|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 0228-2348-10
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.46 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna American Axle |
$163.18
|
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.18
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$175.73
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.38
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.73
|
| Rate for Payer: Priority Health SBD |
$158.16
|
| Rate for Payer: UMR Bronson Commercial |
$110.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
PR ORAL DEXAMETHASONE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J8540
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna Commercial |
$0.09
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
|
|
PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 90712
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR ORAL PRESCRIP DRUG NON CHEMO
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J8499
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: BCBS Complete |
$1.60
|
| 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 ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95933
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$115.50 |
| Rate for Payer: Aetna Commercial |
$92.26
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.33
|
| Rate for Payer: Priority Health Narrow Network |
$41.33
|
| Rate for Payer: Priority Health SBD |
$110.49
|
| Rate for Payer: UMR Bronson Commercial |
$75.90
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ
|
Professional
|
Both
|
$7,800.00
|
|
|
Service Code
|
HCPCS 61584
|
| Min. Negotiated Rate |
$420.53 |
| Max. Negotiated Rate |
$5,460.00 |
| Rate for Payer: Aetna Commercial |
$3,731.75
|
| Rate for Payer: BCBS Complete |
$1,950.90
|
| Rate for Payer: BCBS Trust/PPO |
$420.53
|
| Rate for Payer: Cash Price |
$6,240.00
|
| Rate for Payer: Cash Price |
$6,240.00
|
| Rate for Payer: Meridian Medicaid |
$1,950.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,858.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,460.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,957.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,957.28
|
| Rate for Payer: Priority Health SBD |
$4,957.28
|
| Rate for Payer: UMR Bronson Commercial |
$3,588.00
|
|
|
PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE
|
Professional
|
Both
|
$5,646.00
|
|
|
Service Code
|
HCPCS 61592
|
| Min. Negotiated Rate |
$397.28 |
| Max. Negotiated Rate |
$5,405.73 |
| Rate for Payer: Aetna Commercial |
$4,118.86
|
| Rate for Payer: BCBS Complete |
$2,148.60
|
| Rate for Payer: BCBS Trust/PPO |
$397.28
|
| Rate for Payer: Cash Price |
$4,516.80
|
| Rate for Payer: Cash Price |
$4,516.80
|
| Rate for Payer: Meridian Medicaid |
$2,148.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,046.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,952.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,405.73
|
| Rate for Payer: Priority Health Narrow Network |
$5,405.73
|
| Rate for Payer: Priority Health SBD |
$5,405.73
|
| Rate for Payer: UMR Bronson Commercial |
$2,597.16
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN
|
Professional
|
Both
|
$3,518.00
|
|
|
Service Code
|
HCPCS 67445
|
| Min. Negotiated Rate |
$348.68 |
| Max. Negotiated Rate |
$2,656.05 |
| Rate for Payer: Aetna Commercial |
$1,975.12
|
| Rate for Payer: BCBS Complete |
$1,017.61
|
| Rate for Payer: BCBS Trust/PPO |
$348.68
|
| Rate for Payer: Cash Price |
$2,814.40
|
| Rate for Payer: Cash Price |
$2,814.40
|
| Rate for Payer: Meridian Medicaid |
$1,017.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$969.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,462.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,656.05
|
| Rate for Payer: Priority Health Narrow Network |
$2,656.05
|
| Rate for Payer: Priority Health SBD |
$2,656.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,618.28
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$1,629.00
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$359.77 |
| Max. Negotiated Rate |
$1,807.79 |
| Rate for Payer: Aetna Commercial |
$1,329.81
|
| Rate for Payer: BCBS Complete |
$691.97
|
| Rate for Payer: BCBS Trust/PPO |
$359.77
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Meridian Medicaid |
$691.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,807.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,807.79
|
| Rate for Payer: Priority Health SBD |
$1,807.79
|
| Rate for Payer: UMR Bronson Commercial |
$749.34
|
|
|
PR ORCHIECTOMY PARTIAL
|
Professional
|
Both
|
$1,081.00
|
|
|
Service Code
|
HCPCS 54522
|
| Min. Negotiated Rate |
$374.88 |
| Max. Negotiated Rate |
$1,501.96 |
| Rate for Payer: Aetna Commercial |
$755.38
|
| Rate for Payer: BCBS Complete |
$393.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,501.96
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Meridian Medicaid |
$393.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.60
|
| Rate for Payer: Priority Health Narrow Network |
$938.60
|
| Rate for Payer: Priority Health SBD |
$938.60
|
| Rate for Payer: UMR Bronson Commercial |
$497.26
|
|
|
PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 54530
|
