|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Facility
|
OP
|
$1,406.00
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
45381
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$333.93 |
| Max. Negotiated Rate |
$1,265.40 |
| Rate for Payer: Aetna Commercial |
$1,195.10
|
| Rate for Payer: Aetna Medicare |
$365.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$439.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$439.38
|
| Rate for Payer: BCBS Complete |
$895.16
|
| Rate for Payer: BCBS MAPPO |
$351.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,155.87
|
| Rate for Payer: BCN Commercial |
$1,093.16
|
| Rate for Payer: BCN Medicare Advantage |
$351.50
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cofinity Commercial |
$1,209.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,124.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.50
|
| Rate for Payer: Healthscope Commercial |
$1,265.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,054.50
|
| Rate for Payer: Mclaren Medicaid |
$852.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.07
|
| Rate for Payer: Meridian Medicaid |
$895.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$404.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.10
|
| Rate for Payer: Nomi Health Commercial |
$1,152.92
|
| Rate for Payer: PACE Senior Care Partners |
$333.93
|
| Rate for Payer: PACE SWMI |
$351.50
|
| Rate for Payer: PHP Commercial |
$1,195.10
|
| Rate for Payer: PHP Medicare Advantage |
$351.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$852.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1,223.22
|
| Rate for Payer: Priority Health Medicare |
$355.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$942.02
|
| Rate for Payer: Railroad Medicare Medicare |
$351.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,237.28
|
| Rate for Payer: UHC Core |
$1,174.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.50
|
| Rate for Payer: UHC Exchange |
$351.50
|
| Rate for Payer: UHC Medicare Advantage |
$351.50
|
| Rate for Payer: UHCCP Medicaid |
$852.47
|
| Rate for Payer: VA VA |
$351.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,054.50
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$1,406.00
|
|
|
Service Code
|
HCPCS 45381
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Aetna Commercial |
$254.41
|
| Rate for Payer: Aetna Medicare |
$197.45
|
| Rate for Payer: BCBS Complete |
$562.40
|
| Rate for Payer: BCBS MAPPO |
$189.86
|
| Rate for Payer: BCN Medicare Advantage |
$189.86
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cofinity Commercial |
$273.40
|
| Rate for Payer: Cofinity Commercial |
$254.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.35
|
| Rate for Payer: Nomi Health Commercial |
$227.83
|
| Rate for Payer: PACE SWMI |
$189.86
|
| Rate for Payer: PHP Medicare Advantage |
$189.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.90
|
| Rate for Payer: Priority Health Medicare |
$191.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.86
|
| Rate for Payer: UHC Exchange |
$189.86
|
| Rate for Payer: UHC Medicare Advantage |
$189.86
|
|
|
PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 45391
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$353.60 |
| Rate for Payer: Aetna Commercial |
$324.52
|
| Rate for Payer: Aetna Medicare |
$251.87
|
| Rate for Payer: BCBS Complete |
$217.60
|
| Rate for Payer: BCBS MAPPO |
$242.18
|
| Rate for Payer: BCN Medicare Advantage |
$242.18
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cofinity Commercial |
$348.74
|
| Rate for Payer: Cofinity Commercial |
$324.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.29
|
| Rate for Payer: Nomi Health Commercial |
$290.62
|
| Rate for Payer: PACE SWMI |
$242.18
|
| Rate for Payer: PHP Medicare Advantage |
$242.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.60
|
| Rate for Payer: Priority Health Medicare |
$244.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.18
|
| Rate for Payer: UHC Exchange |
$242.18
|
| Rate for Payer: UHC Medicare Advantage |
$242.18
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$1,303.20 |
| Rate for Payer: Aetna Commercial |
$1,230.80
|
| Rate for Payer: Aetna Medicare |
$376.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.50
|
| Rate for Payer: BCBS Complete |
$895.16
|
| Rate for Payer: BCBS MAPPO |
$362.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,190.40
|
| Rate for Payer: BCN Commercial |
$1,125.82
|
| Rate for Payer: BCN Medicare Advantage |
$362.00
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,245.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.00
