|
PR BIOPSY BREAST OPEN INCISIONAL
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 19101
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$391.30 |
| Rate for Payer: Aetna Commercial |
$243.74
|
| Rate for Payer: BCBS Complete |
$150.74
|
| Rate for Payer: BCBS Trust/PPO |
$8.65
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Meridian Medicaid |
$150.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.80
|
| Rate for Payer: Priority Health Narrow Network |
$275.80
|
| Rate for Payer: Priority Health SBD |
$275.80
|
| Rate for Payer: UMR Bronson Commercial |
$257.14
|
|
|
PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 57500
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$225.58 |
| Rate for Payer: Aetna Commercial |
$88.96
|
| Rate for Payer: BCBS Complete |
$50.55
|
| Rate for Payer: BCBS Trust/PPO |
$225.58
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Meridian Medicaid |
$50.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.58
|
| Rate for Payer: Priority Health Narrow Network |
$105.58
|
| Rate for Payer: Priority Health SBD |
$105.58
|
| Rate for Payer: UMR Bronson Commercial |
$116.38
|
|
|
PR BIOPSY, EACH ADDED LESION
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 11101
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$46.90 |
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: UMR Bronson Commercial |
$30.82
|
|
|
PR BIOPSY EXTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 69105
|
| Min. Negotiated Rate |
$40.90 |
| Max. Negotiated Rate |
$2,308.67 |
| Rate for Payer: Aetna Commercial |
$69.92
|
| Rate for Payer: BCBS Complete |
$42.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,308.67
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Meridian Medicaid |
$42.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.58
|
| Rate for Payer: Priority Health Narrow Network |
$89.58
|
| Rate for Payer: Priority Health SBD |
$89.58
|
| Rate for Payer: UMR Bronson Commercial |
$107.64
|
|
|
PR BIOPSY EXTERNAL EAR
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 69100
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$1,733.35 |
| Rate for Payer: Aetna Commercial |
$52.85
|
| Rate for Payer: BCBS Complete |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,733.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Meridian Medicaid |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.53
|
| Rate for Payer: Priority Health Narrow Network |
$65.53
|
| Rate for Payer: Priority Health SBD |
$65.53
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
PR BIOPSY FLOOR MOUTH
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 41108
|
| Min. Negotiated Rate |
$58.79 |
| Max. Negotiated Rate |
$1,421.66 |
| Rate for Payer: Aetna Commercial |
$119.24
|
| Rate for Payer: BCBS Complete |
$61.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,421.66
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Meridian Medicaid |
$61.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.69
|
| Rate for Payer: Priority Health Narrow Network |
$161.69
|
| Rate for Payer: Priority Health SBD |
$161.69
|
| Rate for Payer: UMR Bronson Commercial |
$108.10
|
|
|
PR BIOPSY HYPOPHARYNX
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 42802
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: BCBS Complete |
$172.80
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.40
|
| Rate for Payer: UMR Bronson Commercial |
$198.72
|
|
|
PR BIOPSY INTRANASAL
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 30100
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$591.70 |
| Rate for Payer: Aetna Commercial |
$84.78
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$591.70
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.53
|
| Rate for Payer: Priority Health Narrow Network |
$93.53
|
| Rate for Payer: Priority Health SBD |
$93.53
|
| Rate for Payer: UMR Bronson Commercial |
$103.04
|
|
|
PR BIOPSY LIVER NEEDLE PERCUTANEOUS
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
HCPCS 47000
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$1,914.56 |
| Rate for Payer: Aetna Commercial |
$117.26
|
| Rate for Payer: BCBS Complete |
$57.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.56
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Meridian Medicaid |
$57.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.29
|
| Rate for Payer: Priority Health Narrow Network |
$152.29
|
| Rate for Payer: Priority Health SBD |
$152.29
|
| Rate for Payer: UMR Bronson Commercial |
$267.26
|
|
|
PR BIOPSY LIVER WEDGE
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 47100
|
| Min. Negotiated Rate |
$545.07 |
| Max. Negotiated Rate |
$2,085.20 |
| Rate for Payer: Aetna Commercial |
$1,144.02
|
| Rate for Payer: BCBS Complete |
$572.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,085.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Meridian Medicaid |
$572.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$545.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,494.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,494.03
|
| Rate for Payer: Priority Health SBD |
$1,494.03
|
| Rate for Payer: UMR Bronson Commercial |
$806.84
|
|
|
PR BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 32405
|
| Min. Negotiated Rate |
$298.80 |
| Max. Negotiated Rate |
$522.90 |
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.90
|
| Rate for Payer: UMR Bronson Commercial |
$343.62
|
|
|
PR BIOPSY MUSCLE DEEP
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 20205
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$206.66
|
| Rate for Payer: BCBS Complete |
$104.22
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Meridian Medicaid |
$104.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$405.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.41
|
| Rate for Payer: Priority Health Narrow Network |
$235.41
|
| Rate for Payer: Priority Health SBD |
$235.41
|
| Rate for Payer: UMR Bronson Commercial |
$266.34
|
|
|
PR BIOPSY MUSCLE PERCUTANEOUS NEEDLE
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 20206
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$2,284.30 |
| Rate for Payer: Aetna Commercial |
$75.67
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,284.30
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.30
|
| Rate for Payer: Priority Health Narrow Network |
$86.30
|
| Rate for Payer: Priority Health SBD |
$86.30
|
| Rate for Payer: UMR Bronson Commercial |
$186.76
|
|
|
PR BIOPSY MUSCLE SUPERFICIAL
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 20200
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$672.75 |
| Rate for Payer: Aetna Commercial |
$125.65
