,281.27 |
| Rate for Payer: Aetna Commercial |
$4,563.31
|
| Rate for Payer: BCBS Complete |
$2,224.20
|
| Rate for Payer: BCBS Trust/PPO |
$313.81
|
| Rate for Payer: Cash Price |
$5,588.00
|
| Rate for Payer: Cash Price |
$5,588.00
|
| Rate for Payer: Meridian Medicaid |
$2,224.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,118.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,889.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,281.27
|
| Rate for Payer: Priority Health Narrow Network |
$5,281.27
|
| Rate for Payer: Priority Health SBD |
$5,281.27
|
| Rate for Payer: UMR Bronson Commercial |
$3,213.10
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/THN DSJ
|
Professional
|
Both
|
$5,011.00
|
|
|
Service Code
|
HCPCS 33859
|
| Min. Negotiated Rate |
$1,128.45 |
| Max. Negotiated Rate |
$3,793.40 |
| Rate for Payer: Aetna Commercial |
$3,277.53
|
| Rate for Payer: BCBS Complete |
$1,598.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.45
|
| Rate for Payer: Cash Price |
$4,008.80
|
| Rate for Payer: Cash Price |
$4,008.80
|
| Rate for Payer: Meridian Medicaid |
$1,598.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,522.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,507.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,793.40
|
| Rate for Payer: Priority Health Narrow Network |
$3,793.40
|
| Rate for Payer: Priority Health SBD |
$3,793.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,305.06
|
|
|
PR ASCEND AORTA GRAFT INCL VAVLE SUSPENSION
|
Professional
|
Both
|
$9,858.00
|
|
|
Service Code
|
HCPCS 33860
|
| Min. Negotiated Rate |
$3,943.20 |
| Max. Negotiated Rate |
$6,900.60 |
| Rate for Payer: BCBS Complete |
$3,943.20
|
| Rate for Payer: Cash Price |
$7,886.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.60
|
| Rate for Payer: UMR Bronson Commercial |
$4,534.68
|
|
|
PR ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL
|
Professional
|
Both
|
$5,125.00
|
|
|
Service Code
|
HCPCS 33864
|
| Min. Negotiated Rate |
$1,166.49 |
| Max. Negotiated Rate |
$5,000.94 |
| Rate for Payer: Aetna Commercial |
$4,324.43
|
| Rate for Payer: BCBS Complete |
$2,105.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,166.49
|
| Rate for Payer: Cash Price |
$4,100.00
|
| Rate for Payer: Cash Price |
$4,100.00
|
| Rate for Payer: Meridian Medicaid |
$2,105.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,005.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,587.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,000.94
|
| Rate for Payer: Priority Health Narrow Network |
$5,000.94
|
| Rate for Payer: Priority Health SBD |
$5,000.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,357.50
|
|
|
PR ASPIRATION AND/OR INJECTION THYROID CYST
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 60300
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$3,338.86 |
| Rate for Payer: Aetna Commercial |
$63.32
|
| Rate for Payer: BCBS Complete |
$31.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,338.86
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Meridian Medicaid |
$31.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.66
|
| Rate for Payer: Priority Health Narrow Network |
$67.66
|
| Rate for Payer: Priority Health SBD |
$67.66
|
| Rate for Payer: UMR Bronson Commercial |
$73.14
|
|
|
PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 51102
|
| Min. Negotiated Rate |
$89.89 |
| Max. Negotiated Rate |
$1,872.30 |
| Rate for Payer: Aetna Commercial |
$185.74
|
| Rate for Payer: BCBS Complete |
$94.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Meridian Medicaid |
$94.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.02
|
| Rate for Payer: Priority Health Narrow Network |
$228.02
|
| Rate for Payer: Priority Health SBD |
$228.02
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
PR ASPIRATION BLADDER NEEDLE
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 51100
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$2,925.20 |
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.20
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$62.14
|
| Rate for Payer: Priority Health SBD |
$62.14
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
PR ASPIRATION BLADDER TROCAR/INTRACATHETER
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 51101
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$2,914.10 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,914.10
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.51
|
| Rate for Payer: Priority Health Narrow Network |
$80.51
|
| Rate for Payer: Priority Health SBD |
$80.51
|
| Rate for Payer: UMR Bronson Commercial |
$174.34
|
|