| Min. Negotiated Rate |
$325.89 |
| Max. Negotiated Rate |
$2,667.39 |
| Rate for Payer: Aetna Commercial |
$650.96
|
| Rate for Payer: BCBS Complete |
$342.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,667.39
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Meridian Medicaid |
$342.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.86
|
| Rate for Payer: Priority Health Narrow Network |
$814.86
|
| Rate for Payer: Priority Health SBD |
$814.86
|
| Rate for Payer: UMR Bronson Commercial |
$437.00
|
|
|
PR ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL
|
Professional
|
Both
|
$1,374.00
|
|
|
Service Code
|
HCPCS 54535
|
| Min. Negotiated Rate |
$474.14 |
| Max. Negotiated Rate |
$3,333.04 |
| Rate for Payer: Aetna Commercial |
$955.05
|
| Rate for Payer: BCBS Complete |
$497.85
|
| Rate for Payer: BCBS Trust/PPO |
$3,333.04
|
| Rate for Payer: Cash Price |
$1,099.20
|
| Rate for Payer: Cash Price |
$1,099.20
|
| Rate for Payer: Meridian Medicaid |
$497.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$474.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,187.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,187.16
|
| Rate for Payer: Priority Health SBD |
$1,187.16
|
| Rate for Payer: UMR Bronson Commercial |
$632.04
|
|
|
PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 54520
|
| Min. Negotiated Rate |
$210.66 |
| Max. Negotiated Rate |
$2,233.12 |
| Rate for Payer: Aetna Commercial |
$419.79
|
| Rate for Payer: BCBS Complete |
$221.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,233.12
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Meridian Medicaid |
$221.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$525.76
|
| Rate for Payer: Priority Health Narrow Network |
$525.76
|
| Rate for Payer: Priority Health SBD |
$525.76
|
| Rate for Payer: UMR Bronson Commercial |
$277.38
|
|
|
PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 54650
|
| Min. Negotiated Rate |
$454.54 |
| Max. Negotiated Rate |
$2,517.35 |
| Rate for Payer: Aetna Commercial |
$913.59
|
| Rate for Payer: BCBS Complete |
$477.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,517.35
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Meridian Medicaid |
$477.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,137.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,137.46
|
| Rate for Payer: Priority Health SBD |
$1,137.46
|
| Rate for Payer: UMR Bronson Commercial |
$676.20
|
|
|
PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 54640
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$2,048.75 |
| Rate for Payer: Aetna Commercial |
$557.83
|
| Rate for Payer: BCBS Complete |
$288.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.75
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Meridian Medicaid |
$288.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.50
|
| Rate for Payer: Priority Health Narrow Network |
$689.50
|
| Rate for Payer: Priority Health SBD |
$689.50
|
| Rate for Payer: UMR Bronson Commercial |
$792.12
|
|
|
PR ORPHENADRINE INJECTION
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS J2360
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.88
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
|
|
PR ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 97760
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$466.49 |
| Rate for Payer: Aetna Commercial |
$35.53
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS Trust/PPO |
$466.49
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: Priority Health SBD |
$75.00
|
| Rate for Payer: UMR Bronson Commercial |
$32.66
|
|
|
PR ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 97763
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$674.11 |
| Rate for Payer: Aetna Commercial |
$57.97
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS Trust/PPO |
$674.11
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: Priority Health SBD |
$75.00
|
| Rate for Payer: UMR Bronson Commercial |
$47.84
|
|
|
PROSTATECTOMY WITH CC
|
Facility
|
IP
|
$28,719.93
|
|
|
Service Code
|
MS-DRG 666
|
| Min. Negotiated Rate |
$13,059.36 |
| Max. Negotiated Rate |
$28,719.93 |
| Rate for Payer: Aetna Medicare |
$14,296.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,183.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,183.38
|
| Rate for Payer: BCBS MAPPO |
$13,746.70
|
| Rate for Payer: BCBS Trust/PPO |
$28,719.93
|
| Rate for Payer: BCN Medicare Advantage |
$13,746.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,746.70
|
| Rate for Payer: Mclaren Medicare |
$13,746.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,434.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,808.70
|
| Rate for Payer: PACE Medicare |
$13,059.36
|
| Rate for Payer: PACE SWMI |
$13,746.70
|
| Rate for Payer: PHP Medicare Advantage |
$13,746.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,644.55
|
| Rate for Payer: Priority Health Medicare |
$13,746.70
|
| Rate for Payer: Priority Health Narrow Network |
$19,715.64
|
| Rate for Payer: Railroad Medicare Medicare |
$13,746.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,197.22
|
| Rate for Payer: UHC Core |
$21,481.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,746.70
|
| Rate for Payer: UHC Exchange |
