|
PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING
|
Facility
|
OP
|
$1,548.00
|
|
|
Service Code
|
CPT 44378
|
| Hospital Charge Code |
44378
|
| Min. Negotiated Rate |
$367.65 |
| Max. Negotiated Rate |
$1,440.19 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Aetna Medicare |
$402.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$483.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$483.75
|
| Rate for Payer: BCBS Complete |
$1,440.19
|
| Rate for Payer: BCBS MAPPO |
$387.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,272.61
|
| Rate for Payer: BCN Commercial |
$1,203.57
|
| Rate for Payer: BCN Medicare Advantage |
$387.00
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.00
|
| Rate for Payer: Healthscope Commercial |
$1,393.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,161.00
|
| Rate for Payer: Mclaren Medicaid |
$1,371.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.35
|
| Rate for Payer: Meridian Medicaid |
$1,440.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$445.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: PACE Senior Care Partners |
$367.65
|
| Rate for Payer: PACE SWMI |
$387.00
|
| Rate for Payer: PHP Commercial |
$1,315.80
|
| Rate for Payer: PHP Medicare Advantage |
$387.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,371.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,346.76
|
| Rate for Payer: Priority Health Medicare |
$390.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,037.16
|
| Rate for Payer: Railroad Medicare Medicare |
$387.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,362.24
|
| Rate for Payer: UHC Core |
$1,292.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.00
|
| Rate for Payer: UHC Exchange |
$387.00
|
| Rate for Payer: UHC Medicare Advantage |
$387.00
|
| Rate for Payer: UHCCP Medicaid |
$1,371.52
|
| Rate for Payer: VA VA |
$387.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,161.00
|
|
|
PR ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
HCPCS 44370
|
| Min. Negotiated Rate |
$250.37 |
| Max. Negotiated Rate |
$899.60 |
| Rate for Payer: Aetna Commercial |
$335.50
|
| Rate for Payer: Aetna Medicare |
$260.38
|
| Rate for Payer: BCBS Complete |
$553.60
|
| Rate for Payer: BCBS MAPPO |
$250.37
|
| Rate for Payer: BCN Medicare Advantage |
$250.37
|
| Rate for Payer: Cash Price |
$1,107.20
|
| Rate for Payer: Cash Price |
$1,107.20
|
| Rate for Payer: Cofinity Commercial |
$360.53
|
| Rate for Payer: Cofinity Commercial |
$335.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$262.89
|
| Rate for Payer: Nomi Health Commercial |
$300.44
|
| Rate for Payer: PACE SWMI |
$250.37
|
| Rate for Payer: PHP Medicare Advantage |
$250.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.60
|
| Rate for Payer: Priority Health Medicare |
$252.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.37
|
| Rate for Payer: UHC Exchange |
$250.37
|
| Rate for Payer: UHC Medicare Advantage |
$250.37
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING
|
Professional
|
Both
|
$1,318.00
|
|
|
Service Code
|
HCPCS 44366
|
| Min. Negotiated Rate |
$225.25 |
| Max. Negotiated Rate |
$856.70 |
| Rate for Payer: Aetna Commercial |
$301.83
|
| Rate for Payer: Aetna Medicare |
$234.26
|
| Rate for Payer: BCBS Complete |
$527.20
|
| Rate for Payer: BCBS MAPPO |
$225.25
|
| Rate for Payer: BCN Medicare Advantage |
$225.25
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cofinity Commercial |
$324.36
|
| Rate for Payer: Cofinity Commercial |
$301.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.51
|
| Rate for Payer: Nomi Health Commercial |
$270.30
|
| Rate for Payer: PACE SWMI |
$225.25
|
| Rate for Payer: PHP Medicare Advantage |
$225.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.70