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS Trust/PPO |
$672.75
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.51
|
| Rate for Payer: Priority Health Narrow Network |
$144.51
|
| Rate for Payer: Priority Health SBD |
$144.51
|
| Rate for Payer: UMR Bronson Commercial |
$161.92
|
|
|
PR BIOPSY MUSCLE SUPERFICIAL
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
CPT 20200
|
| Hospital Charge Code |
20200
|
| Min. Negotiated Rate |
$154.88 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna American Axle |
$228.80
|
| Rate for Payer: Aetna Commercial |
$299.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.80
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cofinity Commercial |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$302.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.60
|
| Rate for Payer: Healthscope Commercial |
$316.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.20
|
| Rate for Payer: PHP Commercial |
$299.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.40
|
| Rate for Payer: Priority Health SBD |
$221.76
|
| Rate for Payer: UMR Bronson Commercial |
$154.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.00
|
|
|
PR BIOPSY MUSCLE SUPERFICIAL
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 20200
|
| Hospital Charge Code |
20200
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$672.75 |
| Rate for Payer: Aetna Commercial |
$125.65
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS Trust/PPO |
$672.75
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.51
|
| Rate for Payer: Priority Health Narrow Network |
$144.51
|
| Rate for Payer: Priority Health SBD |
$144.51
|
| Rate for Payer: UMR Bronson Commercial |
$161.92
|
|
|
PR BIOPSY MUSCLE SUPERFICIAL
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
CPT 20200
|
| Hospital Charge Code |
20200
|
| Min. Negotiated Rate |
$93.65 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$228.80
|
| Rate for Payer: Aetna Commercial |
$299.20
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,056.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cofinity Commercial |
$302.72
|
| Rate for Payer: Cofinity Commercial |
$246.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$316.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.00
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.20
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$299.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$221.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$93.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$130.24
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.00
|
|
|
PR BIOPSY NAIL UNIT SEPARATE PROCEDURE
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 11755
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$151.90 |
| Rate for Payer: Aetna Commercial |
$63.74
|
| Rate for Payer: BCBS Complete |
$40.26
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Meridian Medicaid |
$40.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.58
|
| Rate for Payer: Priority Health Narrow Network |
$73.58
|
| Rate for Payer: Priority Health SBD |
$73.58
|
| Rate for Payer: UMR Bronson Commercial |
$99.82
|
|
|
PR BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 42804
|
| Min. Negotiated Rate |
$79.66 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna Commercial |
$153.57
|
| Rate for Payer: BCBS Complete |
$83.64
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Meridian Medicaid |
$83.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.55
|
| Rate for Payer: Priority Health Narrow Network |
$217.55
|
| Rate for Payer: Priority Health SBD |
$217.55
|
| Rate for Payer: UMR Bronson Commercial |
$378.12
|
|
|
PR BIOPSY NERVE
|
Professional
|
Both
|
$708.00
|
|
|
Service Code
|
HCPCS 64795
|
| Min. Negotiated Rate |
$124.82 |
| Max. Negotiated Rate |
$495.60 |
| Rate for Payer: Aetna Commercial |
$245.85
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS Trust/PPO |
$218.19
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.28
|
| Rate for Payer: Priority Health Narrow Network |
$327.28
|
| Rate for Payer: Priority Health SBD |
$327.28
|
| Rate for Payer: UMR Bronson Commercial |
$325.68
|
|
|
PR BIOPSY OF LIP
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 40490
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$637.13 |
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$637.13
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.54
|
| Rate for Payer: Priority Health Narrow Network |
$120.54
|
| Rate for Payer: Priority Health SBD |
$120.54
|
| Rate for Payer: UMR Bronson Commercial |
$103.04
|
|
|
PR BIOPSY OF SKIN LESION
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 11100
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$117.60 |
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR BIOPSY OROPHARYNX
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 42800
|
| Min. Negotiated Rate |
$75.62 |
| Max. Negotiated Rate |
$205.80 |
| Rate for Payer: Aetna Commercial |
$149.58
|
| Rate for Payer: BCBS Complete |
$79.40
|
| Rate for Payer: BCBS Trust/PPO |
$175.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Meridian Medicaid |
$79.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.80
|
| Rate for Payer: Priority Health Narrow Network |
$205.80
|
| Rate for Payer: Priority Health SBD |
$205.80
|
| Rate for Payer: UMR Bronson Commercial |
$116.38
|
|
|
PR BIOPSY OVARY UNI/BI SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,585.00
|
|
|
Service Code
|
HCPCS 58900
|
| Min. Negotiated Rate |
$170.11 |
| Max. Negotiated Rate |
$1,109.50 |
| Rate for Payer: Aetna Commercial |
$516.89
|
| Rate for Payer: BCBS Complete |
$296.34
|
| Rate for Payer: BCBS Trust/PPO |
$170.11
|
| Rate for Payer: Cash Price |
$1,268.00
|
| Rate for Payer: Cash Price |
$1,268.00
|
| Rate for Payer: Meridian Medicaid |
$296.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,109.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$624.44
|
| Rate for Payer: Priority Health Narrow Network |
$624.44
|
| Rate for Payer: Priority Health SBD |
$624.44
|
| Rate for Payer: UMR Bronson Commercial |
$729.10
|
|
|
PR BIOPSY PALATE UVULA
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 42100
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$796.68 |
| Rate for Payer: Aetna Commercial |
$141.39
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS Trust/PPO |
$796.68
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Meridian Medicaid |
$74.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.03
|
| Rate for Payer: Priority Health Narrow Network |
$194.03
|
| Rate for Payer: Priority Health SBD |
$194.03
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
