|
PR REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Professional
|
Both
|
$471.00
|
|
|
Service Code
|
HCPCS 67938
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$1,699.01 |
| Rate for Payer: Aetna Commercial |
$151.12
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,699.01
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.32
|
| Rate for Payer: Priority Health Narrow Network |
$204.32
|
| Rate for Payer: Priority Health SBD |
$204.32
|
| Rate for Payer: UMR Bronson Commercial |
$216.66
|
|
|
PR REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 20694
|
| Min. Negotiated Rate |
$221.95 |
| Max. Negotiated Rate |
$22,818.32 |
| Rate for Payer: Aetna Commercial |
$448.62
|
| Rate for Payer: BCBS Complete |
$233.05
|
| Rate for Payer: BCBS Trust/PPO |
$22,818.32
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Meridian Medicaid |
$233.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$524.44
|
| Rate for Payer: Priority Health Narrow Network |
$524.44
|
| Rate for Payer: Priority Health SBD |
$524.44
|
| Rate for Payer: UMR Bronson Commercial |
$430.10
|
|
|
PR REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 65205
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$238.26 |
| Rate for Payer: Aetna Commercial |
$38.66
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.34
|
| Rate for Payer: Priority Health Narrow Network |
$50.34
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
|
|
PR REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 54115
|
| Min. Negotiated Rate |
$273.71 |
| Max. Negotiated Rate |
$2,119.54 |
| Rate for Payer: Aetna Commercial |
$543.74
|
| Rate for Payer: BCBS Complete |
$287.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,119.54
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Meridian Medicaid |
$287.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.48
|
| Rate for Payer: Priority Health Narrow Network |
$682.48
|
| Rate for Payer: Priority Health SBD |
$682.48
|
| Rate for Payer: UMR Bronson Commercial |
$383.18
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
27372
|
| Min. Negotiated Rate |
$259.65 |
| Max. Negotiated Rate |
$3,545.42 |
| Rate for Payer: Aetna Commercial |
$533.27
|
| Rate for Payer: BCBS Complete |
$272.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,545.42
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Meridian Medicaid |
$272.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.38
|
| Rate for Payer: Priority Health Narrow Network |
$617.38
|
| Rate for Payer: Priority Health SBD |
$617.38
|
| Rate for Payer: UMR Bronson Commercial |
$502.32
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 27372
|
| Min. Negotiated Rate |
$259.65 |
| Max. Negotiated Rate |
$3,545.42 |
| Rate for Payer: Aetna Commercial |
$533.27
|
| Rate for Payer: BCBS Complete |
$272.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,545.42
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Meridian Medicaid |
$272.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.38
|
| Rate for Payer: Priority Health Narrow Network |
$617.38
|
| Rate for Payer: Priority Health SBD |
$617.38
|
| Rate for Payer: UMR Bronson Commercial |
$502.32
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
27372
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$399.15 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna American Axle |
$709.80
|
| Rate for Payer: Aetna Commercial |
$928.20
|
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,787.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cofinity Commercial |
$764.40
|
| Rate for Payer: Cofinity Commercial |
$939.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$982.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$764.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.00
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$928.20
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$928.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,951.14
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,360.91
|
| Rate for Payer: Priority Health SBD |
$687.96
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$399.15
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: UMR Bronson Commercial |
$404.04
|
| Rate for Payer: VA VA |
$2,525.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.00
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
27372
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$982.80 |
| Rate for Payer: Aetna American Axle |
$709.80
|
| Rate for Payer: Aetna Commercial |
$928.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.80
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cofinity Commercial |
$764.40
|
| Rate for Payer: Cofinity Commercial |
$939.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.60
|
| Rate for Payer: Healthscope Commercial |
$982.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$764.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$928.20
|
| Rate for Payer: PHP Commercial |