|
| Rate for Payer: Priority Health Medicare |
$227.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.25
|
| Rate for Payer: UHC Exchange |
$225.25
|
| Rate for Payer: UHC Medicare Advantage |
$225.25
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT
|
Professional
|
Both
|
$1,532.00
|
|
|
Service Code
|
HCPCS 44379
|
| Min. Negotiated Rate |
$383.86 |
| Max. Negotiated Rate |
$995.80 |
| Rate for Payer: Aetna Commercial |
$514.37
|
| Rate for Payer: Aetna Medicare |
$399.21
|
| Rate for Payer: BCBS Complete |
$612.80
|
| Rate for Payer: BCBS MAPPO |
$383.86
|
| Rate for Payer: BCN Medicare Advantage |
$383.86
|
| Rate for Payer: Cash Price |
$1,225.60
|
| Rate for Payer: Cash Price |
$1,225.60
|
| Rate for Payer: Cofinity Commercial |
$552.76
|
| Rate for Payer: Cofinity Commercial |
$514.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.05
|
| Rate for Payer: Nomi Health Commercial |
$460.63
|
| Rate for Payer: PACE SWMI |
$383.86
|
| Rate for Payer: PHP Medicare Advantage |
$383.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.80
|
| Rate for Payer: Priority Health Medicare |
$387.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$383.86
|
| Rate for Payer: UHC Exchange |
$383.86
|
| Rate for Payer: UHC Medicare Advantage |
$383.86
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 44372
|
| Min. Negotiated Rate |
$226.51 |
| Max. Negotiated Rate |
$611.00 |
| Rate for Payer: Aetna Commercial |
$303.52
|
| Rate for Payer: Aetna Medicare |
$235.57
|
| Rate for Payer: BCBS Complete |
$376.00
|
| Rate for Payer: BCBS MAPPO |
$226.51
|
| Rate for Payer: BCN Medicare Advantage |
$226.51
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cofinity Commercial |
$326.17
|
| Rate for Payer: Cofinity Commercial |
$303.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.84
|
| Rate for Payer: Nomi Health Commercial |
$271.81
|
| Rate for Payer: PACE SWMI |
$226.51
|
| Rate for Payer: PHP Medicare Advantage |
$226.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.00
|
| Rate for Payer: Priority Health Medicare |
$228.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.51
|
| Rate for Payer: UHC Exchange |
$226.51
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$974.00
|
|
|
Service Code
|
HCPCS 44363
|
| Min. Negotiated Rate |
$179.94 |
| Max. Negotiated Rate |
$633.10 |
| Rate for Payer: Aetna Commercial |
$241.12
|
| Rate for Payer: Aetna Medicare |
$187.14
|
| Rate for Payer: BCBS Complete |
$389.60
|
| Rate for Payer: BCBS MAPPO |
$179.94
|
| Rate for Payer: BCN Medicare Advantage |
$179.94
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cofinity Commercial |
$259.11
|
| Rate for Payer: Cofinity Commercial |
$241.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.94
|
| Rate for Payer: Nomi Health Commercial |
$215.93
|
| Rate for Payer: PACE SWMI |
$179.94
|
| Rate for Payer: PHP Medicare Advantage |
$179.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.10
|
| Rate for Payer: Priority Health Medicare |
$181.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.94
|
| Rate for Payer: UHC Exchange |
$179.94
|
| Rate for Payer: UHC Medicare Advantage |
$179.94
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 44365
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$229.65
|
| Rate for Payer: Aetna Medicare |
$178.24
|
| Rate for Payer: BCBS Complete |
$448.00
|
| Rate for Payer: BCBS MAPPO |
$171.38
|
| Rate for Payer: BCN Medicare Advantage |
$171.38
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$246.79
|
| Rate for Payer: Cofinity Commercial |
$229.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.95
|
| Rate for Payer: Nomi Health Commercial |
$205.66
|
| Rate for Payer: PACE SWMI |
$171.38
|