|
| Rate for Payer: Healthscope Commercial |
$1,303.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.00
|
| Rate for Payer: Mclaren Medicaid |
$852.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.10
|
| Rate for Payer: Meridian Medicaid |
$895.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: PACE Senior Care Partners |
$343.90
|
| Rate for Payer: PACE SWMI |
$362.00
|
| Rate for Payer: PHP Commercial |
$1,230.80
|
| Rate for Payer: PHP Medicare Advantage |
$362.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$852.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,259.76
|
| Rate for Payer: Priority Health Medicare |
$365.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.16
|
| Rate for Payer: Railroad Medicare Medicare |
$362.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.24
|
| Rate for Payer: UHC Core |
$1,209.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.00
|
| Rate for Payer: UHC Exchange |
$362.00
|
| Rate for Payer: UHC Medicare Advantage |
$362.00
|
| Rate for Payer: UHCCP Medicaid |
$852.47
|
| Rate for Payer: VA VA |
$362.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.00
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$941.20 |
| Max. Negotiated Rate |
$1,303.20 |
| Rate for Payer: Aetna Commercial |
$1,230.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.00
|
| Rate for Payer: BCN Commercial |
$1,119.01
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,245.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Healthscope Commercial |
$1,303.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: PHP Commercial |
$1,230.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,259.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.24
|
| Rate for Payer: UHC Core |
$1,209.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.00
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
45384
|
| Min. Negotiated Rate |
$216.55 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$290.18
|
| Rate for Payer: Aetna Medicare |
$225.21
|
| Rate for Payer: BCBS Complete |
$579.20
|
| Rate for Payer: BCBS MAPPO |
$216.55
|
| Rate for Payer: BCN Medicare Advantage |
$216.55
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$311.83
|
| Rate for Payer: Cofinity Commercial |
$290.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.38
|
| Rate for Payer: Nomi Health Commercial |
$259.86
|
| Rate for Payer: PACE SWMI |
$216.55
|
| Rate for Payer: PHP Medicare Advantage |
$216.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health Medicare |
$218.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.55
|
| Rate for Payer: UHC Exchange |
$216.55
|
| Rate for Payer: UHC Medicare Advantage |
$216.55
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45384
|
| Min. Negotiated Rate |
$216.55 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$290.18
|
| Rate for Payer: Aetna Medicare |
$225.21
|
| Rate for Payer: BCBS Complete |
$579.20
|
| Rate for Payer: BCBS MAPPO |
$216.55
|
| Rate for Payer: BCN Medicare Advantage |
$216.55
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$311.83
|
| Rate for Payer: Cofinity Commercial |
$290.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.38
|
| Rate for Payer: Nomi Health Commercial |
$259.86
|
| Rate for Payer: PACE SWMI |
$216.55
|
| Rate for Payer: PHP Medicare Advantage |
$216.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health Medicare |
$218.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.55
|
| Rate for Payer: UHC Exchange |
$216.55
|
| Rate for Payer: UHC Medicare Advantage |
$216.55
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
45385
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$320.53
|
| Rate for Payer: Aetna Medicare |
$248.77
|
| Rate for Payer: BCBS Complete |
$579.20
|
| Rate for Payer: BCBS MAPPO |
$239.20
|
| Rate for Payer: BCN Medicare Advantage |
$239.20
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$344.45
|
| Rate for Payer: Cofinity Commercial |
$320.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.16
|
| Rate for Payer: Nomi Health Commercial |
$287.04
|
| Rate for Payer: PACE SWMI |
$239.20
|
| Rate for Payer: PHP Medicare Advantage |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health Medicare |
$241.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.20
|
| Rate for Payer: UHC Exchange |
$239.20
|
| Rate for Payer: UHC Medicare Advantage |
$239.20
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$941.20 |
| Max. Negotiated Rate |
$1,303.20 |
| Rate for Payer: Aetna Commercial |
$1,230.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.00
|
