|
PR FASCIOTOMY FOOT&/TOE
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$260.85 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna American Axle |
$458.25
|
| Rate for Payer: Aetna Commercial |
$599.25
|
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,199.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$606.30
|
| Rate for Payer: Cofinity Commercial |
$493.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$634.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.75
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.25
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$599.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Priority Health SBD |
$444.15
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$291.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: UMR Bronson Commercial |
$260.85
|
| Rate for Payer: VA VA |
$2,877.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.75
|
|
|
PR FASCIOTOMY HIP/THIGH ANY TYPE
|
Professional
|
Both
|
$3,417.00
|
|
|
Service Code
|
HCPCS 27025
|
| Min. Negotiated Rate |
$191.38 |
| Max. Negotiated Rate |
$2,391.90 |
| Rate for Payer: Aetna Commercial |
$1,229.24
|
| Rate for Payer: BCBS Complete |
$628.91
|
| Rate for Payer: BCBS Trust/PPO |
$191.38
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Meridian Medicaid |
$628.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$598.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,391.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,413.48
|
| Rate for Payer: Priority Health SBD |
$1,413.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,571.82
|
|
|
PR FASCIOTOMY ILIOTIBIAL OPEN
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 27305
|
| Min. Negotiated Rate |
$314.81 |
| Max. Negotiated Rate |
$1,940.97 |
| Rate for Payer: Aetna Commercial |
$642.16
|
| Rate for Payer: BCBS Complete |
$330.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,940.97
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Meridian Medicaid |
$330.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$314.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$907.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.11
|
| Rate for Payer: Priority Health Narrow Network |
$748.11
|
| Rate for Payer: Priority Health SBD |
$748.11
|
| Rate for Payer: UMR Bronson Commercial |
$596.62
|
|
|
PR FASCIOTOMY PALMAR OPEN PARTIAL
|
Professional
|
Both
|
$1,341.00
|
|
|
Service Code
|
HCPCS 26045
|
| Min. Negotiated Rate |
$153.67 |
| Max. Negotiated Rate |
$938.70 |
| Rate for Payer: Aetna Commercial |
$627.38
|
| Rate for Payer: BCBS Complete |
$324.51
|
| Rate for Payer: BCBS Trust/PPO |
$153.67
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Meridian Medicaid |
$324.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.78
|
| Rate for Payer: Priority Health Narrow Network |
$732.78
|
| Rate for Payer: Priority Health SBD |
$732.78
|
| Rate for Payer: UMR Bronson Commercial |
$616.86
|
|
|
PR FASCIOTOMY PALMAR PERCUTANEOUS
|
Professional
|
Both
|
$912.00
|
|
|
Service Code
|
HCPCS 26040
|
| Min. Negotiated Rate |
$139.24 |
| Max. Negotiated Rate |
$638.40 |
| Rate for Payer: Aetna Commercial |
$417.73
|
| Rate for Payer: BCBS Complete |
$218.28
|
| Rate for Payer: BCBS Trust/PPO |
$139.24
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Meridian Medicaid |
$218.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.26
|
| Rate for Payer: Priority Health Narrow Network |
$492.26
|
| Rate for Payer: Priority Health SBD |
$492.26
|
| Rate for Payer: UMR Bronson Commercial |
$419.52
|
|
|
PR FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT
|
Professional
|
Both
|
$2,315.00
|
|
|
Service Code
|
HCPCS 26121
|
| Min. Negotiated Rate |
$250.03 |
| Max. Negotiated Rate |
$1,620.50 |
| Rate for Payer: Aetna Commercial |
$797.78
|
| Rate for Payer: BCBS Complete |
$409.95
|
| Rate for Payer: BCBS Trust/PPO |
$250.03
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Meridian Medicaid |
$409.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.50
|
| 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 |
$1,064.90
|
|
|
PR FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$2,894.00
|
|
|
Service Code
|
HCPCS 26123
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$2,025.80 |
| Rate for Payer: Aetna Commercial |
$1,109.61
|
| Rate for Payer: BCBS Complete |
$571.20
|
| Rate for Payer: BCBS Trust/PPO |
$337.48
|
| Rate for Payer: Cash Price |
$2,315.20
|
| Rate for Payer: Cash Price |
$2,315.20
|
| Rate for Payer: Meridian Medicaid |
$571.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$544.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,025.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,291.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,291.44
|
| Rate for Payer: Priority Health SBD |
$1,291.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,331.24
|
|
|
PR FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 26125
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$607.60 |
| Rate for Payer: Aetna Commercial |
$361.78
|
| Rate for Payer: BCBS Complete |
$178.92
|
| Rate for Payer: BCBS Trust/PPO |
$555.24
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Meridian Medicaid |
$178.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.50
|
| Rate for Payer: Priority Health Narrow Network |
$407.50
|
| Rate for Payer: Priority Health SBD |
$407.50
|
| Rate for Payer: UMR Bronson Commercial |
$399.28
|
|
|
PR FECAL BLOOD SCRN IMMUNOASSAY
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS G0328
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$1,270.03 |
| Rate for Payer: Aetna Commercial |
$17.15
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,270.03
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.63
|
| Rate for Payer: Priority Health Narrow Network |
$18.63
|
| Rate for Payer: Priority Health SBD |
$18.63
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR FECAL MICROBIOTA PREP INSTIL
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS G0455
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$1,923.54 |
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,923.54
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.06
|
| Rate for Payer: Priority Health Narrow Network |
$124.06
|
| Rate for Payer: Priority Health SBD |
$124.06
|
| Rate for Payer: UMR Bronson Commercial |
$92.00
|
|
|
PR FERN TEST
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS Q0114
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$126.79 |
