|
PR ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 95824
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$262.57 |
| Rate for Payer: Aetna Commercial |
$106.88
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.20
|
| Rate for Payer: Priority Health Narrow Network |
$51.20
|
| Rate for Payer: Priority Health SBD |
$131.15
|
| Rate for Payer: UMR Bronson Commercial |
$90.62
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
HCPCS 95812
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$1,286.41 |
| Rate for Payer: Aetna Commercial |
$364.65
|
| Rate for Payer: BCBS Complete |
$295.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,286.41
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.10
|
| Rate for Payer: Priority Health Narrow Network |
$74.10
|
| Rate for Payer: Priority Health SBD |
$463.52
|
| Rate for Payer: UMR Bronson Commercial |
$339.48
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 95822
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$614.41 |
| Rate for Payer: Aetna Commercial |
$435.49
|
| Rate for Payer: BCBS Complete |
$144.00
|
| Rate for Payer: BCBS Trust/PPO |
$614.41
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.55
|
| Rate for Payer: Priority Health Narrow Network |
$74.55
|
| Rate for Payer: Priority Health SBD |
$558.29
|
| Rate for Payer: UMR Bronson Commercial |
$165.60
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 95819
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$596.01 |
| Rate for Payer: Aetna Commercial |
$477.15
|
| Rate for Payer: Aetna Commercial |
$477.15
|
| Rate for Payer: BCBS Complete |
$311.20
|
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: BCBS Trust/PPO |
$150.04
|
| Rate for Payer: BCBS Trust/PPO |
$150.04
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.10
|
| Rate for Payer: Priority Health Narrow Network |
$74.10
|
| Rate for Payer: Priority Health Narrow Network |
$74.10
|
| Rate for Payer: Priority Health SBD |
$596.01
|
| Rate for Payer: Priority Health SBD |
$596.01
|
| Rate for Payer: UMR Bronson Commercial |
$92.92
|
| Rate for Payer: UMR Bronson Commercial |
$357.88
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS 95816
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$513.82 |
| Rate for Payer: Aetna Commercial |
$398.47
|
| Rate for Payer: Aetna Commercial |
$398.47
|
| Rate for Payer: BCBS Complete |
$110.40
|
| Rate for Payer: BCBS Complete |
$271.20
|
| Rate for Payer: BCBS Trust/PPO |
$231.92
|
| Rate for Payer: BCBS Trust/PPO |
$231.92
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.10
|
| Rate for Payer: Priority Health Narrow Network |
$74.10
|
| Rate for Payer: Priority Health Narrow Network |
$74.10
|
| Rate for Payer: Priority Health SBD |
$513.82
|
| Rate for Payer: Priority Health SBD |
$513.82
|
| Rate for Payer: UMR Bronson Commercial |
$126.96
|
| Rate for Payer: UMR Bronson Commercial |
$311.88
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS 91132
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$600.05 |
| Rate for Payer: Aetna Commercial |
$438.73
|
| Rate for Payer: BCBS Complete |
$110.40
|
| Rate for Payer: BCBS Trust/PPO |
$538.87
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.58
|
| Rate for Payer: Priority Health Narrow Network |
$34.58
|
| Rate for Payer: Priority Health SBD |
$600.05
|
| Rate for Payer: UMR Bronson Commercial |
$126.96
|
|
|
PR ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 93724
|
| Min. Negotiated Rate |
$65.72 |
| Max. Negotiated Rate |
$396.26 |
| Rate for Payer: Aetna Commercial |
$311.50
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: BCBS Trust/PPO |
$99.85
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.72
|
| Rate for Payer: Priority Health Narrow Network |
$65.72
|
| Rate for Payer: Priority Health SBD |
$396.26
|
| Rate for Payer: UMR Bronson Commercial |
$257.60
|
|
|
PR ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL
|
Professional
|
Both
|
$4,063.00
|
|
|
Service Code
|
HCPCS 62000
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,844.10 |
| Rate for Payer: Aetna Commercial |
$1,335.49
|
| Rate for Payer: BCBS Complete |
$708.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.99
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Meridian Medicaid |
$708.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$675.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,844.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,776.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,776.81
|
| Rate for Payer: Priority Health SBD |
$1,776.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,868.98
|
|
|
PR ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL
|
Professional
|
Both
|
$5,136.00
|
|
|
Service Code
|
HCPCS 62005
|
| Min. Negotiated Rate |
$829.00 |
| Max. Negotiated Rate |
$3,595.20 |
| Rate for Payer: Aetna Commercial |
$1,642.59
|
| Rate for Payer: BCBS Complete |
$870.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.49
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Meridian Medicaid |
$870.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$829.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,595.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,182.22
|
| Rate for Payer: Priority Health Narrow Network |
$2,182.22
|
| Rate for Payer: Priority Health SBD |
