|
PR DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 93321
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$2,553.80 |
| Rate for Payer: Aetna Commercial |
$34.13
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,553.80
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.94
|
| Rate for Payer: Priority Health Narrow Network |
$9.94
|
| Rate for Payer: Priority Health SBD |
$35.47
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
PR DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
93320
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna American Axle |
$165.10
|
| Rate for Payer: Aetna American Axle |
$112.45
|
| Rate for Payer: Aetna Commercial |
$147.05
|
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.45
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS Trust/PPO |
$165.88
|
| Rate for Payer: BCBS Trust/PPO |
$165.88
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$177.80
|
| Rate for Payer: Cofinity Commercial |
$121.10
|
| Rate for Payer: Cofinity Commercial |
$148.78
|
| Rate for Payer: Cofinity Commercial |
$218.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.20
|
| Rate for Payer: Healthscope Commercial |
$228.60
|
| Rate for Payer: Healthscope Commercial |
$155.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.90
|
| Rate for Payer: PHP Commercial |
$147.05
|
| Rate for Payer: PHP Commercial |
$215.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.10
|
| Rate for Payer: Priority Health SBD |
$160.02
|
| Rate for Payer: Priority Health SBD |
$108.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.75
|
| Rate for Payer: UHC Exchange |
$49.77
|
| Rate for Payer: UHC Exchange |
$49.77
|
| Rate for Payer: UMR Bronson Commercial |
$64.01
|
| Rate for Payer: UMR Bronson Commercial |
$93.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.50
|
|
|
PR DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 93320
|
| Min. Negotiated Rate |
$24.59 |
| Max. Negotiated Rate |
$1,902.94 |
| Rate for Payer: Aetna Commercial |
$68.60
|
| Rate for Payer: Aetna Commercial |
$68.60
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,902.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,902.94
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.59
|
| Rate for Payer: Priority Health Narrow Network |
$24.59
|
| Rate for Payer: Priority Health Narrow Network |
$24.59
|
| Rate for Payer: Priority Health SBD |
$71.40
|
| Rate for Payer: Priority Health SBD |
$71.40
|
| Rate for Payer: UMR Bronson Commercial |
$79.58
|
| Rate for Payer: UMR Bronson Commercial |
$116.84
|
|
|
PR DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
93320
|
| Min. Negotiated Rate |
$76.12 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Aetna American Axle |
$112.45
|
| Rate for Payer: Aetna American Axle |
$165.10
|
| Rate for Payer: Aetna Commercial |
$147.05
|
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.45
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$121.10
|
| Rate for Payer: Cofinity Commercial |
$177.80
|
| Rate for Payer: Cofinity Commercial |
$218.44
|
| Rate for Payer: Cofinity Commercial |
$148.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.20
|
| Rate for Payer: Healthscope Commercial |
$228.60
|
| Rate for Payer: Healthscope Commercial |
$155.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.90
|
| Rate for Payer: PHP Commercial |
$147.05
|
| Rate for Payer: PHP Commercial |
$215.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health SBD |
$108.99
|
| Rate for Payer: Priority Health SBD |
$160.02
|
| Rate for Payer: UMR Bronson Commercial |
$111.76
|
| Rate for Payer: UMR Bronson Commercial |
$76.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.50
|
|
|
PR DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 93320
|
| Hospital Charge Code |
93320
|
| Min. Negotiated Rate |
$24.59 |
| Max. Negotiated Rate |
$1,902.94 |
| Rate for Payer: Aetna Commercial |
$68.60
|
| Rate for Payer: Aetna Commercial |
$68.60
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,902.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,902.94
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.59
|
| Rate for Payer: Priority Health Narrow Network |
$24.59
|
| Rate for Payer: Priority Health Narrow Network |
$24.59
|
| Rate for Payer: Priority Health SBD |
$71.40
|
| Rate for Payer: Priority Health SBD |
$71.40
|
| Rate for Payer: UMR Bronson Commercial |
$116.84
|
| Rate for Payer: UMR Bronson Commercial |
$79.58
|
|
|
PR DRAIN ABD ABSCESS PERCUTANEOUS
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 49021
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$424.90 |
| Rate for Payer: BCBS Complete |
$242.80
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$424.90
|
| Rate for Payer: UMR Bronson Commercial |
$279.22
|
|
|
PR DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 30000
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$1,942.56 |
| Rate for Payer: Aetna Commercial |
$150.43
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,942.56
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Meridian Medicaid |
$82.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.01
|
| Rate for Payer: Priority Health Narrow Network |
$169.01
|
| Rate for Payer: Priority Health SBD |
$169.01
|
| Rate for Payer: UMR Bronson Commercial |
$168.82
|
|
|
PR DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
HCPCS 30020
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,109.43 |