| Rate for Payer: BCN Commercial |
$1,119.01
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,245.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Healthscope Commercial |
$1,303.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: PHP Commercial |
$1,230.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,259.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.24
|
| Rate for Payer: UHC Core |
$1,209.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.00
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45385
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$320.53
|
| Rate for Payer: Aetna Medicare |
$248.77
|
| Rate for Payer: BCBS Complete |
$579.20
|
| Rate for Payer: BCBS MAPPO |
$239.20
|
| Rate for Payer: BCN Medicare Advantage |
$239.20
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$344.45
|
| Rate for Payer: Cofinity Commercial |
$320.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.16
|
| Rate for Payer: Nomi Health Commercial |
$287.04
|
| Rate for Payer: PACE SWMI |
$239.20
|
| Rate for Payer: PHP Medicare Advantage |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health Medicare |
$241.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.20
|
| Rate for Payer: UHC Exchange |
$239.20
|
| Rate for Payer: UHC Medicare Advantage |
$239.20
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$1,303.20 |
| Rate for Payer: Aetna Commercial |
$1,230.80
|
| Rate for Payer: Aetna Medicare |
$376.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.50
|
| Rate for Payer: BCBS Complete |
$895.16
|
| Rate for Payer: BCBS MAPPO |
$362.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,190.40
|
| Rate for Payer: BCN Commercial |
$1,125.82
|
| Rate for Payer: BCN Medicare Advantage |
$362.00
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,245.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.00
|
| Rate for Payer: Healthscope Commercial |
$1,303.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.00
|
| Rate for Payer: Mclaren Medicaid |
$852.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.10
|
| Rate for Payer: Meridian Medicaid |
$895.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: PACE Senior Care Partners |
$343.90
|
| Rate for Payer: PACE SWMI |
$362.00
|
| Rate for Payer: PHP Commercial |
$1,230.80
|
| Rate for Payer: PHP Medicare Advantage |
$362.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$852.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,259.76
|
| Rate for Payer: Priority Health Medicare |
$365.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.16
|
| Rate for Payer: Railroad Medicare Medicare |
$362.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.24
|
| Rate for Payer: UHC Core |
$1,209.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.00
|
| Rate for Payer: UHC Exchange |
$362.00
|
| Rate for Payer: UHC Medicare Advantage |
$362.00
|
| Rate for Payer: UHCCP Medicaid |
$852.47
|
| Rate for Payer: VA VA |
$362.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.00
|
|
|
PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 45392
|
| Min. Negotiated Rate |
$285.58 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$382.68
|
| Rate for Payer: Aetna Medicare |
$297.00
|
| Rate for Payer: BCBS Complete |
$398.00
|
| Rate for Payer: BCBS MAPPO |
$285.58
|
| Rate for Payer: BCN Medicare Advantage |
$285.58
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cofinity Commercial |
$411.24
|
| Rate for Payer: Cofinity Commercial |
$382.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.86
|
| Rate for Payer: Nomi Health Commercial |
$342.70
|
| Rate for Payer: PACE SWMI |
$285.58
|
| Rate for Payer: PHP Medicare Advantage |
$285.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health Medicare |
$288.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.58
|
| Rate for Payer: UHC Exchange |
$285.58
|
| Rate for Payer: UHC Medicare Advantage |
$285.58
|
|
|
PR COMM SVCS BY RHC/FQHC 5 MIN
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS G0071
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
|
|
PR COMPLETE REPLACEMENT PICC RS&I
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 36584
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$261.30 |
| Rate for Payer: Aetna Commercial |
$74.81
|
| Rate for Payer: Aetna Medicare |
$58.06
|
| Rate for Payer: BCBS Complete |
$160.80
|
| Rate for Payer: BCBS MAPPO |
$55.83
|
| Rate for Payer: BCN Medicare Advantage |
$55.83
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$80.40
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.62
|
| Rate for Payer: Nomi Health Commercial |
$67.00
|