$17,077.83
|
| Rate for Payer: UHC Medicare Advantage |
$14,159.10
|
| Rate for Payer: VA VA |
$13,746.70
|
|
|
PROSTATECTOMY WITH MCC
|
Facility
|
IP
|
$54,879.22
|
|
|
Service Code
|
MS-DRG 665
|
| Min. Negotiated Rate |
$23,101.21 |
| Max. Negotiated Rate |
$54,879.22 |
| Rate for Payer: Aetna Medicare |
$25,289.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,396.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,396.32
|
| Rate for Payer: BCBS MAPPO |
$24,317.06
|
| Rate for Payer: BCBS Trust/PPO |
$54,879.22
|
| Rate for Payer: BCN Medicare Advantage |
$24,317.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,317.06
|
| Rate for Payer: Mclaren Medicare |
$24,317.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,532.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,964.62
|
| Rate for Payer: PACE Medicare |
$23,101.21
|
| Rate for Payer: PACE SWMI |
$24,317.06
|
| Rate for Payer: PHP Medicare Advantage |
$24,317.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44,328.34
|
| Rate for Payer: Priority Health Medicare |
$24,317.06
|
| Rate for Payer: Priority Health Narrow Network |
$35,462.67
|
| Rate for Payer: Railroad Medicare Medicare |
$24,317.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,121.13
|
| Rate for Payer: UHC Core |
$38,638.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,317.06
|
| Rate for Payer: UHC Exchange |
$30,718.01
|
| Rate for Payer: UHC Medicare Advantage |
$25,046.57
|
| Rate for Payer: VA VA |
$24,317.06
|
|
|
PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$17,552.61
|
|
|
Service Code
|
MS-DRG 667
|
| Min. Negotiated Rate |
$8,170.57 |
| Max. Negotiated Rate |
$17,552.61 |
| Rate for Payer: Aetna Medicare |
$8,944.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,750.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,750.75
|
| Rate for Payer: BCBS MAPPO |
$8,600.60
|
| Rate for Payer: BCBS Trust/PPO |
$17,552.61
|
| Rate for Payer: BCN Medicare Advantage |
$8,600.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,600.60
|
| Rate for Payer: Mclaren Medicare |
$8,600.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,030.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,890.69
|
| Rate for Payer: PACE Medicare |
$8,170.57
|
| Rate for Payer: PACE SWMI |
$8,600.60
|
| Rate for Payer: PHP Medicare Advantage |
$8,600.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,061.68
|
| Rate for Payer: Priority Health Medicare |
$8,600.60
|
| Rate for Payer: Priority Health Narrow Network |
$12,049.34
|
| Rate for Payer: Railroad Medicare Medicare |
$8,600.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,010.60
|
| Rate for Payer: UHC Core |
$13,128.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,600.60
|
| Rate for Payer: UHC Exchange |
$10,437.22
|
| Rate for Payer: UHC Medicare Advantage |
$8,858.62
|
| Rate for Payer: VA VA |
$8,600.60
|
|
|
PR OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 28114
|
| Min. Negotiated Rate |
$539.10 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$1,103.34
|
| Rate for Payer: BCBS Complete |
$566.06
|
| Rate for Payer: BCBS Trust/PPO |
$864.83
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Meridian Medicaid |
$566.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,277.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,277.14
|
| Rate for Payer: Priority Health SBD |
$1,277.14
|
| Rate for Payer: UMR Bronson Commercial |
$874.00
|
|
|
PR OSTC PRTL EXOSTC/CONDYLC METAR HEAD
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 28288
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna Commercial |
$571.03
|
| Rate for Payer: BCBS Complete |
$295.44
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Meridian Medicaid |
$295.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.81
|
| Rate for Payer: Priority Health Narrow Network |
$661.81
|
| Rate for Payer: Priority Health SBD |
$661.81
|
| Rate for Payer: UMR Bronson Commercial |
$445.74
|
|
|
PR OSTECTOMY CALCANEUS
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 28118
|
| Min. Negotiated Rate |
$273.07 |
| Max. Negotiated Rate |
$2,262.71 |
| Rate for Payer: Aetna Commercial |
$555.17
|
| Rate for Payer: BCBS Complete |
$286.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,262.71
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Meridian Medicaid |
$286.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.88
|
| Rate for Payer: Priority Health Narrow Network |
$641.88
|
| Rate for Payer: Priority Health SBD |
$641.88
|
| Rate for Payer: UMR Bronson Commercial |
$464.14
|
|
|
PR OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS
|
Professional
|
Both
|
$1,198.00
|
|
|
Service Code
|
HCPCS 28119
|
| Min. Negotiated Rate |
$235.37 |
| Max. Negotiated Rate |
$838.60 |
| Rate for Payer: Aetna Commercial |
$477.77
|
| Rate for Payer: BCBS Complete |
$247.14
|
| Rate for Payer: BCBS Trust/PPO |
$811.47
|
| Rate for Payer: Cash Price |
$958.40
|
| Rate for Payer: Cash Price |
$958.40
|
| Rate for Payer: Meridian Medicaid |
$247.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$553.55
|
| Rate for Payer: Priority Health Narrow Network |
$553.55
|
| Rate for Payer: Priority Health SBD |
$553.55
|
| Rate for Payer: UMR Bronson Commercial |
$551.08
|
|