| Rate for Payer: PHP Medicare Advantage |
$171.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.00
|
| Rate for Payer: Priority Health Medicare |
$173.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.38
|
| Rate for Payer: UHC Exchange |
$171.38
|
| Rate for Payer: UHC Medicare Advantage |
$171.38
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 44364
|
| Min. Negotiated Rate |
$192.08 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$257.39
|
| Rate for Payer: Aetna Medicare |
$199.76
|
| Rate for Payer: BCBS Complete |
$448.00
|
| Rate for Payer: BCBS MAPPO |
$192.08
|
| Rate for Payer: BCN Medicare Advantage |
$192.08
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$276.60
|
| Rate for Payer: Cofinity Commercial |
$257.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.68
|
| Rate for Payer: Nomi Health Commercial |
$230.50
|
| Rate for Payer: PACE SWMI |
$192.08
|
| Rate for Payer: PHP Medicare Advantage |
$192.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.00
|
| Rate for Payer: Priority Health Medicare |
$194.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.08
|
| Rate for Payer: UHC Exchange |
$192.08
|
| Rate for Payer: UHC Medicare Advantage |
$192.08
|
|
|
PR ENTEROTOMY SM INT OTH/THN DUO DCMPRN
|
Professional
|
Both
|
$2,764.00
|
|
|
Service Code
|
HCPCS 44021
|
| Min. Negotiated Rate |
$947.33 |
| Max. Negotiated Rate |
$1,796.60 |
| Rate for Payer: Aetna Commercial |
$1,269.42
|
| Rate for Payer: Aetna Medicare |
$985.22
|
| Rate for Payer: BCBS Complete |
$1,105.60
|
| Rate for Payer: BCBS MAPPO |
$947.33
|
| Rate for Payer: BCN Medicare Advantage |
$947.33
|
| Rate for Payer: Cash Price |
$2,211.20
|
| Rate for Payer: Cash Price |
$2,211.20
|
| Rate for Payer: Cofinity Commercial |
$1,364.16
|
| Rate for Payer: Cofinity Commercial |
$1,269.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$947.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$994.70
|
| Rate for Payer: Nomi Health Commercial |
$1,136.80
|
| Rate for Payer: PACE SWMI |
$947.33
|
| Rate for Payer: PHP Medicare Advantage |
$947.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,796.60
|
| Rate for Payer: Priority Health Medicare |
$956.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$947.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$947.33
|
| Rate for Payer: UHC Exchange |
$947.33
|
| Rate for Payer: UHC Medicare Advantage |
$947.33
|
|
|
PR ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL
|
Professional
|
Both
|
$2,946.00
|
|
|
Service Code
|
HCPCS 44020
|
| Min. Negotiated Rate |
$947.95 |
| Max. Negotiated Rate |
$1,914.90 |
| Rate for Payer: Aetna Commercial |
$1,270.25
|
| Rate for Payer: Aetna Medicare |
$985.87
|
| Rate for Payer: BCBS Complete |
$1,178.40
|
| Rate for Payer: BCBS MAPPO |
$947.95
|
| Rate for Payer: BCN Medicare Advantage |
$947.95
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cofinity Commercial |
$1,365.05
|
| Rate for Payer: Cofinity Commercial |
$1,270.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$947.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$995.35
|
| Rate for Payer: Nomi Health Commercial |
$1,137.54
|
| Rate for Payer: PACE SWMI |
$947.95
|
| Rate for Payer: PHP Medicare Advantage |
$947.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,914.90
|
| Rate for Payer: Priority Health Medicare |
$957.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$947.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$947.95
|
| Rate for Payer: UHC Exchange |
$947.95
|
| Rate for Payer: UHC Medicare Advantage |
$947.95
|
|
|
PR ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$1,992.00
|
|
|
Service Code
|
HCPCS 44128
|
| Min. Negotiated Rate |
$236.17 |
| Max. Negotiated Rate |