$928.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.40
|
| Rate for Payer: Priority Health SBD |
$687.96
|
| Rate for Payer: UMR Bronson Commercial |
$480.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.00
|
|
|
PR REMOVAL FOREIGN BODY FOOT COMPLICATED
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 28193
|
| Min. Negotiated Rate |
$235.15 |
| Max. Negotiated Rate |
$1,271.09 |
| Rate for Payer: Aetna Commercial |
$486.43
|
| Rate for Payer: BCBS Complete |
$246.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Meridian Medicaid |
$246.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.10
|
| Rate for Payer: Priority Health Narrow Network |
$556.10
|
| Rate for Payer: Priority Health SBD |
$556.10
|
| Rate for Payer: UMR Bronson Commercial |
$425.04
|
|
|
PR REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 28192
|
| Min. Negotiated Rate |
$199.79 |
| Max. Negotiated Rate |
$1,065.05 |
| Rate for Payer: Aetna Commercial |
$411.56
|
| Rate for Payer: BCBS Complete |
$209.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.05
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Meridian Medicaid |
$209.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.33
|
| Rate for Payer: Priority Health Narrow Network |
$471.33
|
| Rate for Payer: Priority Health SBD |
$471.33
|
| Rate for Payer: UMR Bronson Commercial |
$345.00
|
|
|
PR REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
HCPCS 28190
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$996.37 |
| Rate for Payer: Aetna Commercial |
$176.00
|
| Rate for Payer: BCBS Complete |
$89.46
|
| Rate for Payer: BCBS Trust/PPO |
$996.37
|
| Rate for Payer: Cash Price |
$468.80
|
| Rate for Payer: Cash Price |
$468.80
|
| Rate for Payer: Meridian Medicaid |
$89.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.69
|
| Rate for Payer: Priority Health Narrow Network |
$200.69
|
| Rate for Payer: Priority Health SBD |
$200.69
|
| Rate for Payer: UMR Bronson Commercial |
$269.56
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 30310
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$1,405.81 |
| Rate for Payer: Aetna Commercial |
$262.26
|
| Rate for Payer: BCBS Complete |
$140.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,405.81
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Meridian Medicaid |
$140.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.72
|
| Rate for Payer: Priority Health Narrow Network |
$291.72
|
| Rate for Payer: Priority Health SBD |
$291.72
|
| Rate for Payer: UMR Bronson Commercial |
$166.52
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 30300
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$829.43 |
| Rate for Payer: Aetna Commercial |
$151.15
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$829.43
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Meridian Medicaid |
$83.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.65
|
| Rate for Payer: Priority Health Narrow Network |
$173.65
|
| Rate for Payer: Priority Health SBD |
$173.65
|
| Rate for Payer: UMR Bronson Commercial |
$176.64
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
20520
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$1,002.07 |
| Rate for Payer: Aetna Commercial |
$194.22
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.07
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.68
|
| Rate for Payer: Priority Health Narrow Network |
$224.68
|
| Rate for Payer: Priority Health SBD |
$224.68
|
| Rate for Payer: UMR Bronson Commercial |
$182.62
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
20520
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.64 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna American Axle |
$215.15
|
| Rate for Payer: Aetna Commercial |
$281.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.15
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$231.70
|
| Rate for Payer: Cofinity Commercial |
$284.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.80
|
| Rate for Payer: Healthscope Commercial |
$297.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.35
|
| Rate for Payer: PHP Commercial |
$281.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health SBD |
$208.53
|
| Rate for Payer: UMR Bronson Commercial |
$145.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.25
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
20520
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$122.47 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$215.15
|
| Rate for Payer: Aetna Commercial |
$281.35
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$284.66
|
| Rate for Payer: Cofinity Commercial |
$231.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$297.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.25
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.35
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$281.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$208.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$146.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$122.47
