|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT
|
Professional
|
Both
|
$1,383.00
|
|
|
Service Code
|
HCPCS 23155
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$1,228.63 |
| Rate for Payer: Aetna Commercial |
$1,063.91
|
| Rate for Payer: BCBS Complete |
$542.36
|
| Rate for Payer: BCBS Trust/PPO |
$59.01
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Meridian Medicaid |
$542.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$968.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,228.63
|
| Rate for Payer: Priority Health SBD |
$1,228.63
|
| Rate for Payer: UMR Bronson Commercial |
$636.18
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 23156
|
| Min. Negotiated Rate |
$32.26 |
| Max. Negotiated Rate |
$1,047.86 |
| Rate for Payer: Aetna Commercial |
$906.58
|
| Rate for Payer: BCBS Complete |
$462.96
|
| Rate for Payer: BCBS Trust/PPO |
$32.26
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Meridian Medicaid |
$462.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,047.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,047.86
|
| Rate for Payer: Priority Health SBD |
$1,047.86
|
| Rate for Payer: UMR Bronson Commercial |
$586.04
|
|
|
PR EXC/CURTG CST/B9 TUM PHALANGES FOOT
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 28108
|
| Min. Negotiated Rate |
$186.38 |
| Max. Negotiated Rate |
$438.13 |
| Rate for Payer: Aetna Commercial |
$378.46
|
| Rate for Payer: BCBS Complete |
$195.70
|
| Rate for Payer: BCBS Trust/PPO |
$252.00
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Meridian Medicaid |
$195.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.13
|
| Rate for Payer: Priority Health Narrow Network |
$438.13
|
| Rate for Payer: Priority Health SBD |
$438.13
|
| Rate for Payer: UMR Bronson Commercial |
$240.12
|
|
|
PR EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 28106
|
| Min. Negotiated Rate |
$273.71 |
| Max. Negotiated Rate |
$907.62 |
| Rate for Payer: Aetna Commercial |
$566.51
|
| Rate for Payer: BCBS Complete |
$287.40
|
| Rate for Payer: BCBS Trust/PPO |
$907.62
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Meridian Medicaid |
$287.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.96
|
| Rate for Payer: Priority Health Narrow Network |
$644.96
|
| Rate for Payer: Priority Health SBD |
$644.96
|
| Rate for Payer: UMR Bronson Commercial |
$433.32
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 25136
|
| Min. Negotiated Rate |
$325.46 |
| Max. Negotiated Rate |
$1,019.62 |
| Rate for Payer: Aetna Commercial |
$663.57
|
| Rate for Payer: BCBS Complete |
$341.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,019.62
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Meridian Medicaid |
$341.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$688.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$772.10
|
| Rate for Payer: Priority Health Narrow Network |
$772.10
|
| Rate for Payer: Priority Health SBD |
$772.10
|
| Rate for Payer: UMR Bronson Commercial |
$452.18
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT
|
Professional
|
Both
|
$991.00
|
|
|
Service Code
|
HCPCS 25135
|
| Min. Negotiated Rate |
$366.57 |
| Max. Negotiated Rate |
$1,158.03 |
| Rate for Payer: Aetna Commercial |
$747.91
|
| Rate for Payer: BCBS Complete |
$384.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.03
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Meridian Medicaid |
$384.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$867.08
|
| Rate for Payer: Priority Health Narrow Network |
$867.08
|
| Rate for Payer: Priority Health SBD |
$867.08
|
| Rate for Payer: UMR Bronson Commercial |
$455.86
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT
|
Professional
|
Both
|
$1,192.00
|
|
|
Service Code
|
HCPCS 25126
|
| Min. Negotiated Rate |
$391.07 |
| Max. Negotiated Rate |
$1,153.28 |
| Rate for Payer: Aetna Commercial |
$799.55
|
| Rate for Payer: BCBS Complete |
$410.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,153.28
|
| Rate for Payer: Cash Price |
$953.60
|
| Rate for Payer: Cash Price |
$953.60
|
| Rate for Payer: Meridian Medicaid |
$410.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$391.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$834.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$927.34
|
| Rate for Payer: Priority Health Narrow Network |
$927.34
|
| Rate for Payer: Priority Health SBD |
$927.34
|
| Rate for Payer: UMR Bronson Commercial |
$548.32
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$2,274.00
|
|
|
Service Code
|
HCPCS 25125
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$1,591.80 |
| Rate for Payer: Aetna Commercial |
$793.59
|
| Rate for Payer: BCBS Complete |
$407.72
|
| Rate for Payer: BCBS Trust/PPO |
$87.17
|
| Rate for Payer: Cash Price |
$1,819.20
|
| Rate for Payer: Cash Price |
$1,819.20
|
| Rate for Payer: Meridian Medicaid |
$407.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$921.22
|
| Rate for Payer: Priority Health Narrow Network |
$921.22
|
| Rate for Payer: Priority Health SBD |
$921.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,046.04
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
19120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$381.47 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna American Axle |
$670.15
|
| Rate for Payer: Aetna Commercial |
$876.35
|
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,657.94
|
| Rate for Payer: BCCCP Commercial |
$559.44
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$721.70
