|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$104.98
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.76
|
| Rate for Payer: Priority Health Narrow Network |
$138.76
|
| Rate for Payer: Priority Health SBD |
$138.76
|
| Rate for Payer: UMR Bronson Commercial |
$148.12
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 43450
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$104.98
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.76
|
| Rate for Payer: Priority Health Narrow Network |
$138.76
|
| Rate for Payer: Priority Health SBD |
$138.76
|
| Rate for Payer: UMR Bronson Commercial |
$148.12
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$209.30
|
| Rate for Payer: Aetna Commercial |
$273.70
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$655.17
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$276.92
|
| Rate for Payer: Cofinity Commercial |
$225.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$289.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.50
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.70
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$273.70
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$202.86
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$77.60
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$119.14
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.50
|
|
|
PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 68801
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,061.88 |
| Rate for Payer: Aetna Commercial |
$100.58
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.41
|
| Rate for Payer: Priority Health Narrow Network |
$136.41
|
| Rate for Payer: Priority Health SBD |
$136.41
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
PR DILATION SALIVARY DUCT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 42650
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$619.17 |
| Rate for Payer: Aetna Commercial |
$75.67
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCBS Trust/PPO |
$619.17
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.48
|
| Rate for Payer: Priority Health Narrow Network |
$103.48
|
| Rate for Payer: Priority Health SBD |
$103.48
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
|
|
PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 57400
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$1,877.58 |
| Rate for Payer: Aetna Commercial |
$156.29
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.58
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.74
|
| Rate for Payer: Priority Health Narrow Network |
$182.74
|
| Rate for Payer: Priority Health SBD |
$182.74
|
| Rate for Payer: UMR Bronson Commercial |
$166.98
|
|
|
PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 45910
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$1,149.58 |
| Rate for Payer: Aetna Commercial |
$255.45
|
| Rate for Payer: BCBS Complete |
$130.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.58
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Meridian Medicaid |
$130.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$905.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.26
|
| Rate for Payer: Priority Health Narrow Network |
$339.26
|
| Rate for Payer: Priority Health SBD |
$339.26
|
| Rate for Payer: UMR Bronson Commercial |
$595.24
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$549.43 |
| Rate for Payer: Aetna Commercial |
$81.77
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$549.43
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Meridian Medicaid |
$42.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.13
|
| Rate for Payer: Priority Health Narrow Network |
$102.13
|
| Rate for Payer: Priority Health SBD |
$102.13
|
| Rate for Payer: UMR Bronson Commercial |
$77.74
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$244.07 |
| Rate for Payer: Aetna Commercial |
$68.82
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$244.07
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.83
|
| Rate for Payer: Priority Health Narrow Network |
$84.83
|
| Rate for Payer: Priority Health SBD |
$84.83
|
| Rate for Payer: UMR Bronson Commercial |
$73.60
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 53620
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$1,543.16 |
| Rate for Payer: Aetna Commercial |
$111.68
|
| Rate for Payer: BCBS Complete |
$57.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Meridian Medicaid |
$57.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.79
|
| Rate for Payer: Priority Health Narrow Network |
$137.79
|
| Rate for Payer: Priority Health SBD |
$137.79
|
| Rate for Payer: UMR Bronson Commercial |
$117.76
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 53621
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$91.87
|
| Rate for Payer: BCBS Complete |
$47.64
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Meridian Medicaid |
$47.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.01
|
| Rate for Payer: Priority Health Narrow Network |
$114.01
|
| Rate for Payer: Priority Health SBD |
$114.01
|
| Rate for Payer: UMR Bronson Commercial |
$110.86
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$1,411.09 |
| Rate for Payer: Aetna Commercial |
$82.91
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,411.09
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.13
|
| Rate for Payer: Priority Health Narrow Network |
$102.13
|
| Rate for Payer: Priority Health SBD |
$102.13
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J1200
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$0.83
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$16.00
|
| 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 DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 90700
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$34.91 |
| Rate for Payer: Aetna Commercial |
$29.53
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG
|
Professional
|
Both
|
$7,478.00
|
|
|
Service Code
|
HCPCS 33645
|
| Min. Negotiated Rate |
$1,086.30 |
| Max. Negotiated Rate |
$5,234.60 |
| Rate for Payer: Aetna Commercial |
$2,324.74
|
| Rate for Payer: BCBS Complete |
$1,140.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.01
|
| Rate for Payer: Cash Price |
$5,982.40
|
| Rate for Payer: Cash Price |
$5,982.40
|
| Rate for Payer: Meridian Medicaid |
$1,140.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,086.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,234.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,702.34
|
| Rate for Payer: Priority Health Narrow Network |
$2,702.34
|
| Rate for Payer: Priority Health SBD |
$2,702.34
|
| Rate for Payer: UMR Bronson Commercial |
$3,439.88
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS
|
Professional
|
Both
|
$3,648.00
|
|
|
Service Code
|
HCPCS 35102
|
| Min. Negotiated Rate |
$1,173.42 |
| Max. Negotiated Rate |
$2,910.88 |
| Rate for Payer: Aetna Commercial |
$2,527.67
|
| Rate for Payer: BCBS Complete |
$1,232.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.33
|
| Rate for Payer: Cash Price |
$2,918.40
|
| Rate for Payer: Cash Price |
$2,918.40
|