| Rate for Payer: PACE SWMI |
$55.83
|
| Rate for Payer: PHP Medicare Advantage |
$55.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health Medicare |
$56.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.83
|
| Rate for Payer: UHC Exchange |
$55.83
|
| Rate for Payer: UHC Medicare Advantage |
$55.83
|
|
|
PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 93303
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$279.94 |
| Rate for Payer: Aetna Commercial |
$260.50
|
| Rate for Payer: Aetna Medicare |
$202.18
|
| Rate for Payer: BCBS Complete |
$145.20
|
| Rate for Payer: BCBS MAPPO |
$194.40
|
| Rate for Payer: BCN Medicare Advantage |
$194.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cofinity Commercial |
$260.50
|
| Rate for Payer: Cofinity Commercial |
$279.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.12
|
| Rate for Payer: Nomi Health Commercial |
$233.28
|
| Rate for Payer: PACE SWMI |
$194.40
|
| Rate for Payer: PHP Medicare Advantage |
$194.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.95
|
| Rate for Payer: Priority Health Medicare |
$196.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.40
|
| Rate for Payer: UHC Exchange |
$194.40
|
| Rate for Payer: UHC Medicare Advantage |
$194.40
|
|
|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$123.24 |
| Rate for Payer: Aetna Commercial |
$114.68
|
| Rate for Payer: Aetna Medicare |
$89.00
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$85.58
|
| Rate for Payer: BCN Medicare Advantage |
$85.58
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$123.24
|
| Rate for Payer: Cofinity Commercial |
$114.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.86
|
| Rate for Payer: Nomi Health Commercial |
$102.70
|
| Rate for Payer: PACE SWMI |
$85.58
|
| Rate for Payer: PHP Medicare Advantage |
$85.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$86.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.58
|
| Rate for Payer: UHC Exchange |
$85.58
|
| Rate for Payer: UHC Medicare Advantage |
$85.58
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 51727
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$445.25 |
| Rate for Payer: Aetna Commercial |
$414.02
|
| Rate for Payer: Aetna Medicare |
$321.33
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCBS MAPPO |
$308.97
|
| Rate for Payer: BCN Medicare Advantage |
$308.97
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$444.92
|
| Rate for Payer: Cofinity Commercial |
$414.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.42
|
| Rate for Payer: Nomi Health Commercial |
$370.76
|
| Rate for Payer: PACE SWMI |
$308.97
|
| Rate for Payer: PHP Medicare Advantage |
$308.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.25
|
| Rate for Payer: Priority Health Medicare |
$312.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.97
|
| Rate for Payer: UHC Exchange |
$308.97
|
| Rate for Payer: UHC Medicare Advantage |
$308.97
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 51728
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$442.31 |
| Rate for Payer: Aetna Commercial |
$411.59
|
| Rate for Payer: Aetna Medicare |
$319.45
|
| Rate for Payer: BCBS Complete |
$264.00
|
| Rate for Payer: BCBS MAPPO |
$307.16
|
| Rate for Payer: BCN Medicare Advantage |
$307.16
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$442.31
|
| Rate for Payer: Cofinity Commercial |
$411.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$322.52
|
| Rate for Payer: Nomi Health Commercial |
$368.59
|
| Rate for Payer: PACE SWMI |
$307.16
|
| Rate for Payer: PHP Medicare Advantage |
$307.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.00
|
| Rate for Payer: Priority Health Medicare |
$310.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$307.16
|
| Rate for Payer: UHC Exchange |
$307.16
|
| Rate for Payer: UHC Medicare Advantage |
$307.16
|
|
|
PR COMPLEX E/M VISIT ADD ON
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G2211
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Aetna Medicare |
$15.87
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$15.26
|
| Rate for Payer: BCN Medicare Advantage |
$15.26
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$21.97
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.02
|
| Rate for Payer: Nomi Health Commercial |
$18.31
|
| Rate for Payer: PACE SWMI |
$15.26
|
| Rate for Payer: PHP Medicare Advantage |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$15.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.26
|
| Rate for Payer: UHC Exchange |
$15.26
|
| Rate for Payer: UHC Medicare Advantage |
$15.26
|
|
|