|
| Rate for Payer: Cofinity Commercial |
$886.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$927.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$721.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.25
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.35
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$876.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Priority Health SBD |
$649.53
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$414.54
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: UMR Bronson Commercial |
$381.47
|
| Rate for Payer: VA VA |
$3,388.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.25
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 19120
|
| Min. Negotiated Rate |
$269.66 |
| Max. Negotiated Rate |
$721.70 |
| Rate for Payer: Aetna Commercial |
$453.99
|
| Rate for Payer: BCBS Complete |
$283.14
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Meridian Medicaid |
$283.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$515.45
|
| Rate for Payer: Priority Health Narrow Network |
$515.45
|
| Rate for Payer: Priority Health SBD |
$515.45
|
| Rate for Payer: UMR Bronson Commercial |
$474.26
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
19120
|
| Min. Negotiated Rate |
$269.66 |
| Max. Negotiated Rate |
$721.70 |
| Rate for Payer: Aetna Commercial |
$453.99
|
| Rate for Payer: BCBS Complete |
$283.14
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Meridian Medicaid |
$283.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$515.45
|
| Rate for Payer: Priority Health Narrow Network |
$515.45
|
| Rate for Payer: Priority Health SBD |
$515.45
|
| Rate for Payer: UMR Bronson Commercial |
$474.26
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Facility
|
IP
|
$1,031.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
19120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$453.64 |
| Max. Negotiated Rate |
$927.90 |
| Rate for Payer: Aetna American Axle |
$670.15
|
| Rate for Payer: Aetna Commercial |
$876.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.15
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$886.66
|
| Rate for Payer: Cofinity Commercial |
$721.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.80
|
| Rate for Payer: Healthscope Commercial |
$927.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$721.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.35
|
| Rate for Payer: PHP Commercial |
$876.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.70
|
| Rate for Payer: Priority Health SBD |
$649.53
|
| Rate for Payer: UMR Bronson Commercial |
$453.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.25
|
|
|
PR EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS
|
Professional
|
Both
|
$1,383.00
|
|
|
Service Code
|
HCPCS 60200
|
| Min. Negotiated Rate |
$217.13 |
| Max. Negotiated Rate |
$968.10 |
| Rate for Payer: Aetna Commercial |
$855.88
|
| Rate for Payer: BCBS Complete |
$451.99
|
| Rate for Payer: BCBS Trust/PPO |
$217.13
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Meridian Medicaid |
$451.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$968.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.54
|
| Rate for Payer: Priority Health Narrow Network |
$950.54
|
| Rate for Payer: Priority Health SBD |
$950.54
|
| Rate for Payer: UMR Bronson Commercial |
$636.18
|
|
|
PR EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM
|
Professional
|
Both
|
$3,892.00
|
|
|
Service Code
|
HCPCS 49204
|
| Min. Negotiated Rate |
$624.45 |
| Max. Negotiated Rate |
$2,724.40 |
| Rate for Payer: Aetna Commercial |
$2,046.13
|
| Rate for Payer: BCBS Complete |
$1,021.41
|
| Rate for Payer: BCBS Trust/PPO |
$624.45
|
| Rate for Payer: Cash Price |
$3,113.60
|
| Rate for Payer: Cash Price |
$3,113.60
|
| Rate for Payer: Meridian Medicaid |
$1,021.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$972.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,724.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,667.04
|
| Rate for Payer: Priority Health Narrow Network |
$2,667.04
|
| Rate for Payer: Priority Health SBD |
$2,667.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,790.32
|
|
|
PR EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM
|
Professional
|
Both
|
$3,145.00
|
|
|
Service Code
|
HCPCS 49205
|
| Min. Negotiated Rate |
$366.64 |
| Max. Negotiated Rate |
$3,061.58 |
| Rate for Payer: Aetna Commercial |
$2,348.49
|
| Rate for Payer: BCBS Complete |
$1,171.71
|
| Rate for Payer: BCBS Trust/PPO |
$366.64
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Meridian Medicaid |
$1,171.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,115.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,201.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,061.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,061.58
|
| Rate for Payer: Priority Health SBD |
$3,061.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,446.70
|
|
|
PR EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 42870
|
| Min. Negotiated Rate |
$377.65 |
| Max. Negotiated Rate |
$1,046.00 |
| Rate for Payer: Aetna Commercial |
$780.39
|
| Rate for Payer: BCBS Complete |
$396.53
|
| Rate for Payer: BCBS Trust/PPO |
$829.43
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Meridian Medicaid |
$396.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,046.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,046.00
|
| Rate for Payer: Priority Health SBD |
