|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$881.00
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$3,486.25 |
| Rate for Payer: Aetna Commercial |
$292.11
|
| Rate for Payer: BCBS Complete |
$159.92
|
| Rate for Payer: BCBS Trust/PPO |
$3,486.25
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Meridian Medicaid |
$159.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.26
|
| Rate for Payer: Priority Health Narrow Network |
$391.26
|
| Rate for Payer: Priority Health SBD |
$391.26
|
| Rate for Payer: UMR Bronson Commercial |
$405.26
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.55
|
| Rate for Payer: Priority Health Narrow Network |
$111.55
|
| Rate for Payer: Priority Health SBD |
$111.55
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$654.04 |
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: BCBS Complete |
$38.91
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Meridian Medicaid |
$38.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.52
|
| Rate for Payer: Priority Health Narrow Network |
$98.52
|
| Rate for Payer: Priority Health SBD |
$98.52
|
| Rate for Payer: UMR Bronson Commercial |
$151.34
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$427.00 |
| Rate for Payer: Aetna Commercial |
$287.73
|
| Rate for Payer: BCBS Complete |
$128.37
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Meridian Medicaid |
$128.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.91
|
| Rate for Payer: Priority Health Narrow Network |
$319.91
|
| Rate for Payer: Priority Health SBD |
$319.91
|
| Rate for Payer: UMR Bronson Commercial |
$280.60
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$427.00 |
| Rate for Payer: Aetna Commercial |
$287.73
|
| Rate for Payer: BCBS Complete |
$128.37
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Meridian Medicaid |
$128.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.91
|
| Rate for Payer: Priority Health Narrow Network |
$319.91
|
| Rate for Payer: Priority Health SBD |
$319.91
|
| Rate for Payer: UMR Bronson Commercial |
$280.60
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$187.95 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna American Axle |
$396.50
|
| Rate for Payer: Aetna Commercial |
$518.50
|
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,313.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$427.00
|
| Rate for Payer: Cofinity Commercial |
$524.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$549.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.50
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$518.50
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Commercial |
$518.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Priority Health SBD |
$384.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$187.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: UMR Bronson Commercial |
$225.70
|
| Rate for Payer: VA VA |
$1,716.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.50
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$268.40 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna American Axle |
$396.50
|
| Rate for Payer: Aetna Commercial |
$518.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.50
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$427.00
|
| Rate for Payer: Cofinity Commercial |
$524.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.00
|
| Rate for Payer: Healthscope Commercial |
$549.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$518.50
|
| Rate for Payer: PHP Commercial |
$518.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health SBD |
$384.30
|
| Rate for Payer: UMR Bronson Commercial |
$268.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.50
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$265.32 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Aetna American Axle |
$391.95
|
| Rate for Payer: Aetna Commercial |
$512.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.95
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$518.58
|
| Rate for Payer: Cofinity Commercial |
$422.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.40
|
| Rate for Payer: Healthscope Commercial |
$542.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$422.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$512.55
|
| Rate for Payer: PHP Commercial |
$512.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health SBD |
$379.89
|
| Rate for Payer: UMR Bronson Commercial |
$265.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.25
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 64635
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$283.74
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Narrow Network |
$320.48
|
| Rate for Payer: Priority Health SBD |
$320.48
|
| Rate for Payer: UMR Bronson Commercial |
$277.38
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$188.28 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna American Axle |
$391.95
|
| Rate for Payer: Aetna Commercial |
$512.55
|
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$422.10
|
| Rate for Payer: Cofinity Commercial |
$518.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$542.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$422.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.25
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$512.55
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Commercial |
$512.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Priority Health SBD |
$379.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$188.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: UMR Bronson Commercial |
$223.11
|
| Rate for Payer: VA VA |
$1,716.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.25
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$283.74
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Narrow Network |
$320.48
|
| Rate for Payer: Priority Health SBD |
$320.48
|
| Rate for Payer: UMR Bronson Commercial |
$277.38