| Rate for Payer: Aetna Commercial |
$151.26
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.43
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Meridian Medicaid |
$83.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.39
|
| Rate for Payer: Priority Health Narrow Network |
$170.39
|
| Rate for Payer: Priority Health SBD |
$170.39
|
| Rate for Payer: UMR Bronson Commercial |
$137.08
|
|
|
PR DRAINAGE ABSCESS PAROTID COMPLICATED
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 42305
|
| Min. Negotiated Rate |
$200.75 |
| Max. Negotiated Rate |
$747.91 |
| Rate for Payer: Aetna Commercial |
$561.76
|
| Rate for Payer: BCBS Complete |
$293.65
|
| Rate for Payer: BCBS Trust/PPO |
$200.75
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Meridian Medicaid |
$293.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$747.91
|
| Rate for Payer: Priority Health Narrow Network |
$747.91
|
| Rate for Payer: Priority Health SBD |
$747.91
|
| Rate for Payer: UMR Bronson Commercial |
$353.28
|
|
|
PR DRAINAGE ABSCESS PAROTID SIMPLE
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 42300
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$891.77 |
| Rate for Payer: Aetna Commercial |
$202.70
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS Trust/PPO |
$891.77
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Meridian Medicaid |
$106.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.94
|
| Rate for Payer: Priority Health Narrow Network |
$276.94
|
| Rate for Payer: Priority Health SBD |
$276.94
|
| Rate for Payer: UMR Bronson Commercial |
$157.32
|
|
|
PR DRAINAGE DEEP PERIURETHRAL ABSCESS
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 53040
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$758.64 |
| Rate for Payer: Aetna Commercial |
$501.88
|
| Rate for Payer: BCBS Complete |
$263.69
|
| Rate for Payer: BCBS Trust/PPO |
$758.64
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Meridian Medicaid |
$263.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.44
|
| Rate for Payer: Priority Health Narrow Network |
$628.44
|
| Rate for Payer: Priority Health SBD |
$628.44
|
| Rate for Payer: UMR Bronson Commercial |
$367.54
|
|
|
PR DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
HCPCS 69020
|
| Min. Negotiated Rate |
$92.87 |
| Max. Negotiated Rate |
$282.64 |
| Rate for Payer: Aetna Commercial |
$158.84
|
| Rate for Payer: BCBS Complete |
$97.51
|
| Rate for Payer: BCBS Trust/PPO |
$282.64
|
| Rate for Payer: Cash Price |
$298.40
|
| Rate for Payer: Cash Price |
$298.40
|
| Rate for Payer: Meridian Medicaid |
$97.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.09
|
| Rate for Payer: Priority Health Narrow Network |
$205.09
|
| Rate for Payer: Priority Health SBD |
$205.09
|
| Rate for Payer: UMR Bronson Commercial |
$171.58
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 69005
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$5,834.02 |
| Rate for Payer: Aetna Commercial |
$177.45
|
| Rate for Payer: BCBS Complete |
$109.37
|
| Rate for Payer: BCBS Trust/PPO |
$5,834.02
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Meridian Medicaid |
$109.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.78
|
| Rate for Payer: Priority Health Narrow Network |
$226.78
|
| Rate for Payer: Priority Health SBD |
$226.78
|
| Rate for Payer: UMR Bronson Commercial |
$173.42
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 69000
|
| Min. Negotiated Rate |
$80.94 |
| Max. Negotiated Rate |
$5,524.43 |
| Rate for Payer: Aetna Commercial |
$136.46
|
| Rate for Payer: BCBS Complete |
$84.99
|
| Rate for Payer: BCBS Trust/PPO |
$5,524.43
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Meridian Medicaid |
$84.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.80
|
| Rate for Payer: Priority Health Narrow Network |
$176.80
|
| Rate for Payer: Priority Health SBD |
$176.80
|
| Rate for Payer: UMR Bronson Commercial |
$143.06
|
|
|
PR DRAINAGE FINGER ABSCESS COMPLICATED
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 26011
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Aetna Commercial |
$245.87
|
| Rate for Payer: BCBS Complete |
$125.92
|
| Rate for Payer: BCBS Trust/PPO |
$452.09
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Meridian Medicaid |
$125.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.97
|
| Rate for Payer: Priority Health Narrow Network |
$285.97
|
| Rate for Payer: Priority Health SBD |
$285.97
|
| Rate for Payer: UMR Bronson Commercial |
$365.70
|
|
|
PR DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 26010
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$184.30
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS Trust/PPO |
$348.51
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.03
|
| Rate for Payer: Priority Health Narrow Network |
$217.03
|
| Rate for Payer: Priority Health SBD |
$217.03
|
| Rate for Payer: UMR Bronson Commercial |
$259.90
|
|
|
PR DRAINAGE OF PALMAR BURSA MULTIPLE BURSA
|
Professional
|
Both
|
$3,116.00
|
|
|
Service Code
|
HCPCS 26030
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$2,181.20 |
| Rate for Payer: Aetna Commercial |
$651.70
|
| Rate for Payer: BCBS Complete |
$336.37
|
| Rate for Payer: BCBS Trust/PPO |
$104.00
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Meridian Medicaid |
$336.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$320.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$759.84
