|
PR RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE
|
Professional
|
Both
|
$3,440.00
|
|
|
Service Code
|
HCPCS 21244
|
| Min. Negotiated Rate |
$110.96 |
| Max. Negotiated Rate |
$2,408.00 |
| Rate for Payer: Aetna Commercial |
$1,342.79
|
| Rate for Payer: BCBS Complete |
$675.87
|
| Rate for Payer: BCBS Trust/PPO |
$110.96
|
| Rate for Payer: Cash Price |
$2,752.00
|
| Rate for Payer: Cash Price |
$2,752.00
|
| Rate for Payer: Meridian Medicaid |
$675.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,408.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,541.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,541.15
|
| Rate for Payer: Priority Health SBD |
$1,541.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,582.40
|
|
|
PR RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
HCPCS 26587
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$1,602.42 |
| Rate for Payer: Aetna Commercial |
$1,391.35
|
| Rate for Payer: BCBS Complete |
$707.63
|
| Rate for Payer: BCBS Trust/PPO |
$57.06
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Meridian Medicaid |
$707.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,602.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,602.42
|
| Rate for Payer: Priority Health SBD |
$1,602.42
|
| Rate for Payer: UMR Bronson Commercial |
$784.30
|
|
|
PR RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR
|
Professional
|
Both
|
$1,453.00
|
|
|
Service Code
|
HCPCS 28238
|
| Min. Negotiated Rate |
$315.03 |
| Max. Negotiated Rate |
$2,785.20 |
| Rate for Payer: Aetna Commercial |
$642.89
|
| Rate for Payer: BCBS Complete |
$330.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,785.20
|
| Rate for Payer: Cash Price |
$1,162.40
|
| Rate for Payer: Cash Price |
$1,162.40
|
| Rate for Payer: Meridian Medicaid |
$330.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.62
|
| Rate for Payer: Priority Health Narrow Network |
$748.62
|
| Rate for Payer: Priority Health SBD |
$748.62
|
| Rate for Payer: UMR Bronson Commercial |
$668.38
|
|
|
PR RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ
|
Professional
|
Both
|
$3,376.00
|
|
|
Service Code
|
HCPCS 25337
|
| Min. Negotiated Rate |
$336.53 |
| Max. Negotiated Rate |
$2,363.20 |
| Rate for Payer: Aetna Commercial |
$1,179.01
|
| Rate for Payer: BCBS Complete |
$604.31
|
| Rate for Payer: BCBS Trust/PPO |
$336.53
|
| Rate for Payer: Cash Price |
$2,700.80
|
| Rate for Payer: Cash Price |
$2,700.80
|
| Rate for Payer: Meridian Medicaid |
$604.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$575.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,363.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,366.50
|
| Rate for Payer: Priority Health SBD |
$1,366.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,552.96
|
|
|
PR RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD
|
Professional
|
Both
|
$4,390.00
|
|
|
Service Code
|
HCPCS 21172
|
| Min. Negotiated Rate |
$580.95 |
| Max. Negotiated Rate |
$3,263.56 |
| Rate for Payer: Aetna Commercial |
$2,826.55
|
| Rate for Payer: BCBS Complete |
$1,439.19
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: Cash Price |
$3,512.00
|
| Rate for Payer: Cash Price |
$3,512.00
|
| Rate for Payer: Meridian Medicaid |
$1,439.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,370.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,073.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,263.56
|
| Rate for Payer: Priority Health Narrow Network |
$3,263.56
|
| Rate for Payer: Priority Health SBD |
$3,263.56
|
| Rate for Payer: UMR Bronson Commercial |
$2,019.40
|
|
|
PR RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX
|
Professional
|
Both
|
$1,406.00
|
|
|
Service Code
|
HCPCS 26502
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$2,792.59 |
| Rate for Payer: Aetna Commercial |
$1,000.01
|
| Rate for Payer: BCBS Complete |
$514.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,792.59
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Meridian Medicaid |
$514.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,175.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,175.00
|
| Rate for Payer: Priority Health SBD |
$1,175.00
|
| Rate for Payer: UMR Bronson Commercial |
$646.76
|
|
|
PR RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 26500
|
| Min. Negotiated Rate |
$446.24 |
| Max. Negotiated Rate |
$5,862.74 |
| Rate for Payer: Aetna Commercial |
$873.76
|
| Rate for Payer: BCBS Complete |
$468.55
|
| Rate for Payer: BCBS Trust/PPO |
$5,862.74
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Meridian Medicaid |
$468.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,031.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,031.51
|
| Rate for Payer: Priority Health SBD |
$1,031.51
|
| Rate for Payer: UMR Bronson Commercial |
$626.06
|
|
|
PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 45900
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$771.85 |
| Rate for Payer: Aetna Commercial |
$285.26
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS Trust/PPO |
$771.85
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.13
|
| Rate for Payer: Priority Health Narrow Network |
$375.13
|
| Rate for Payer: Priority Health SBD |
$375.13
|
| Rate for Payer: UMR Bronson Commercial |
$174.34
|
|
|
PR RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Professional
|
Both
|
$801.00
|
|
|
Service Code
|
HCPCS 54600
|
| Min. Negotiated Rate |
$290.11 |
| Max. Negotiated Rate |
$2,890.86 |
| Rate for Payer: Aetna Commercial |
$579.83
|
| Rate for Payer: BCBS Complete |
$304.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,890.86
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Meridian Medicaid |
