|
PR INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 93290
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$108.83 |
| Rate for Payer: Aetna Commercial |
$67.56
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Trust/PPO |
$108.83
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.32
|
| Rate for Payer: Priority Health Narrow Network |
$29.32
|
| Rate for Payer: Priority Health SBD |
$76.13
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 93288
|
| Min. Negotiated Rate |
$28.37 |
| Max. Negotiated Rate |
$117.60 |
| Rate for Payer: Aetna Commercial |
$70.53
|
| Rate for Payer: Aetna Commercial |
$70.53
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS Trust/PPO |
$79.25
|
| Rate for Payer: BCBS Trust/PPO |
$79.25
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.37
|
| Rate for Payer: Priority Health Narrow Network |
$28.37
|
| Rate for Payer: Priority Health Narrow Network |
$28.37
|
| Rate for Payer: Priority Health SBD |
$79.92
|
| Rate for Payer: Priority Health SBD |
$79.92
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 93291
|
| Min. Negotiated Rate |
$25.06 |
| Max. Negotiated Rate |
$313.28 |
| Rate for Payer: Aetna Commercial |
$62.12
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS Trust/PPO |
$313.28
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.06
|
| Rate for Payer: Priority Health Narrow Network |
$25.06
|
| Rate for Payer: Priority Health SBD |
$70.45
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 93289
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$141.40 |
| Rate for Payer: Aetna Commercial |
$92.99
|
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: BCBS Trust/PPO |
$120.45
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.07
|
| Rate for Payer: Priority Health Narrow Network |
$51.07
|
| Rate for Payer: Priority Health SBD |
$103.08
|
| Rate for Payer: UMR Bronson Commercial |
$92.92
|
|
|
PR INTERTHORACOSCAPULAR AMPUTATION
|
Professional
|
Both
|
$5,872.00
|
|
|
Service Code
|
HCPCS 23900
|
| Min. Negotiated Rate |
$354.88 |
| Max. Negotiated Rate |
$4,110.40 |
| Rate for Payer: Aetna Commercial |
$1,852.71
|
| Rate for Payer: BCBS Complete |
$932.40
|
| Rate for Payer: BCBS Trust/PPO |
$354.88
|
| Rate for Payer: Cash Price |
$4,697.60
|
| Rate for Payer: Cash Price |
$4,697.60
|
| Rate for Payer: Meridian Medicaid |
$932.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$888.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,110.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,115.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,115.63
|
| Rate for Payer: Priority Health SBD |
$2,115.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,701.12
|
|
|
PR INTESTINAL PLICATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 44680
|
| Min. Negotiated Rate |
$305.89 |
| Max. Negotiated Rate |
$2,036.30 |
| Rate for Payer: Aetna Commercial |
$1,457.86
|
| Rate for Payer: BCBS Complete |
$722.61
|
| Rate for Payer: BCBS Trust/PPO |
$305.89
|
| Rate for Payer: Cash Price |
$2,327.20
|
| Rate for Payer: Cash Price |
$2,327.20
|
| Rate for Payer: Meridian Medicaid |
$722.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$688.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,036.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,892.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,892.10
|
| Rate for Payer: Priority Health SBD |
$1,892.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,338.14
|
|
|
PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 46946
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$1,392.60 |
| Rate for Payer: Aetna Commercial |
$507.35
|
| Rate for Payer: BCBS Complete |
$256.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.60
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Meridian Medicaid |
$256.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$672.05
|
| Rate for Payer: Priority Health Narrow Network |
$672.05
|
| Rate for Payer: Priority Health SBD |
$672.05
|
| Rate for Payer: UMR Bronson Commercial |
$220.80
|
|
|
PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 46945
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$1,245.20 |
| Rate for Payer: Aetna Commercial |
$449.56
|
| Rate for Payer: BCBS Complete |
$229.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.20
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Meridian Medicaid |
$229.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.14
|
| Rate for Payer: Priority Health Narrow Network |
$599.14
|
| Rate for Payer: Priority Health SBD |
$599.14
|
| Rate for Payer: UMR Bronson Commercial |
$207.92
|
|
|
PR INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 93662
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$200.90 |
| Rate for Payer: Aetna Commercial |
$195.64
|
| Rate for Payer: Aetna Commercial |
$195.64
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS Complete |
$219.20
|
| Rate for Payer: BCBS Trust/PPO |
$68.15
|
| Rate for Payer: BCBS Trust/PPO |
$68.15
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.05
|
| Rate for Payer: Priority Health Narrow Network |
$34.05
|
| Rate for Payer: Priority Health Narrow Network |