|
| Rate for Payer: Priority Health Narrow Network |
$759.84
|
| Rate for Payer: Priority Health SBD |
$759.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,433.36
|
|
|
PR DRAINAGE OF PALMAR BURSA SINGLE BURSA
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS 26025
|
| Min. Negotiated Rate |
$84.90 |
| Max. Negotiated Rate |
$935.20 |
| Rate for Payer: Aetna Commercial |
$560.79
|
| Rate for Payer: BCBS Complete |
$287.16
|
| Rate for Payer: BCBS Trust/PPO |
$84.90
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Meridian Medicaid |
$287.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$935.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$649.55
|
| Rate for Payer: Priority Health Narrow Network |
$649.55
|
| Rate for Payer: Priority Health SBD |
$649.55
|
| Rate for Payer: UMR Bronson Commercial |
$614.56
|
|
|
PR DRAINAGE OF RETROPERITONEAL ABSCESS OPEN
|
Professional
|
Both
|
$2,205.00
|
|
|
Service Code
|
HCPCS 49060
|
| Min. Negotiated Rate |
$698.85 |
| Max. Negotiated Rate |
$1,919.15 |
| Rate for Payer: Aetna Commercial |
$1,480.16
|
| Rate for Payer: BCBS Complete |
$733.79
|
| Rate for Payer: BCBS Trust/PPO |
$798.26
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Meridian Medicaid |
$733.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$698.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,543.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,919.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,919.15
|
| Rate for Payer: Priority Health SBD |
$1,919.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,014.30
|
|
|
PR DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH
|
Professional
|
Both
|
$1,691.00
|
|
|
Service Code
|
HCPCS 58822
|
| Min. Negotiated Rate |
$280.53 |
| Max. Negotiated Rate |
$1,183.70 |
| Rate for Payer: Aetna Commercial |
$854.23
|
| Rate for Payer: BCBS Complete |
$482.63
|
| Rate for Payer: BCBS Trust/PPO |
$280.53
|
| Rate for Payer: Cash Price |
$1,352.80
|
| Rate for Payer: Cash Price |
$1,352.80
|
| Rate for Payer: Meridian Medicaid |
$482.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,017.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,017.39
|
| Rate for Payer: Priority Health SBD |
$1,017.39
|
| Rate for Payer: UMR Bronson Commercial |
$777.86
|
|
|
PR DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 58820
|
| Min. Negotiated Rate |
$136.83 |
| Max. Negotiated Rate |
$615.30 |
| Rate for Payer: Aetna Commercial |
$398.40
|
| Rate for Payer: BCBS Complete |
$230.14
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Meridian Medicaid |
$230.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$484.78
|
| Rate for Payer: Priority Health Narrow Network |
$484.78
|
| Rate for Payer: Priority Health SBD |
$484.78
|
| Rate for Payer: UMR Bronson Commercial |
$404.34
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 58805
|
| Min. Negotiated Rate |
$275.77 |
| Max. Negotiated Rate |
$1,106.00 |
| Rate for Payer: Aetna Commercial |
$506.69
|
| Rate for Payer: BCBS Complete |
$290.29
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Meridian Medicaid |
$290.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,106.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.19
|
| Rate for Payer: Priority Health Narrow Network |
$611.19
|
| Rate for Payer: Priority Health SBD |
$611.19
|
| Rate for Payer: UMR Bronson Commercial |
$726.80
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR
|
Professional
|
Both
|
$974.00
|
|
|
Service Code
|
HCPCS 58800
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$681.80 |
| Rate for Payer: Aetna Commercial |
$373.31
|
| Rate for Payer: BCBS Complete |
$214.03
|
| Rate for Payer: BCBS Trust/PPO |
$503.47
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Meridian Medicaid |
$214.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.23
|
| Rate for Payer: Priority Health Narrow Network |
$450.23
|
| Rate for Payer: Priority Health SBD |
$450.23
|
| Rate for Payer: UMR Bronson Commercial |
$448.04
|
|
|
PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN
|
Professional
|
Both
|
$2,773.00
|
|
|
Service Code
|
HCPCS 49020
|
| Min. Negotiated Rate |
$537.81 |
| Max. Negotiated Rate |
$2,791.69 |
| Rate for Payer: Aetna Commercial |
$2,149.64
|
| Rate for Payer: BCBS Complete |
$1,068.83
|
| Rate for Payer: BCBS Trust/PPO |
$537.81
|
| Rate for Payer: Cash Price |
$2,218.40
|
| Rate for Payer: Cash Price |
$2,218.40
|
| Rate for Payer: Meridian Medicaid |
$1,068.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,941.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,791.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,791.69
|
| Rate for Payer: Priority Health SBD |
$2,791.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,275.58
|
|
|
PR DRAINAGE SCROTAL WALL ABSCESS
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 55100
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$1,199.77 |
| Rate for Payer: Aetna Commercial |
$212.60
|
| Rate for Payer: BCBS Complete |
$113.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,199.77
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Meridian Medicaid |
$113.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.10
|
| Rate for Payer: Priority Health Narrow Network |
$269.10
|
| Rate for Payer: Priority Health SBD |
$269.10
|
| Rate for Payer: UMR Bronson Commercial |
$179.86
|
|
