|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$413.65 |
| Max. Negotiated Rate |
$4,106.40 |
| Rate for Payer: Aetna Commercial |
$703.16
|
| Rate for Payer: BCBS Complete |
$434.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,106.40
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Meridian Medicaid |
$434.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$793.30
|
| Rate for Payer: Priority Health Narrow Network |
$793.30
|
| Rate for Payer: Priority Health SBD |
$793.30
|
| Rate for Payer: UMR Bronson Commercial |
$731.86
|
|
|
PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS
|
Professional
|
Both
|
$1,535.00
|
|
|
Service Code
|
HCPCS 15572
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Aetna Commercial |
$789.01
|
| Rate for Payer: BCBS Complete |
$495.39
|
| Rate for Payer: BCBS Trust/PPO |
$6,341.25
|
| Rate for Payer: Cash Price |
$1,228.00
|
| Rate for Payer: Cash Price |
$1,228.00
|
| Rate for Payer: Meridian Medicaid |
$495.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,074.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$903.87
|
| Rate for Payer: Priority Health Narrow Network |
$903.87
|
| Rate for Payer: Priority Health SBD |
$903.87
|
| Rate for Payer: UMR Bronson Commercial |
$706.10
|
|
|
PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F
|
Professional
|
Both
|
$1,880.00
|
|
|
Service Code
|
HCPCS 15574
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna Commercial |
$791.76
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$901.00
|
| Rate for Payer: Priority Health Narrow Network |
$901.00
|
| Rate for Payer: Priority Health SBD |
$901.00
|
| Rate for Payer: UMR Bronson Commercial |
$864.80
|
|
|
PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$603.68 |
| Max. Negotiated Rate |
$1,234.80 |
| Rate for Payer: Aetna American Axle |
$891.80
|
| Rate for Payer: Aetna Commercial |
$1,166.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.80
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,179.92
|
| Rate for Payer: Cofinity Commercial |
$960.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Healthscope Commercial |
$1,234.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$960.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,166.20
|
| Rate for Payer: PHP Commercial |
$1,166.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.40
|
| Rate for Payer: Priority Health SBD |
$864.36
|
| Rate for Payer: UMR Bronson Commercial |
$603.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.00
|
|
|
PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$507.64 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna American Axle |
$891.80
|
| Rate for Payer: Aetna Commercial |
$1,166.20
|
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,843.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$960.40
|
| Rate for Payer: Cofinity Commercial |
$1,179.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$1,234.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$960.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.00
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,166.20
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,166.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Priority Health SBD |
$864.36
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$861.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$783.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: UMR Bronson Commercial |
$507.64
|
| Rate for Payer: VA VA |
$1,620.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.00
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$1,166.90 |
| Rate for Payer: Aetna Commercial |
$898.38
|
| Rate for Payer: BCBS Complete |
$566.96
|
| Rate for Payer: BCBS Trust/PPO |
$35.25
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Meridian Medicaid |
$566.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,166.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,032.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,032.12
|
| Rate for Payer: Priority Health SBD |
$1,032.12
|
| Rate for Payer: UMR Bronson Commercial |
$766.82
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<
|
Professional
|
Both
|
$1,656.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$390.64 |
| Max. Negotiated Rate |
$12,622.63 |
| Rate for Payer: Aetna Commercial |
$650.11
|
| Rate for Payer: BCBS Complete |
$410.17
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Meridian Medicaid |
$410.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,159.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.62
|
| Rate for Payer: Priority Health Narrow Network |
$745.62
|
| Rate for Payer: Priority Health SBD |
$745.62
|
| Rate for Payer: UMR Bronson Commercial |
$761.76
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$940.10 |
| Rate for Payer: Aetna Commercial |
$720.22
|
| Rate for Payer: BCBS Complete |
$452.90
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Meridian Medicaid |
$452.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$823.72
|
| Rate for Payer: Priority Health Narrow Network |
$823.72
|
| Rate for Payer: Priority Health SBD |
$823.72
|
| Rate for Payer: UMR Bronson Commercial |
$617.78
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<
|
Professional
|
Both
|
$1,372.00
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$509.50 |
| Max. Negotiated Rate |
$972.10 |
| Rate for Payer: Aetna Commercial |
$845.41
|
| Rate for Payer: BCBS Complete |
$534.98
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Meridian Medicaid |
$534.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$972.10
|
| Rate for Payer: Priority Health Narrow Network |
$972.10
|
| Rate for Payer: Priority Health SBD |
$972.10
|
| Rate for Payer: UMR Bronson Commercial |
$631.12
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM/<
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$194.60 |
| Rate for Payer: Aetna Commercial |
$75.94
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Meridian Medicaid |
$45.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$83.85
|
| Rate for Payer: Priority Health SBD |
$83.85
|
| Rate for Payer: UMR Bronson Commercial |
$127.88
|
|
|
PR FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$115.10
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.25
|
| Rate for Payer: Priority Health Narrow Network |
$128.25
|
| Rate for Payer: Priority Health SBD |
$128.25
|