$2,182.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,362.56
|
|
|
PR ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN
|
Professional
|
Both
|
$6,743.00
|
|
|
Service Code
|
HCPCS 62010
|
| Min. Negotiated Rate |
$1,000.46 |
| Max. Negotiated Rate |
$4,720.10 |
| Rate for Payer: Aetna Commercial |
$1,985.02
|
| Rate for Payer: BCBS Complete |
$1,050.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,117.43
|
| Rate for Payer: Cash Price |
$5,394.40
|
| Rate for Payer: Cash Price |
$5,394.40
|
| Rate for Payer: Meridian Medicaid |
$1,050.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,720.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,634.64
|
| Rate for Payer: Priority Health Narrow Network |
$2,634.64
|
| Rate for Payer: Priority Health SBD |
$2,634.64
|
| Rate for Payer: UMR Bronson Commercial |
$3,101.78
|
|
|
PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 99318
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: UMR Bronson Commercial |
$65.32
|
|
|
PREMATURITY WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$62,506.32
|
|
|
Service Code
|
MS-DRG 791
|
| Min. Negotiated Rate |
$12,448.91 |
| Max. Negotiated Rate |
$62,506.32 |
| Rate for Payer: Aetna Medicare |
$33,372.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,111.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,111.70
|
| Rate for Payer: BCBS MAPPO |
$32,089.36
|
| Rate for Payer: BCBS Trust/PPO |
$12,448.91
|
| Rate for Payer: BCN Medicare Advantage |
$32,089.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,089.36
|
| Rate for Payer: Mclaren Medicare |
$32,089.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33,693.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,902.76
|
| Rate for Payer: PACE Medicare |
$30,484.89
|
| Rate for Payer: PACE SWMI |
$32,089.36
|
| Rate for Payer: PHP Medicare Advantage |
$32,089.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58,801.67
|
| Rate for Payer: Priority Health Medicare |
$32,089.36
|
| Rate for Payer: Priority Health Narrow Network |
$47,041.34
|
| Rate for Payer: Railroad Medicare Medicare |
$32,089.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62,506.32
|
| Rate for Payer: UHC Core |
$51,254.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$32,089.36
|
| Rate for Payer: UHC Exchange |
$40,747.53
|
| Rate for Payer: UHC Medicare Advantage |
$33,052.04
|
| Rate for Payer: VA VA |
$32,089.36
|
|
|
PREMATURITY WITHOUT MAJOR PROBLEMS
|
Facility
|
IP
|
$37,715.52
|
|
|
Service Code
|
MS-DRG 792
|
| Min. Negotiated Rate |
$6,513.44 |
| Max. Negotiated Rate |
$37,715.52 |
| Rate for Payer: Aetna Medicare |
$20,348.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,456.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,456.90
|
| Rate for Payer: BCBS MAPPO |
$19,565.52
|
| Rate for Payer: BCBS Trust/PPO |
$6,513.44
|
| Rate for Payer: BCN Medicare Advantage |
$19,565.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,565.52
|
| Rate for Payer: Mclaren Medicare |
$19,565.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,543.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,500.35
|
| Rate for Payer: PACE Medicare |
$18,587.24
|
| Rate for Payer: PACE SWMI |
$19,565.52
|
| Rate for Payer: PHP Medicare Advantage |
$19,565.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,480.18
|
| Rate for Payer: Priority Health Medicare |
$19,565.52
|
| Rate for Payer: Priority Health Narrow Network |
$28,384.14
|
| Rate for Payer: Railroad Medicare Medicare |
$19,565.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,715.52
|
| Rate for Payer: UHC Core |
$30,926.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,565.52
|
| Rate for Payer: UHC Exchange |
$24,586.54
|
| Rate for Payer: UHC Medicare Advantage |
$20,152.49
|
| Rate for Payer: VA VA |
$19,565.52
|
|
|
PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART
|
Professional
|
Both
|
$2,291.00
|
|
|
Service Code
|
HCPCS 34101
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,746.03 |
| Rate for Payer: Aetna Commercial |
$800.84
|
| Rate for Payer: BCBS Complete |
$391.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,746.03
|
| Rate for Payer: Cash Price |
$1,832.80
|
| Rate for Payer: Cash Price |
$1,832.80
|
| Rate for Payer: Meridian Medicaid |
$391.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,603.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$930.40
|
| Rate for Payer: Priority Health Narrow Network |
$930.40
|
| Rate for Payer: Priority Health SBD |
$930.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,053.86
|
|
|
PR EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART
|
Professional
|
Both
|
$1,994.00
|
|
|
Service Code
|
HCPCS 34001
|
| Min. Negotiated Rate |
$571.48 |
| Max. Negotiated Rate |
$1,434.86 |
| Rate for Payer: Aetna Commercial |
$1,229.89
|
| Rate for Payer: BCBS Complete |
$600.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.86
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Meridian Medicaid |
$600.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,420.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,420.86
|
| Rate for Payer: Priority Health SBD |
$1,420.86
|
| Rate for Payer: UMR Bronson Commercial |
$917.24
|
|
|
PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART
|
Professional
|
Both
|
$1,956.00
|
|
|
Service Code