$1,046.00
|
| Rate for Payer: UMR Bronson Commercial |
$473.80
|
|
|
PR EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$2,599.00
|
|
|
Service Code
|
HCPCS 26390
|
| Min. Negotiated Rate |
$153.74 |
| Max. Negotiated Rate |
$1,819.30 |
| Rate for Payer: Aetna Commercial |
$1,166.48
|
| Rate for Payer: BCBS Complete |
$595.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.74
|
| Rate for Payer: Cash Price |
$2,079.20
|
| Rate for Payer: Cash Price |
$2,079.20
|
| Rate for Payer: Meridian Medicaid |
$595.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,819.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,361.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,361.90
|
| Rate for Payer: Priority Health SBD |
$1,361.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,195.54
|
|
|
PR EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 40819
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$760.22 |
| Rate for Payer: Aetna Commercial |
$264.81
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS Trust/PPO |
$760.22
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.67
|
| Rate for Payer: Priority Health Narrow Network |
$348.67
|
| Rate for Payer: Priority Health SBD |
$348.67
|
| Rate for Payer: UMR Bronson Commercial |
$230.00
|
|
|
PR EXC/FULGURATION URETHRAL CARUNCLE
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 53265
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$1,099.39 |
| Rate for Payer: Aetna Commercial |
$241.82
|
| Rate for Payer: BCBS Complete |
$126.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.39
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Meridian Medicaid |
$126.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.69
|
| Rate for Payer: Priority Health Narrow Network |
$303.69
|
| Rate for Payer: Priority Health SBD |
$303.69
|
| Rate for Payer: UMR Bronson Commercial |
$185.84
|
|
|
PR EXC/FULGURATION URETHRAL POLYP DSTL URETHRA
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 53260
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$546.26 |
| Rate for Payer: Aetna Commercial |
$232.51
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS Trust/PPO |
$546.26
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.25
|
| Rate for Payer: Priority Health Narrow Network |
$291.25
|
| Rate for Payer: Priority Health SBD |
$291.25
|
| Rate for Payer: UMR Bronson Commercial |
$124.20
|
|
|
PR EXCHNG ABSC/CST DRG CATH RAD GID SPX
|
Professional
|
Both
|
$1,249.00
|
|
|
Service Code
|
HCPCS 49423
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$1,009.05 |
| Rate for Payer: Aetna Commercial |
$94.51
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.05
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.31
|
| Rate for Payer: Priority Health Narrow Network |
$122.31
|
| Rate for Payer: Priority Health SBD |
$122.31
|
| Rate for Payer: UMR Bronson Commercial |
$574.54
|
|
|
PR EXC HYDROCELE SPRMATIC CORD UNI SPX
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
HCPCS 55500
|
| Min. Negotiated Rate |
$251.55 |
| Max. Negotiated Rate |
$2,419.09 |
| Rate for Payer: Aetna Commercial |
$504.41
|
| Rate for Payer: BCBS Complete |
$264.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,419.09
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Meridian Medicaid |
$264.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$631.13
|
| Rate for Payer: Priority Health Narrow Network |
$631.13
|
| Rate for Payer: Priority Health SBD |
$631.13
|
| Rate for Payer: UMR Bronson Commercial |
$327.06
|
|
|
PR EXC ILEOANAL RSVR W/ILEOSTOMY
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
HCPCS 45136
|
| Min. Negotiated Rate |
$1,129.33 |
| Max. Negotiated Rate |
$3,106.85 |
| Rate for Payer: Aetna Commercial |
$2,383.65
|
| Rate for Payer: BCBS Complete |
$1,185.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.07
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Meridian Medicaid |
$1,185.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,129.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,233.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,106.85
|
| Rate for Payer: Priority Health Narrow Network |
$3,106.85
|
| Rate for Payer: Priority Health SBD |
$3,106.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,467.40
|
|
|
PR EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP
|
Professional
|
Both
|
$4,305.90
|
|
|
Service Code
|
HCPCS 33120
|
| Min. Negotiated Rate |
$1,008.52 |
| Max. Negotiated Rate |
$3,256.64 |
| Rate for Payer: Aetna Commercial |
$2,813.37
|
| Rate for Payer: BCBS Complete |
$1,374.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.52
|
| Rate for Payer: Cash Price |
$3,444.72
|
| Rate for Payer: Cash Price |
$3,444.72
|
| Rate for Payer: Meridian Medicaid |
$1,374.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,309.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,014.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,256.64
|
| Rate for Payer: Priority Health Narrow Network |
$3,256.64
|
| Rate for Payer: Priority Health SBD |
$3,256.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,980.71
|
|
|
PR EXCIS CHEST WALL TUMOR/RIBS
|
Professional
|
Both
|
$2,221.00
|
|
|
Service Code
|
HCPCS 19260
|
| Min. Negotiated Rate |
$888.40 |
| Max. Negotiated Rate |
$1,554.70 |
| Rate for Payer: BCBS Complete |
$888.40
|
| Rate for Payer: Cash Price |
$1,776.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,554.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,021.66
|
|