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$95.50 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.92
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: UMR Bronson Commercial |
$55.20
|
|
|
PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 90697
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$175.01 |
| Rate for Payer: Aetna Commercial |
$154.01
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$175.01
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: UMR Bronson Commercial |
$73.60
|
|
|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 90698
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$118.20 |
| Rate for Payer: Aetna Commercial |
$118.20
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCBS Trust/PPO |
$109.23
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: UMR Bronson Commercial |
$49.68
|
|
|
PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 90696
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$62.89 |
| Rate for Payer: Aetna Commercial |
$62.89
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS Trust/PPO |
$59.91
|
| Rate for Payer: Cash Price |
$53.60
|
| 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 DTP/HIB VACCINE,IM
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 90720
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: UMR Bronson Commercial |
$36.80
|
|
|
PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 90702
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.01 |
| Rate for Payer: Aetna Commercial |
$67.16
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$79.01
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
PR DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 43756
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$67.03
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$194.41
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.78
|
| Rate for Payer: Priority Health Narrow Network |
$88.78
|
| Rate for Payer: Priority Health SBD |
$88.78
|
| Rate for Payer: UMR Bronson Commercial |
$218.50
|
|
|
PR DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,878.00
|
|
|
Service Code
|
HCPCS 44010
|
| Min. Negotiated Rate |
$542.30 |
| Max. Negotiated Rate |
$2,014.60 |
| Rate for Payer: Aetna Commercial |
$1,155.16
|
| Rate for Payer: BCBS Complete |
$569.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,969.50
|
| Rate for Payer: Cash Price |
$2,302.40
|
| Rate for Payer: Cash Price |
$2,302.40
|
| Rate for Payer: Meridian Medicaid |
$569.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,014.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,488.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,488.74
|
| Rate for Payer: Priority Health SBD |
$1,488.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,323.88
|
|
|
PR DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ
|
Professional
|
Both
|
$6,158.00
|
|
|
Service Code
|
HCPCS 48547
|
| Min. Negotiated Rate |
$749.66 |
| Max. Negotiated Rate |
$4,310.60 |
| Rate for Payer: Aetna Commercial |
$2,429.46
|
| Rate for Payer: BCBS Complete |
$1,200.11
|
| Rate for Payer: BCBS Trust/PPO |
$749.66
|
| Rate for Payer: Cash Price |
$4,926.40
|
| Rate for Payer: Cash Price |
$4,926.40
|
| Rate for Payer: Meridian Medicaid |
$1,200.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,142.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,310.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,143.30
|
| Rate for Payer: Priority Health Narrow Network |
$3,143.30
|
| Rate for Payer: Priority Health SBD |
$3,143.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,832.68
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 93985
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$334.16 |
| Rate for Payer: Aetna Commercial |
$282.30
|
| Rate for Payer: BCBS Complete |
$30.40
|
| Rate for Payer: BCBS Trust/PPO |
$243.55
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.30
|
| Rate for Payer: Priority Health Narrow Network |
$50.30
|
| Rate for Payer: Priority Health SBD |
$334.16
|
| Rate for Payer: UMR Bronson Commercial |
$34.96
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 93986
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$198.97 |
| Rate for Payer: Aetna Commercial |
$137.95
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| 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: Priority Health HMO/PPO/Tiered Network |
$31.44
|
| Rate for Payer: Priority Health Narrow Network |
$31.44
|
| Rate for Payer: Priority Health SBD |
$198.97
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 93880
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Aetna Commercial |
$211.27
|
| Rate for Payer: BCBS Complete |
$174.00
|
| Rate for Payer: BCBS Trust/PPO |
$80.30
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.75
|
| Rate for Payer: Priority Health Narrow Network |
$50.75
|
| Rate for Payer: Priority Health SBD |
$257.35
|
| Rate for Payer: UMR Bronson Commercial |
$200.10
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 93882
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$137.60
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.89
|
| Rate for Payer: Priority Health Narrow Network |
$31.89
|
| Rate for Payer: Priority Health SBD |
$167.08
|
| Rate for Payer: UMR Bronson Commercial |
$143.52
|
|
|
PR DUPLEX SCAN HEMODIALYSIS ACCESS
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 93990
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Aetna Commercial |
$138.39
|
| Rate for Payer: Aetna Commercial |
$138.39
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$16.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.91
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.99
|
| Rate for Payer: Priority Health Narrow Network |
$30.99
|
| Rate for Payer: Priority Health Narrow Network |
$30.99
|
| Rate for Payer: Priority Health SBD |
$197.17
|
| Rate for Payer: Priority Health SBD |
$197.17
|
| Rate for Payer: UMR Bronson Commercial |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
