|
PR LIGATION MAJOR ARTERY NECK
|
Professional
|
Both
|
$1,189.00
|
|
|
Service Code
|
HCPCS 37615
|
| Min. Negotiated Rate |
$329.09 |
| Max. Negotiated Rate |
$1,021.20 |
| Rate for Payer: Aetna Commercial |
$713.42
|
| Rate for Payer: BCBS Complete |
$345.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.20
|
| Rate for Payer: Cash Price |
$951.20
|
| Rate for Payer: Cash Price |
$951.20
|
| Rate for Payer: Meridian Medicaid |
$345.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.09
|
| Rate for Payer: Priority Health Narrow Network |
$817.09
|
| Rate for Payer: Priority Health SBD |
$817.09
|
| Rate for Payer: UMR Bronson Commercial |
$546.94
|
|
|
PR LIGATION OF FEMORAL VEIN
|
Professional
|
Both
|
$1,646.00
|
|
|
Service Code
|
HCPCS 37650
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$1,285.88 |
| Rate for Payer: Aetna Commercial |
$615.48
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.88
|
| Rate for Payer: Cash Price |
$1,316.80
|
| Rate for Payer: Cash Price |
$1,316.80
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$717.08
|
| Rate for Payer: Priority Health Narrow Network |
$717.08
|
| Rate for Payer: Priority Health SBD |
$717.08
|
| Rate for Payer: UMR Bronson Commercial |
$757.16
|
|
|
PR LIGATION OF INFERIOR VENA CAVA
|
Professional
|
Both
|
$3,374.00
|
|
|
Service Code
|
HCPCS 37619
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$2,732.14 |
| Rate for Payer: Aetna Commercial |
$2,337.83
|
| Rate for Payer: BCBS Complete |
$1,152.02
|
| Rate for Payer: BCBS Trust/PPO |
$980.00
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: Meridian Medicaid |
$1,152.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,097.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,361.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,732.14
|
| Rate for Payer: Priority Health Narrow Network |
$2,732.14
|
| Rate for Payer: Priority Health SBD |
$2,732.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,552.04
|
|
|
PR LIGATION OF SPERM DUCT
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 55450
|
| Min. Negotiated Rate |
$255.20 |
| Max. Negotiated Rate |
$446.60 |
| Rate for Payer: BCBS Complete |
$255.20
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.60
|
| Rate for Payer: UMR Bronson Commercial |
$293.48
|
|
|
PR LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA
|
Professional
|
Both
|
$1,076.00
|
|
|
Service Code
|
HCPCS 37607
|
| Min. Negotiated Rate |
$235.79 |
| Max. Negotiated Rate |
$929.28 |
| Rate for Payer: Aetna Commercial |
$500.75
|
| Rate for Payer: BCBS Complete |
$247.58
|
| Rate for Payer: BCBS Trust/PPO |
$929.28
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Meridian Medicaid |
$247.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.69
|
| Rate for Payer: Priority Health Narrow Network |
$585.69
|
| Rate for Payer: Priority Health SBD |
$585.69
|
| Rate for Payer: UMR Bronson Commercial |
$494.96
|
|
|
PR LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 37700
|
| Min. Negotiated Rate |
$150.57 |
| Max. Negotiated Rate |
$385.13 |
| Rate for Payer: Aetna Commercial |
$327.02
|
| Rate for Payer: BCBS Complete |
$162.37
|
| Rate for Payer: BCBS Trust/PPO |
$150.57
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Meridian Medicaid |
$162.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.13
|
| Rate for Payer: Priority Health Narrow Network |
$385.13
|
| Rate for Payer: Priority Health SBD |
$385.13
|
| Rate for Payer: UMR Bronson Commercial |
$213.90
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$161.45 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna Commercial |
$342.53
|
| Rate for Payer: BCBS Complete |
$169.52
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Meridian Medicaid |
$169.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.03
|
| Rate for Payer: Priority Health Narrow Network |
$400.03
|
| Rate for Payer: Priority Health SBD |
$400.03
|
| Rate for Payer: UMR Bronson Commercial |
$437.00
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna American Axle |
$617.50
|
| Rate for Payer: Aetna Commercial |
$807.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.50
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$665.00
|
| Rate for Payer: Cofinity Commercial |
$817.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Healthscope Commercial |
$855.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: PHP Commercial |
$807.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health SBD |
$598.50
|
| Rate for Payer: UMR Bronson Commercial |
$418.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.50
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$248.20 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna American Axle |
$617.50
|
| Rate for Payer: Aetna Commercial |
$807.50
|
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,894.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$665.00