$304.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$724.62
|
| Rate for Payer: Priority Health Narrow Network |
$724.62
|
| Rate for Payer: Priority Health SBD |
$724.62
|
| Rate for Payer: UMR Bronson Commercial |
$368.46
|
|
|
PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT
|
Professional
|
Both
|
$2,329.00
|
|
|
Service Code
|
HCPCS 44050
|
| Min. Negotiated Rate |
$598.96 |
| Max. Negotiated Rate |
$2,793.65 |
| Rate for Payer: Aetna Commercial |
$1,263.25
|
| Rate for Payer: BCBS Complete |
$628.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,793.65
|
| Rate for Payer: Cash Price |
$1,863.20
|
| Rate for Payer: Cash Price |
$1,863.20
|
| Rate for Payer: Meridian Medicaid |
$628.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$598.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,643.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,643.98
|
| Rate for Payer: Priority Health SBD |
$1,643.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,071.34
|
|
|
PR REALIGNMENT EXTENSOR TENDON HAND EACH TENDON
|
Professional
|
Both
|
$1,555.00
|
|
|
Service Code
|
HCPCS 26437
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,088.50 |
| Rate for Payer: Aetna Commercial |
$878.32
|
| Rate for Payer: BCBS Complete |
$454.01
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Meridian Medicaid |
$454.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$432.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,088.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,038.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,038.67
|
| Rate for Payer: Priority Health SBD |
$1,038.67
|
| Rate for Payer: UMR Bronson Commercial |
$715.30
|
|
|
PR REAORT VALV W CP BYPASS
|
Professional
|
Both
|
$7,886.00
|
|
|
Service Code
|
HCPCS 33400
|
| Min. Negotiated Rate |
$3,154.40 |
| Max. Negotiated Rate |
$5,520.20 |
| Rate for Payer: BCBS Complete |
$3,154.40
|
| Rate for Payer: Cash Price |
$6,308.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,520.20
|
| Rate for Payer: UMR Bronson Commercial |
$3,627.56
|
|
|
PR RECMPL WND LID,NOS,EAR <1 CM
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 13150
|
| Min. Negotiated Rate |
$236.40 |
| Max. Negotiated Rate |
$413.70 |
| Rate for Payer: BCBS Complete |
$236.40
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.70
|
| Rate for Payer: UMR Bronson Commercial |
$271.86
|
|
|
PR RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX
|
Professional
|
Both
|
$3,397.00
|
|
|
Service Code
|
HCPCS 69310
|
| Min. Negotiated Rate |
$716.53 |
| Max. Negotiated Rate |
$2,377.90 |
| Rate for Payer: Aetna Commercial |
$1,261.16
|
| Rate for Payer: BCBS Complete |
$752.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,074.63
|
| Rate for Payer: Cash Price |
$2,717.60
|
| Rate for Payer: Cash Price |
$2,717.60
|
| Rate for Payer: Meridian Medicaid |
$752.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$716.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,377.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,594.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,594.94
|
| Rate for Payer: Priority Health SBD |
$1,594.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,562.62
|
|
|
PR RECONSTRUCTION NAIL BED W/GRAFT
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 11762
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$306.60 |
| Rate for Payer: Aetna Commercial |
$195.65
|
| Rate for Payer: BCBS Complete |
$125.46
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Meridian Medicaid |
$125.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.12
|
| Rate for Payer: Priority Health Narrow Network |
$228.12
|
| Rate for Payer: Priority Health SBD |
$228.12
|
| Rate for Payer: UMR Bronson Commercial |
$201.48
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Facility
|
IP
|
$3,908.00
|
|
|
Service Code
|
CPT 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$1,719.52 |
| Max. Negotiated Rate |
$3,517.20 |
| Rate for Payer: Aetna American Axle |
$2,540.20
|
| Rate for Payer: Aetna Commercial |
$3,321.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,540.20
|
| Rate for Payer: Cash Price |
$3,126.40
|
| Rate for Payer: Cofinity Commercial |
$2,735.60
|
| Rate for Payer: Cofinity Commercial |
$3,360.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,126.40
|
| Rate for Payer: Healthscope Commercial |
$3,517.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,735.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,931.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,321.80
|
| Rate for Payer: PHP Commercial |
$3,321.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,735.60
|
| Rate for Payer: Priority Health SBD |
$2,462.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,719.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,931.00
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Professional
|
Both
|
$3,908.00
|
|
|
Service Code
|
HCPCS 23420
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$2,735.60 |
| Rate for Payer: Aetna Commercial |
$1,298.68
|
| Rate for Payer: BCBS Complete |
$660.44
|
| Rate for Payer: BCBS Trust/PPO |
$120.13
|
| Rate for Payer: Cash Price |
$3,126.40
|
| Rate for Payer: Cash Price |
$3,126.40
|
| Rate for Payer: Meridian Medicaid |
$660.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$628.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,735.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,495.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,495.70
|
| Rate for Payer: Priority Health SBD |
$1,495.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,797.68
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Professional
|
Both
|
$3,908.00
|
|
|
Service Code
|
HCPCS 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$2,735.60 |