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.25
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 20520
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$1,002.07 |
| Rate for Payer: Aetna Commercial |
$194.22
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.07
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.68
|
| Rate for Payer: Priority Health Narrow Network |
$224.68
|
| Rate for Payer: Priority Health SBD |
$224.68
|
| Rate for Payer: UMR Bronson Commercial |
$182.62
|
|
|
PR REMOVAL FOREIGN BODY PELVIS/HIP DEEP
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 27087
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$1,172.30 |
| Rate for Payer: Aetna Commercial |
$821.49
|
| Rate for Payer: BCBS Complete |
$417.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,172.30
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Meridian Medicaid |
$417.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$946.75
|
| Rate for Payer: Priority Health Narrow Network |
$946.75
|
| Rate for Payer: Priority Health SBD |
$946.75
|
| Rate for Payer: UMR Bronson Commercial |
$616.40
|
|
|
PR REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 42809
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$222.84 |
| Rate for Payer: Aetna Commercial |
$165.73
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.84
|
| Rate for Payer: Priority Health Narrow Network |
$222.84
|
| Rate for Payer: Priority Health SBD |
$222.84
|
| Rate for Payer: UMR Bronson Commercial |
$136.62
|
|
|
PR REMOVAL FOREIGN BODY SCROTUM
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
HCPCS 55120
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$3,266.48 |
| Rate for Payer: Aetna Commercial |
$452.80
|
| Rate for Payer: BCBS Complete |
$239.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,266.48
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Meridian Medicaid |
$239.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$568.99
|
| Rate for Payer: Priority Health Narrow Network |
$568.99
|
| Rate for Payer: Priority Health SBD |
$568.99
|
| Rate for Payer: UMR Bronson Commercial |
$301.76
|
|
|
PR REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 23330
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$308.70 |
| Rate for Payer: Aetna Commercial |
$220.75
|
| Rate for Payer: BCBS Complete |
$114.28
|
| Rate for Payer: BCBS Trust/PPO |
$64.52
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Meridian Medicaid |
$114.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.85
|
| Rate for Payer: Priority Health Narrow Network |
$256.85
|
| Rate for Payer: Priority Health SBD |
$256.85
|
| Rate for Payer: UMR Bronson Commercial |
$202.86
|
|
|
PR REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
HCPCS 24201
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$622.30 |
| Rate for Payer: Aetna Commercial |
$485.08
|
| Rate for Payer: BCBS Complete |
$274.42
|
| Rate for Payer: BCBS Trust/PPO |
$162.72
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Meridian Medicaid |
$274.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$566.31
|
| Rate for Payer: Priority Health Narrow Network |
$566.31
|
| Rate for Payer: Priority Health SBD |
$566.31
|
| Rate for Payer: UMR Bronson Commercial |
$408.94
|
|
|
PR REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,064.00
|
|
|
Service Code
|
HCPCS 27090
|
| Min. Negotiated Rate |
$412.60 |
| Max. Negotiated Rate |
$1,444.80 |
| Rate for Payer: Aetna Commercial |
$1,106.89
|
| Rate for Payer: BCBS Complete |
$562.03
|
| Rate for Payer: BCBS Trust/PPO |
$412.60
|
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Meridian Medicaid |
$562.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,444.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,277.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,277.65
|
| Rate for Payer: Priority Health SBD |
$1,277.65
|
| Rate for Payer: UMR Bronson Commercial |
$949.44
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 69210
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$2,090.48 |
| Rate for Payer: Aetna Commercial |
$37.88
|
| Rate for Payer: BCBS Complete |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,090.48
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Meridian Medicaid |
$21.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.73
|
| Rate for Payer: Priority Health Narrow Network |
$45.73
|
| Rate for Payer: Priority Health SBD |
$45.73
|
| Rate for Payer: UMR Bronson Commercial |
$43.70
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 69209
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$2,108.45 |
| Rate for Payer: Aetna Commercial |
$16.11
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.45
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.69
|
| Rate for Payer: Priority Health Narrow Network |
$21.69
|
| Rate for Payer: Priority Health SBD |
$21.69
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
|