PR COMPLEX IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$4,304.00
|
|
|
Service Code
|
HCPCS 00564
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,721.60 |
| Max. Negotiated Rate |
$2,797.60 |
| Rate for Payer: Aetna Medicare |
$2,152.00
|
| Rate for Payer: BCBS Complete |
$1,721.60
|
| Rate for Payer: Cash Price |
$3,443.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.60
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$13.41
|
| Rate for Payer: BCN Medicare Advantage |
$13.41
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Cofinity Commercial |
$17.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.08
|
| Rate for Payer: Nomi Health Commercial |
$16.09
|
| Rate for Payer: PACE SWMI |
$13.41
|
| Rate for Payer: PHP Medicare Advantage |
$13.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.41
|
| Rate for Payer: UHC Exchange |
$13.41
|
| Rate for Payer: UHC Medicare Advantage |
$13.41
|
|
|
PR COMPL OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 92018
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$189.20 |
| Rate for Payer: Aetna Commercial |
$176.06
|
| Rate for Payer: Aetna Medicare |
$136.65
|
| Rate for Payer: BCBS Complete |
$85.60
|
| Rate for Payer: BCBS MAPPO |
$131.39
|
| Rate for Payer: BCN Medicare Advantage |
$131.39
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$176.06
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.96
|
| Rate for Payer: Nomi Health Commercial |
$157.67
|
| Rate for Payer: PACE SWMI |
$131.39
|
| Rate for Payer: PHP Medicare Advantage |
$131.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| Rate for Payer: Priority Health Medicare |
$132.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.39
|
| Rate for Payer: UHC Exchange |
$131.39
|
| Rate for Payer: UHC Medicare Advantage |
$131.39
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 51729
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$470.78 |
| Rate for Payer: Aetna Commercial |
$438.09
|
| Rate for Payer: Aetna Medicare |
$340.01
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$326.93
|
| Rate for Payer: BCN Medicare Advantage |
$326.93
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$470.78
|
| Rate for Payer: Cofinity Commercial |
$438.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.28
|
| Rate for Payer: Nomi Health Commercial |
$392.32
|
| Rate for Payer: PACE SWMI |
$326.93
|
| Rate for Payer: PHP Medicare Advantage |
$326.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$330.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.93
|
| Rate for Payer: UHC Exchange |
$326.93
|
| Rate for Payer: UHC Medicare Advantage |
$326.93
|
|
|
PR COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$10,302.00
|
|
|
Service Code
|
HCPCS 61697
|
| Min. Negotiated Rate |
$4,120.80 |
| Max. Negotiated Rate |
$6,696.30 |
| Rate for Payer: Aetna Commercial |
$5,598.91
|
| Rate for Payer: Aetna Medicare |
$4,345.42
|
| Rate for Payer: BCBS Complete |
$4,120.80
|
| Rate for Payer: BCBS MAPPO |
$4,178.29
|
| Rate for Payer: BCN Medicare Advantage |
$4,178.29
|
| Rate for Payer: Cash Price |
$8,241.60
|
| Rate for Payer: Cash Price |
$8,241.60
|
| Rate for Payer: Cofinity Commercial |
$6,016.74
|
| Rate for Payer: Cofinity Commercial |
$5,598.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,178.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,387.20
|
| Rate for Payer: Nomi Health Commercial |
$5,013.95
|
| Rate for Payer: PACE SWMI |
$4,178.29
|
| Rate for Payer: PHP Medicare Advantage |
$4,178.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,696.30
|
| Rate for Payer: Priority Health Medicare |
$4,220.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,178.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,178.29
|
| Rate for Payer: UHC Exchange |
$4,178.29
|
| Rate for Payer: UHC Medicare Advantage |
$4,178.29
|
|
|
PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 92557
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Commercial |
$40.05
|
| Rate for Payer: Aetna Medicare |
$31.09
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS MAPPO |
$29.89
|
| Rate for Payer: BCN Medicare Advantage |
$29.89
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$43.04
|
| Rate for Payer: Cofinity Commercial |
$40.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.38
|
| Rate for Payer: Nomi Health Commercial |
$35.87
|
| Rate for Payer: PACE SWMI |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health Medicare |
$30.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.89
|
| Rate for Payer: UHC Exchange |
$29.89
|
| Rate for Payer: UHC Medicare Advantage |
$29.89
|
|