| Rate for Payer: Aetna Commercial |
$1,298.68
|
| Rate for Payer: BCBS Complete |
$660.44
|
| Rate for Payer: BCBS Trust/PPO |
$120.13
|
| Rate for Payer: Cash Price |
$3,126.40
|
| Rate for Payer: Cash Price |
$3,126.40
|
| Rate for Payer: Meridian Medicaid |
$660.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$628.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,735.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,495.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,495.70
|
| Rate for Payer: Priority Health SBD |
$1,495.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,797.68
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Facility
|
OP
|
$3,908.00
|
|
|
Service Code
|
CPT 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$966.94 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna American Axle |
$2,540.20
|
| Rate for Payer: Aetna Commercial |
$3,321.80
|
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,540.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,590.53
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$3,126.40
|
| Rate for Payer: Cash Price |
$3,126.40
|
| Rate for Payer: Cofinity Commercial |
$3,360.88
|
| Rate for Payer: Cofinity Commercial |
$2,735.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,126.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$3,517.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,735.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,931.00
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,321.80
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$3,321.80
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,735.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Priority Health SBD |
$2,462.04
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$966.94
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,445.96
|
| Rate for Payer: VA VA |
$6,359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,931.00
|
|
|
PR RECONSTRUCTION TOE POLYDACTYLY
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 28344
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$2,741.35 |
| Rate for Payer: Aetna Commercial |
$367.99
|
| Rate for Payer: BCBS Complete |
$189.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,741.35
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Meridian Medicaid |
$189.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.83
|
| Rate for Payer: Priority Health Narrow Network |
$423.83
|
| Rate for Payer: Priority Health SBD |
$423.83
|
| Rate for Payer: UMR Bronson Commercial |
$372.14
|
|
|
PR RECONSTRUCTION VENA CAVA ANY METHOD
|
Professional
|
Both
|
$2,352.00
|
|
|
Service Code
|
HCPCS 34502
|
| Min. Negotiated Rate |
$970.85 |
| Max. Negotiated Rate |
$2,399.01 |
| Rate for Payer: Aetna Commercial |
$2,077.33
|
| Rate for Payer: BCBS Complete |
$1,019.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,399.01
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Meridian Medicaid |
$1,019.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$970.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,394.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,394.87
|
| Rate for Payer: Priority Health SBD |
$2,394.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,081.92
|
|
|
PR RECTAL SESATION TONE & COMPLIANCE TEST
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 91120
|
| Min. Negotiated Rate |
$63.33 |
| Max. Negotiated Rate |
$1,003.77 |
| Rate for Payer: Aetna Commercial |
$562.84
|
| Rate for Payer: Aetna Commercial |
$562.84
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Complete |
$278.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.77
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.33
|
| Rate for Payer: Priority Health Narrow Network |
$63.33
|
| Rate for Payer: Priority Health Narrow Network |
$63.33
|
| Rate for Payer: Priority Health SBD |
$688.08
|
| Rate for Payer: Priority Health SBD |
$688.08
|
| Rate for Payer: UMR Bronson Commercial |
$320.16
|
| Rate for Payer: UMR Bronson Commercial |
$41.40
|
|
|
PR RECTAL TUMOR EXCISION TRANSANAL ENDOSCOPIC
|
Professional
|
Both
|
$1,758.00
|
|
|
Service Code
|
HCPCS 0184T
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$1,238.26 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: BCBS Complete |
$703.20
|
| Rate for Payer: BCBS Trust/PPO |
$25.64
|
| Rate for Payer: Cash Price |
$1,406.40
|
| Rate for Payer: Cash Price |
$1,406.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,230.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,238.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,238.26
|
| Rate for Payer: Priority Health SBD |
$1,238.26
|
| Rate for Payer: UMR Bronson Commercial |
$808.68
|
|
|
PR REGION IV LOCAL ANESTH,UPPER/LOWER EXT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01995
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: BCBS Complete |
$2.00
|
| 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 REIMPLANTATION ANOMALOUS PULMONARY ARTERY
|
Professional
|
Both
|
$6,572.00
|
|
|
Service Code
|
HCPCS 33788
|
| Min. Negotiated Rate |
$963.19 |
| Max. Negotiated Rate |
$4,600.40 |
| Rate for Payer: Aetna Commercial |
$2,061.08
|
| Rate for Payer: BCBS Complete |
$1,011.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,462.33
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Meridian Medicaid |
$1,011.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$963.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,600.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,395.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,395.94
|
| Rate for Payer: Priority Health SBD |
$2,395.94
|
| Rate for Payer: UMR Bronson Commercial |
$3,023.12
|
|