| Rate for Payer: UMR Bronson Commercial |
$160.08
|
|
|
PR FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$189.20
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: UMR Bronson Commercial |
$138.00
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 95961
|
| Min. Negotiated Rate |
$173.28 |
| Max. Negotiated Rate |
$418.60 |
| Rate for Payer: Aetna Commercial |
$340.39
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCBS Trust/PPO |
$173.28
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.51
|
| Rate for Payer: Priority Health Narrow Network |
$207.51
|
| Rate for Payer: Priority Health SBD |
$418.60
|
| Rate for Payer: UMR Bronson Commercial |
$231.84
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 92250
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$1,952.60 |
| Rate for Payer: Aetna Commercial |
$41.28
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,952.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.67
|
| Rate for Payer: Priority Health Narrow Network |
$19.67
|
| Rate for Payer: Priority Health SBD |
$44.56
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$799.32 |
| Rate for Payer: Aetna Commercial |
$208.46
|
| Rate for Payer: BCBS Complete |
$128.40
|
| Rate for Payer: BCBS Trust/PPO |
$799.32
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.12
|
| Rate for Payer: Priority Health Narrow Network |
$50.12
|
| Rate for Payer: Priority Health SBD |
$219.89
|
| Rate for Payer: UMR Bronson Commercial |
$147.66
|
|
|
PR FUROSEMIDE INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$0.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
|
|
PR GARAMYCIN GENTAMICIN INJ
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1580
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.88
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$251.47 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS Trust/PPO |
$251.47
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.72
|
| Rate for Payer: Priority Health Narrow Network |
$15.72
|
| Rate for Payer: Priority Health SBD |
$58.38
|
| Rate for Payer: UMR Bronson Commercial |
$55.66
|
|
|
PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 43753
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$192.83 |
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS Trust/PPO |
$192.83
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.63
|
| Rate for Payer: Priority Health Narrow Network |
$37.63
|
| Rate for Payer: Priority Health SBD |
$37.63
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
|
PR GASTROCNEMIUS RECESSION
|
Professional
|
Both
|
$1,488.00
|
|
|
Service Code
|
HCPCS 27687
|
| Min. Negotiated Rate |
$294.15 |
| Max. Negotiated Rate |
$2,402.71 |
| Rate for Payer: Aetna Commercial |
$603.17
|
| Rate for Payer: BCBS Complete |
$308.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.71
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Meridian Medicaid |
$308.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$696.01
|
| Rate for Payer: Priority Health Narrow Network |
$696.01
|
| Rate for Payer: Priority Health SBD |
$696.01
|
| Rate for Payer: UMR Bronson Commercial |
$684.48
|
|
|
PR GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,437.00
|
|
|
Service Code
|
HCPCS 43810
|
| Min. Negotiated Rate |
$486.56 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,376.05
|
| Rate for Payer: BCBS Complete |
$683.48
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: Cash Price |
$1,949.60
|
| Rate for Payer: Cash Price |
$1,949.60
|
| Rate for Payer: Meridian Medicaid |
$683.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$650.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,705.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,786.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,786.85
|
| Rate for Payer: Priority Health SBD |
$1,786.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,121.02
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$1,518.86 |
| Rate for Payer: Aetna Commercial |
$211.81
|
| Rate for Payer: Aetna Commercial |
$211.81
|
| Rate for Payer: BCBS Complete |
$134.40
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.86
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.58
|
| Rate for Payer: Priority Health Narrow Network |
$65.58
|
| Rate for Payer: Priority Health Narrow Network |
$65.58
|
| Rate for Payer: Priority Health SBD |
$259.16
|
| Rate for Payer: Priority Health SBD |
$259.16
|
| Rate for Payer: UMR Bronson Commercial |
$154.56
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$963.09 |
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS Trust/PPO |
$963.09
|
| Rate for Payer: BCBS Trust/PPO |
$963.09
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.23
|
| Rate for Payer: Priority Health Narrow Network |
$64.23
|
| Rate for Payer: Priority Health Narrow Network |
$64.23
|
| Rate for Payer: Priority Health SBD |
$226.82
|
| Rate for Payer: Priority Health SBD |
$226.82
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
| Rate for Payer: UMR Bronson Commercial |
$43.70
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$976.30 |
| Rate for Payer: Aetna Commercial |
$533.12
|
| Rate for Payer: Aetna Commercial |
$533.12
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS Complete |
$343.20
|
| Rate for Payer: BCBS Trust/PPO |
$976.30
|
| Rate for Payer: BCBS Trust/PPO |
$976.30
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.34
|
| Rate for Payer: Priority Health Narrow Network |
$107.34
|
| Rate for Payer: Priority Health Narrow Network |
$107.34
|
| Rate for Payer: Priority Health SBD |
$622.52
|
| Rate for Payer: Priority Health SBD |
$622.52
|
| Rate for Payer: UMR Bronson Commercial |
$394.68
|
| Rate for Payer: UMR Bronson Commercial |
$76.36
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,570.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$860.09 |
| Max. Negotiated Rate |
$2,359.53 |
| Rate for Payer: Aetna Commercial |
$1,816.01
|
| Rate for Payer: BCBS Complete |
$903.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.26
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Meridian Medicaid |
$903.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,799.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,359.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,359.53
|
| Rate for Payer: Priority Health SBD |
$2,359.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,182.20
|
|