| Rate for Payer: Aetna Commercial |
$9.25
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$126.79
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.20
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
|
|
PR FETAL CONTRACTION STRESS TEST
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 59020
|
| Min. Negotiated Rate |
$47.69 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: Aetna Commercial |
$74.73
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.69
|
| Rate for Payer: Priority Health Narrow Network |
$47.69
|
| Rate for Payer: Priority Health SBD |
$99.63
|
| Rate for Payer: UMR Bronson Commercial |
$74.06
|
|
|
PR FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 59074
|
| Min. Negotiated Rate |
$197.24 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: Aetna Commercial |
$338.16
|
| Rate for Payer: BCBS Complete |
$207.10
|
| Rate for Payer: BCBS Trust/PPO |
$488.15
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Meridian Medicaid |
$207.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.87
|
| Rate for Payer: Priority Health Narrow Network |
$434.87
|
| Rate for Payer: Priority Health SBD |
$434.87
|
| Rate for Payer: UMR Bronson Commercial |
$379.50
|
|
|
PR FETAL NONSTRESS TEST
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 59025
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$522.49 |
| Rate for Payer: Aetna Commercial |
$52.53
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.33
|
| Rate for Payer: Priority Health Narrow Network |
$28.33
|
| Rate for Payer: Priority Health SBD |
$68.94
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
|
|
PR FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$1,045.00
|
|
|
Service Code
|
HCPCS 59076
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$733.76 |
| Rate for Payer: Aetna Commercial |
$572.27
|
| Rate for Payer: BCBS Complete |
$349.11
|
| Rate for Payer: BCBS Trust/PPO |
$125.74
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Meridian Medicaid |
$349.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$733.76
|
| Rate for Payer: Priority Health Narrow Network |
$733.76
|
| Rate for Payer: Priority Health SBD |
$733.76
|
| Rate for Payer: UMR Bronson Commercial |
$480.70
|
|
|
PR FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE
|
Professional
|
Both
|
$1,268.00
|
|
|
Service Code
|
HCPCS 14350
|
| Min. Negotiated Rate |
$432.18 |
| Max. Negotiated Rate |
$5,240.72 |
| Rate for Payer: Aetna Commercial |
$734.78
|
| Rate for Payer: BCBS Complete |
$453.79
|
| Rate for Payer: BCBS Trust/PPO |
$5,240.72
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Meridian Medicaid |
$453.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$432.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.18
|
| Rate for Payer: Priority Health Narrow Network |
$826.18
|
| Rate for Payer: Priority Health SBD |
$826.18
|
| Rate for Payer: UMR Bronson Commercial |
$583.28
|
|
|
PR FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION
|
Professional
|
Both
|
$722.00
|
|
|
Service Code
|
HCPCS 10009
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Aetna Commercial |
$121.91
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS Trust/PPO |
$405.74
|
| Rate for Payer: Cash Price |
$577.60
|
| Rate for Payer: Cash Price |
$577.60
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.36
|
| Rate for Payer: Priority Health Narrow Network |
$132.36
|
| Rate for Payer: Priority Health SBD |
$132.36
|
| Rate for Payer: UMR Bronson Commercial |
$332.12
|
|
|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 10021
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$3,585.00 |
| Rate for Payer: Aetna Commercial |
$60.18
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,585.00
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.00
|
| Rate for Payer: Priority Health Narrow Network |
$67.00
|
| Rate for Payer: Priority Health SBD |
$67.00
|
| Rate for Payer: UMR Bronson Commercial |
$107.18
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 10005
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$79.16
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.60
|
| Rate for Payer: Priority Health Narrow Network |
$89.60
|
| Rate for Payer: Priority Health SBD |
$89.60
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 10006
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$349.63 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: BCBS Complete |
$33.10
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Meridian Medicaid |
$33.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow Network |
$60.83
|
| Rate for Payer: Priority Health SBD |
$60.83
|
| Rate for Payer: UMR Bronson Commercial |
$55.20
|
|
|
PR FINE NEEDLE ASP;W/IMAGING GUIDANCE
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 10022
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$184.80 |
| Rate for Payer: BCBS Complete |
$105.60
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.80
|
| Rate for Payer: UMR Bronson Commercial |
$121.44
|
|
|
PR FINGER SPLINT, STATIC
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
HCPCS 46200
|
| Min. Negotiated Rate |
$218.54 |
| Max. Negotiated Rate |
$1,577.50 |
| Rate for Payer: Aetna Commercial |
$443.17
|
| Rate for Payer: BCBS Complete |
$229.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.50
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Meridian Medicaid |
$229.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.80
|
| Rate for Payer: Priority Health Narrow Network |
$596.80
|
| Rate for Payer: Priority Health SBD |
$596.80
|
| Rate for Payer: UMR Bronson Commercial |
$433.78
|
|
|
PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 92071
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$664.07 |
| Rate for Payer: Aetna Commercial |
$35.00
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.14
|
| Rate for Payer: Priority Health Narrow Network |
$38.14
|
| Rate for Payer: Priority Health SBD |
$38.14
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
|
|
PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 57160
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$2,269.05 |
| Rate for Payer: Aetna Commercial |
$55.97
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,269.05
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.87
|
| Rate for Payer: Priority Health Narrow Network |
$64.87
|
| Rate for Payer: Priority Health SBD |
$64.87
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