|
| Rate for Payer: Cofinity Commercial |
$817.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$855.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.50
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$807.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Priority Health SBD |
$598.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$248.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: UMR Bronson Commercial |
$351.50
|
| Rate for Payer: VA VA |
$2,833.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.50
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 37785
|
| Min. Negotiated Rate |
$161.45 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna Commercial |
$342.53
|
| Rate for Payer: BCBS Complete |
$169.52
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Meridian Medicaid |
$169.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.03
|
| Rate for Payer: Priority Health Narrow Network |
$400.03
|
| Rate for Payer: Priority Health SBD |
$400.03
|
| Rate for Payer: UMR Bronson Commercial |
$437.00
|
|
|
PR LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$755.10 |
| Rate for Payer: Aetna American Axle |
$545.35
|
| Rate for Payer: Aetna Commercial |
$713.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.35
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cofinity Commercial |
$587.30
|
| Rate for Payer: Cofinity Commercial |
$721.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.20
|
| Rate for Payer: Healthscope Commercial |
$755.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$713.15
|
| Rate for Payer: PHP Commercial |
$713.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.30
|
| Rate for Payer: Priority Health SBD |
$528.57
|
| Rate for Payer: UMR Bronson Commercial |
$369.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.25
|
|
|
PR LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$310.43 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna American Axle |
$545.35
|
| Rate for Payer: Aetna Commercial |
$713.15
|
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cofinity Commercial |
$721.54
|
| Rate for Payer: Cofinity Commercial |
$587.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$755.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.25
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$713.15
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$713.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Priority Health SBD |
$528.57
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$618.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$562.22
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: UMR Bronson Commercial |
$310.43
|
| Rate for Payer: VA VA |
$2,833.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.25
|
|
|
PR LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 37722
|
| Min. Negotiated Rate |
$290.32 |
| Max. Negotiated Rate |
$728.26 |
| Rate for Payer: Aetna Commercial |
$630.45
|
| Rate for Payer: BCBS Complete |
$304.84
|
| Rate for Payer: BCBS Trust/PPO |
$407.85
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Meridian Medicaid |
$304.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$728.26
|
| Rate for Payer: Priority Health Narrow Network |
$728.26
|
| Rate for Payer: Priority Health SBD |
$728.26
|
| Rate for Payer: UMR Bronson Commercial |
$427.34
|
|
|
PR LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 37718
|
| Min. Negotiated Rate |
$219.24 |
| Max. Negotiated Rate |
$614.42 |
| Rate for Payer: Aetna Commercial |
$567.92
|
| Rate for Payer: BCBS Complete |
$259.65
|
| Rate for Payer: BCBS Trust/PPO |
$219.24
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Meridian Medicaid |
$259.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.42
|
| Rate for Payer: Priority Health Narrow Network |
$614.42
|
| Rate for Payer: Priority Health SBD |
$614.42
|
| Rate for Payer: UMR Bronson Commercial |
$370.76
|
|
|
PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 37780
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$438.49 |
| Rate for Payer: Aetna Commercial |
$313.05
|
| Rate for Payer: BCBS Complete |
$156.78
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Meridian Medicaid |
$156.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.18
|
| Rate for Payer: Priority Health Narrow Network |
$369.18
|
| Rate for Payer: Priority Health SBD |
$369.18
|
| Rate for Payer: UMR Bronson Commercial |
$218.04
|
|
|
PR LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR
|
Professional
|
Both
|
$2,190.00
|
|
|
Service Code
|
HCPCS 27429
|
| Min. Negotiated Rate |
$812.38 |
| Max. Negotiated Rate |
$2,210.41 |
| Rate for Payer: Aetna Commercial |
$1,675.57
|
| Rate for Payer: BCBS Complete |
$853.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.41