| Rate for Payer: Meridian Medicaid |
$1,232.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,173.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,553.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,910.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,910.88
|
| Rate for Payer: Priority Health SBD |
$2,910.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,678.08
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$3,503.00
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,108.45 |
| Max. Negotiated Rate |
$2,761.38 |
| Rate for Payer: Aetna Commercial |
$2,414.09
|
| Rate for Payer: BCBS Complete |
$1,163.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.81
|
| Rate for Payer: Cash Price |
$2,802.40
|
| Rate for Payer: Cash Price |
$2,802.40
|
| Rate for Payer: Meridian Medicaid |
$1,163.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,108.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,452.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,761.38
|
| Rate for Payer: Priority Health Narrow Network |
$2,761.38
|
| Rate for Payer: Priority Health SBD |
$2,761.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,611.38
|
|
|
PR DIR RPR ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$5,571.00
|
|
|
Service Code
|
HCPCS 35081
|
| Min. Negotiated Rate |
$1,079.27 |
| Max. Negotiated Rate |
$3,899.70 |
| Rate for Payer: Aetna Commercial |
$2,327.67
|
| Rate for Payer: BCBS Complete |
$1,133.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.67
|
| Rate for Payer: Cash Price |
$4,456.80
|
| Rate for Payer: Cash Price |
$4,456.80
|
| Rate for Payer: Meridian Medicaid |
$1,133.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,079.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,899.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,685.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,685.85
|
| Rate for Payer: Priority Health SBD |
$2,685.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,562.66
|
|
|
PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION
|
Professional
|
Both
|
$3,647.00
|
|
|
Service Code
|
HCPCS 35011
|
| Min. Negotiated Rate |
$632.18 |
| Max. Negotiated Rate |
$2,552.90 |
| Rate for Payer: Aetna Commercial |
$1,351.29
|
| Rate for Payer: BCBS Complete |
$663.79
|
| Rate for Payer: BCBS Trust/PPO |
$767.09
|
| Rate for Payer: Cash Price |
$2,917.60
|
| Rate for Payer: Cash Price |
$2,917.60
|
| Rate for Payer: Meridian Medicaid |
$663.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$632.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,552.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,572.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,572.99
|
| Rate for Payer: Priority Health SBD |
$1,572.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,677.62
|
|
|
PR DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,170.00
|
|
|
Service Code
|
HCPCS 35001
|
| Min. Negotiated Rate |
$701.41 |
| Max. Negotiated Rate |
$2,601.88 |
| Rate for Payer: Aetna Commercial |
$1,514.12
|
| Rate for Payer: BCBS Complete |
$736.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.88
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Meridian Medicaid |
$736.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$701.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,519.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,750.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,750.14
|
| Rate for Payer: Priority Health SBD |
$1,750.14
|
| Rate for Payer: UMR Bronson Commercial |
$998.20
|
|
|
PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY
|
Professional
|
Both
|
$2,133.00
|
|
|
Service Code
|
HCPCS 35141
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$1,698.54 |
| Rate for Payer: Aetna Commercial |
$1,476.41
|
| Rate for Payer: BCBS Complete |
$715.68
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: Meridian Medicaid |
$715.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$681.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,698.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,698.54
|
| Rate for Payer: Priority Health SBD |
$1,698.54
|
| Rate for Payer: UMR Bronson Commercial |
$981.18
|
|
|
PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$4,858.00
|
|
|
Service Code
|
HCPCS 35131
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$3,400.60 |
| Rate for Payer: Aetna Commercial |
$1,850.09
|
| Rate for Payer: BCBS Complete |
$905.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,490.86
|
| Rate for Payer: Cash Price |
$3,886.40
|
| Rate for Payer: Cash Price |
$3,886.40
|
| Rate for Payer: Meridian Medicaid |
$905.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$862.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,400.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,140.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,140.06
|
| Rate for Payer: Priority Health SBD |
$2,140.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,234.68
|
|
|
PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,409.00
|
|
|
Service Code
|
HCPCS 35151
|
| Min. Negotiated Rate |
$774.89 |
| Max. Negotiated Rate |
$1,924.09 |
| Rate for Payer: Aetna Commercial |
$1,658.62
|
| Rate for Payer: BCBS Complete |
$813.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.30
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Meridian Medicaid |
$813.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,686.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,924.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,924.09
|
| Rate for Payer: Priority Health SBD |
$1,924.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,108.14
|
|
|
PR DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC
|
Professional
|
Both
|
$3,133.00
|
|
|
Service Code
|
HCPCS 35121
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$2,451.26 |
| Rate for Payer: Aetna Commercial |
$2,126.67
|
| Rate for Payer: BCBS Complete |
$1,035.05
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: Cash Price |
$2,506.40
|
| Rate for Payer: Cash Price |
$2,506.40
|
| Rate for Payer: Meridian Medicaid |
$1,035.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$985.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,193.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,451.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,451.26
|
| Rate for Payer: Priority Health SBD |
$2,451.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,441.18
|
|
|
PR DIR RPR ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$2,720.00
|
|
|
Service Code
|
HCPCS 35111
|
| Min. Negotiated Rate |
$829.42 |
| Max. Negotiated Rate |
$2,062.94 |
| Rate for Payer: Aetna Commercial |
$1,786.57
|
| Rate for Payer: BCBS Complete |
$870.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.86
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Meridian Medicaid |
$870.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$829.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,062.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,062.94
|
| Rate for Payer: Priority Health SBD |
$2,062.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,251.20
|
|