$34.05
|
| Rate for Payer: Priority Health SBD |
$136.19
|
| Rate for Payer: Priority Health SBD |
$136.19
|
| Rate for Payer: UMR Bronson Commercial |
$252.08
|
| Rate for Payer: UMR Bronson Commercial |
$132.02
|
|
|
PR INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS 93613
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$1,339.77 |
| Rate for Payer: Aetna Commercial |
$397.73
|
| Rate for Payer: BCBS Complete |
$190.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.77
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Meridian Medicaid |
$190.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.96
|
| Rate for Payer: Priority Health Narrow Network |
$113.96
|
| Rate for Payer: Priority Health SBD |
$406.67
|
| Rate for Payer: UMR Bronson Commercial |
$541.42
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ DURAL CMPL
|
Professional
|
Both
|
$9,031.00
|
|
|
Service Code
|
HCPCS 61692
|
| Min. Negotiated Rate |
$784.00 |
| Max. Negotiated Rate |
$6,321.70 |
| Rate for Payer: Aetna Commercial |
$4,717.73
|
| Rate for Payer: BCBS Complete |
$2,471.33
|
| Rate for Payer: BCBS Trust/PPO |
$784.00
|
| Rate for Payer: Cash Price |
$7,224.80
|
| Rate for Payer: Cash Price |
$7,224.80
|
| Rate for Payer: Meridian Medicaid |
$2,471.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,353.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,321.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,211.48
|
| Rate for Payer: Priority Health Narrow Network |
$6,211.48
|
| Rate for Payer: Priority Health SBD |
$6,211.48
|
| Rate for Payer: UMR Bronson Commercial |
$4,154.26
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ DURAL SMPL
|
Professional
|
Both
|
$7,667.00
|
|
|
Service Code
|
HCPCS 61690
|
| Min. Negotiated Rate |
$331.77 |
| Max. Negotiated Rate |
$5,366.90 |
| Rate for Payer: Aetna Commercial |
$2,817.87
|
| Rate for Payer: BCBS Complete |
$1,485.71
|
| Rate for Payer: BCBS Trust/PPO |
$331.77
|
| Rate for Payer: Cash Price |
$6,133.60
|
| Rate for Payer: Cash Price |
$6,133.60
|
| Rate for Payer: Meridian Medicaid |
$1,485.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,414.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,366.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,725.19
|
| Rate for Payer: Priority Health Narrow Network |
$3,725.19
|
| Rate for Payer: Priority Health SBD |
$3,725.19
|
| Rate for Payer: UMR Bronson Commercial |
$3,526.82
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL
|
Professional
|
Both
|
$11,885.00
|
|
|
Service Code
|
HCPCS 61686
|
| Min. Negotiated Rate |
$191.24 |
| Max. Negotiated Rate |
$8,319.50 |
| Rate for Payer: Aetna Commercial |
$5,806.18
|
| Rate for Payer: BCBS Complete |
$3,038.95
|
| Rate for Payer: BCBS Trust/PPO |
$191.24
|
| Rate for Payer: Cash Price |
$9,508.00
|
| Rate for Payer: Cash Price |
$9,508.00
|
| Rate for Payer: Meridian Medicaid |
$3,038.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,894.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,319.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,639.49
|
| Rate for Payer: Priority Health Narrow Network |
$7,639.49
|
| Rate for Payer: Priority Health SBD |
$7,639.49
|
| Rate for Payer: UMR Bronson Commercial |
$5,467.10
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL
|
Professional
|
Both
|
$5,870.00
|
|
|
Service Code
|
HCPCS 61684
|
| Min. Negotiated Rate |
$195.47 |
| Max. Negotiated Rate |
$4,848.57 |
| Rate for Payer: Aetna Commercial |
$3,673.33
|
| Rate for Payer: BCBS Complete |
$1,930.32
|
| Rate for Payer: BCBS Trust/PPO |
$195.47
|
| Rate for Payer: Cash Price |
$4,696.00
|
| Rate for Payer: Cash Price |
$4,696.00
|
| Rate for Payer: Meridian Medicaid |
$1,930.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,838.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,109.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,848.57
|
| Rate for Payer: Priority Health Narrow Network |
$4,848.57
|
| Rate for Payer: Priority Health SBD |
$4,848.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,700.20
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL
|
Professional
|
Both
|
$8,741.22
|
|
|
Service Code
|
HCPCS 61682
|
| Min. Negotiated Rate |
$275.77 |
| Max. Negotiated Rate |
$7,065.90 |
| Rate for Payer: Aetna Commercial |
$5,378.16
|
| Rate for Payer: BCBS Complete |
$2,822.24
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: Cash Price |
$6,992.98
|
| Rate for Payer: Cash Price |
$6,992.98
|
| Rate for Payer: Meridian Medicaid |
$2,822.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,687.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,118.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,065.90
|
| Rate for Payer: Priority Health Narrow Network |
$7,065.90
|
| Rate for Payer: Priority Health SBD |
$7,065.90
|
| Rate for Payer: UMR Bronson Commercial |
$4,020.96
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL
|
Professional
|
Both
|
$4,661.04
|
|
|
Service Code
|
HCPCS 61680
|
| Min. Negotiated Rate |
$373.51 |
| Max. Negotiated Rate |
$3,815.78 |
| Rate for Payer: Aetna Commercial |
$2,931.17
|
| Rate for Payer: BCBS Complete |
$1,544.97
|