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Meridian Medicaid |
$853.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,533.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,929.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,929.75
|
| Rate for Payer: Priority Health SBD |
$1,929.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,007.40
|
|
|
PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 37761
|
| Min. Negotiated Rate |
$338.67 |
| Max. Negotiated Rate |
$898.64 |
| Rate for Payer: Aetna Commercial |
$717.95
|
| Rate for Payer: BCBS Complete |
$355.60
|
| Rate for Payer: BCBS Trust/PPO |
$898.64
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Meridian Medicaid |
$355.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$338.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$847.40
|
| Rate for Payer: Priority Health Narrow Network |
$847.40
|
| Rate for Payer: Priority Health SBD |
$847.40
|
| Rate for Payer: UMR Bronson Commercial |
$507.84
|
|
|
PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 58611
|
| Min. Negotiated Rate |
$47.93 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Aetna Commercial |
$91.50
|
| Rate for Payer: BCBS Complete |
$50.33
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Meridian Medicaid |
$50.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.00
|
| Rate for Payer: Priority Health Narrow Network |
$107.00
|
| Rate for Payer: Priority Health SBD |
$107.00
|
| Rate for Payer: UMR Bronson Commercial |
$151.80
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 58600
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Aetna Commercial |
$442.01
|
| Rate for Payer: BCBS Complete |
$251.16
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Meridian Medicaid |
$251.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$882.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$528.34
|
| Rate for Payer: Priority Health Narrow Network |
$528.34
|
| Rate for Payer: Priority Health SBD |
$528.34
|
| Rate for Payer: UMR Bronson Commercial |
$579.60
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$217.47 |
| Max. Negotiated Rate |
$593.60 |
| Rate for Payer: Aetna Commercial |
$400.03
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS Trust/PPO |
$264.15
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Meridian Medicaid |
$228.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.53
|
| Rate for Payer: Priority Health Narrow Network |
$480.53
|
| Rate for Payer: Priority Health SBD |
$480.53
|
| Rate for Payer: UMR Bronson Commercial |
$390.08
|
|
|
PR LILETTA, 52 MG
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS J7297
|
| Min. Negotiated Rate |
$396.98 |
| Max. Negotiated Rate |
$887.36 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: BCBS Complete |
$887.36
|
| Rate for Payer: BCBS Trust/PPO |
$856.93
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Meridian Medicaid |
$887.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$845.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.10
|
| Rate for Payer: UMR Bronson Commercial |
$396.98
|
|
|
PR LINCOMYCIN INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J2010
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$10.14
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.48
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$296.92 |
| Max. Negotiated Rate |
$1,353.50 |
| Rate for Payer: Aetna Commercial |
$607.33
|
| Rate for Payer: BCBS Complete |
$311.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.50
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Meridian Medicaid |
$311.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.69
|
| Rate for Payer: Priority Health Narrow Network |
$745.69
|
| Rate for Payer: Priority Health SBD |
$745.69
|
| Rate for Payer: UMR Bronson Commercial |
$422.28
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$217.26 |
| Max. Negotiated Rate |
$1,148.52 |
| Rate for Payer: Aetna Commercial |
$444.33
|
| Rate for Payer: BCBS Complete |
$228.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,148.52
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Meridian Medicaid |
$228.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.30
|
| Rate for Payer: Priority Health Narrow Network |
$546.30
|
| Rate for Payer: Priority Health SBD |
$546.30
|
| Rate for Payer: UMR Bronson Commercial |
$747.50
|
|
|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$1,061.90 |
| Rate for Payer: Aetna Commercial |
$730.18
|
| Rate for Payer: BCBS Complete |
$383.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.83
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Meridian Medicaid |
$383.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$911.59
|
| Rate for Payer: Priority Health Narrow Network |
$911.59
|
| Rate for Payer: Priority Health SBD |
$911.59
|
| Rate for Payer: UMR Bronson Commercial |
$697.82
|
|