|
HCPCS 34201
|
| Min. Negotiated Rate |
$637.51 |
| Max. Negotiated Rate |
$2,634.63 |
| Rate for Payer: Aetna Commercial |
$1,375.38
|
| Rate for Payer: BCBS Complete |
$669.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,634.63
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Meridian Medicaid |
$669.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,586.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,586.84
|
| Rate for Payer: Priority Health SBD |
$1,586.84
|
| Rate for Payer: UMR Bronson Commercial |
$899.76
|
|
|
PR EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$1,971.00
|
|
|
Service Code
|
HCPCS 34051
|
| Min. Negotiated Rate |
$624.09 |
| Max. Negotiated Rate |
$2,053.50 |
| Rate for Payer: Aetna Commercial |
$1,330.19
|
| Rate for Payer: BCBS Complete |
$655.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,053.50
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Meridian Medicaid |
$655.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,379.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,553.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,553.86
|
| Rate for Payer: Priority Health SBD |
$1,553.86
|
| Rate for Payer: UMR Bronson Commercial |
$906.66
|
|
|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$592.35 |
| Max. Negotiated Rate |
$3,301.73 |
| Rate for Payer: Aetna Commercial |
$1,273.42
|
| Rate for Payer: BCBS Complete |
$621.97
|
| Rate for Payer: BCBS Trust/PPO |
$3,301.73
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Meridian Medicaid |
$621.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$592.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,473.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,473.00
|
| Rate for Payer: Priority Health SBD |
$1,473.00
|
| Rate for Payer: UMR Bronson Commercial |
$891.48
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$2,676.00
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$868.40 |
| Max. Negotiated Rate |
$2,233.15 |
| Rate for Payer: Aetna Commercial |
$1,868.74
|
| Rate for Payer: BCBS Complete |
$911.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,233.15
|
| Rate for Payer: Cash Price |
$2,140.80
|
| Rate for Payer: Cash Price |
$2,140.80
|
| Rate for Payer: Meridian Medicaid |
$911.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$868.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,873.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,164.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,164.00
|
| Rate for Payer: Priority Health SBD |
$2,164.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,230.96
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,233.34
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$372.32 |
| Max. Negotiated Rate |
$1,789.88 |
| Rate for Payer: Aetna Commercial |
$804.67
|
| Rate for Payer: BCBS Complete |
$390.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: Cash Price |
$986.67
|
| Rate for Payer: Cash Price |
$986.67
|
| Rate for Payer: Meridian Medicaid |
$390.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$933.58
|
| Rate for Payer: Priority Health Narrow Network |
$933.58
|
| Rate for Payer: Priority Health SBD |
$933.58
|
| Rate for Payer: UMR Bronson Commercial |
$567.34
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$932.45 |
| Rate for Payer: Aetna Commercial |
$179.88
|
| Rate for Payer: BCBS Complete |
$116.30
|
| Rate for Payer: BCBS Trust/PPO |
$932.45
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Meridian Medicaid |
$116.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.90
|
| Rate for Payer: Priority Health Narrow Network |
$284.90
|
| Rate for Payer: Priority Health SBD |
$284.90
|
| Rate for Payer: UMR Bronson Commercial |
$167.44
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna Commercial |
$72.50
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$75.14
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.57
|
| Rate for Payer: Priority Health Narrow Network |
$108.57
|
| Rate for Payer: Priority Health SBD |
$108.57
|
| Rate for Payer: UMR Bronson Commercial |
$78.20
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Aetna Commercial |
$22.17
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.07
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Meridian Medicaid |
$7.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.13
|
| Rate for Payer: Priority Health Narrow Network |
$35.13
|
| Rate for Payer: Priority Health SBD |
$35.13
|
| Rate for Payer: UMR Bronson Commercial |
$41.86
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$193.43 |
| Rate for Payer: Aetna Commercial |
$123.22
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS Trust/PPO |
$46.49
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Meridian Medicaid |
$80.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.43
|
| Rate for Payer: Priority Health Narrow Network |
$193.43
|
| Rate for Payer: Priority Health SBD |
$193.43
|
| Rate for Payer: UMR Bronson Commercial |
$112.24
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$338.11 |
| Rate for Payer: Aetna Commercial |
$42.97
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.39
|
| Rate for Payer: Priority Health Narrow Network |
$68.39
|
| Rate for Payer: Priority Health SBD |
$68.39
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
|