| Rate for Payer: BCBS Trust/PPO |
$373.51
|
| Rate for Payer: Cash Price |
$3,728.83
|
| Rate for Payer: Cash Price |
$3,728.83
|
| Rate for Payer: Meridian Medicaid |
$1,544.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,471.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,262.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,815.78
|
| Rate for Payer: Priority Health Narrow Network |
$3,815.78
|
| Rate for Payer: Priority Health SBD |
$3,815.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,144.08
|
|
|
PR INTRAFRACTION TRACK MOTION
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS G6017
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$1,256.83 |
| Rate for Payer: Aetna Commercial |
$94.22
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.83
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.50
|
| Rate for Payer: Priority Health Narrow Network |
$126.50
|
| Rate for Payer: Priority Health SBD |
$126.50
|
| Rate for Payer: UMR Bronson Commercial |
$79.58
|
|
|
PR INTRAOPERATIVE COLONIC LAVAGE
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 44701
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$295.16 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$226.64
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Meridian Medicaid |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.16
|
| Rate for Payer: Priority Health Narrow Network |
$295.16
|
| Rate for Payer: Priority Health SBD |
$295.16
|
| Rate for Payer: UMR Bronson Commercial |
$185.84
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$131.56 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna American Axle |
$194.35
|
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.35
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$209.30
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.15
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health SBD |
$188.37
|
| Rate for Payer: UMR Bronson Commercial |
$131.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$110.63 |
| Max. Negotiated Rate |
$483.08 |
| Rate for Payer: Aetna American Axle |
$194.35
|
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.35
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS Trust/PPO |
$483.08
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$209.30
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.15
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health SBD |
$188.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.31
|
| Rate for Payer: UHC Exchange |
$133.92
|
| Rate for Payer: UMR Bronson Commercial |
$110.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 38900
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$438.49 |
| Rate for Payer: Aetna Commercial |
$172.38
|
| Rate for Payer: BCBS Complete |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Meridian Medicaid |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.08
|
| Rate for Payer: Priority Health Narrow Network |
$294.08
|
| Rate for Payer: Priority Health SBD |
$294.08
|
| Rate for Payer: UMR Bronson Commercial |
$137.54
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$438.49 |
| Rate for Payer: Aetna Commercial |
$172.38
|
| Rate for Payer: BCBS Complete |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Meridian Medicaid |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.08
|
| Rate for Payer: Priority Health Narrow Network |
$294.08
|
| Rate for Payer: Priority Health SBD |
$294.08
|
| Rate for Payer: UMR Bronson Commercial |
$137.54
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 41009
|
| Min. Negotiated Rate |
$183.18 |
| Max. Negotiated Rate |
$1,140.60 |
| Rate for Payer: Aetna Commercial |
$371.20
|
| Rate for Payer: BCBS Complete |
$192.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Meridian Medicaid |
$192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$499.77
|
| Rate for Payer: Priority Health Narrow Network |
$499.77
|
| Rate for Payer: Priority Health SBD |
$499.77
|
| Rate for Payer: UMR Bronson Commercial |
$308.20
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
HCPCS 41006
|
| Min. Negotiated Rate |
$148.04 |
| Max. Negotiated Rate |
$931.39 |
| Rate for Payer: Aetna Commercial |
$301.56
|
| Rate for Payer: BCBS Complete |
$155.44
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: Cash Price |
$471.20
|
| Rate for Payer: Cash Price |
$471.20
|
| Rate for Payer: Meridian Medicaid |
$155.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.11
|
| Rate for Payer: Priority Health Narrow Network |
$405.11
|
| Rate for Payer: Priority Health SBD |
$405.11
|
| Rate for Payer: UMR Bronson Commercial |
$270.94
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 41005
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$795.62 |
| Rate for Payer: Aetna Commercial |
$144.95
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS Trust/PPO |
$795.62
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Meridian Medicaid |
$78.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.09
|
| Rate for Payer: Priority Health Narrow Network |
$211.09
|
| Rate for Payer: Priority Health SBD |
$211.09
|
| Rate for Payer: UMR Bronson Commercial |
$176.64
|
|