$1,294.80 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Aetna Medicare |
$245.62
|
| Rate for Payer: BCBS Complete |
$796.80
|
| Rate for Payer: BCBS MAPPO |
$236.17
|
| Rate for Payer: BCN Medicare Advantage |
$236.17
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cofinity Commercial |
$340.08
|
| Rate for Payer: Cofinity Commercial |
$316.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.98
|
| Rate for Payer: Nomi Health Commercial |
$283.40
|
| Rate for Payer: PACE SWMI |
$236.17
|
| Rate for Payer: PHP Medicare Advantage |
$236.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.80
|
| Rate for Payer: Priority Health Medicare |
$238.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.17
|
| Rate for Payer: UHC Exchange |
$236.17
|
| Rate for Payer: UHC Medicare Advantage |
$236.17
|
|
|
PR ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING
|
Professional
|
Both
|
$5,027.00
|
|
|
Service Code
|
HCPCS 44127
|
| Min. Negotiated Rate |
$2,010.80 |
| Max. Negotiated Rate |
$3,991.65 |
| Rate for Payer: Aetna Commercial |
$3,714.45
|
| Rate for Payer: Aetna Medicare |
$2,882.86
|
| Rate for Payer: BCBS Complete |
$2,010.80
|
| Rate for Payer: BCBS MAPPO |
$2,771.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,771.98
|
| Rate for Payer: Cash Price |
$4,021.60
|
| Rate for Payer: Cash Price |
$4,021.60
|
| Rate for Payer: Cofinity Commercial |
$3,991.65
|
| Rate for Payer: Cofinity Commercial |
$3,714.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,771.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,910.58
|
| Rate for Payer: Nomi Health Commercial |
$3,326.38
|
| Rate for Payer: PACE SWMI |
$2,771.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,771.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,267.55
|
| Rate for Payer: Priority Health Medicare |
$2,799.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,771.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,771.98
|
| Rate for Payer: UHC Exchange |
$2,771.98
|
| Rate for Payer: UHC Medicare Advantage |
$2,771.98
|
|
|
PR ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING
|
Professional
|
Both
|
$4,332.00
|
|
|
Service Code
|
HCPCS 44126
|
| Min. Negotiated Rate |
$1,732.80 |
| Max. Negotiated Rate |
$3,457.18 |
| Rate for Payer: Aetna Commercial |
$3,217.10
|
| Rate for Payer: Aetna Medicare |
$2,496.85
|
| Rate for Payer: BCBS Complete |
$1,732.80
|
| Rate for Payer: BCBS MAPPO |
$2,400.82
|
| Rate for Payer: BCN Medicare Advantage |
$2,400.82
|
| Rate for Payer: Cash Price |
$3,465.60
|
| Rate for Payer: Cash Price |
$3,465.60
|
| Rate for Payer: Cofinity Commercial |
$3,457.18
|
| Rate for Payer: Cofinity Commercial |
$3,217.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,400.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,520.86
|
| Rate for Payer: Nomi Health Commercial |
$2,880.98
|
| Rate for Payer: PACE SWMI |
$2,400.82
|
| Rate for Payer: PHP Medicare Advantage |
$2,400.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,815.80
|
| Rate for Payer: Priority Health Medicare |
$2,424.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,400.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,400.82
|
| Rate for Payer: UHC Exchange |
$2,400.82
|
| Rate for Payer: UHC Medicare Advantage |
$2,400.82
|
|
|
PR ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$3,316.00
|
|
|
Service Code
|
HCPCS 44120
|
| Min. Negotiated Rate |
$1,186.81 |
| Max. Negotiated Rate |
$2,155.40 |
| Rate for Payer: Aetna Commercial |
$1,590.33
|
| Rate for Payer: Aetna Medicare |
$1,234.28
|
| Rate for Payer: BCBS Complete |
$1,326.40
|
| Rate for Payer: BCBS MAPPO |
$1,186.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,186.81
|
| Rate for Payer: Cash Price |
$2,652.80
|
| Rate for Payer: Cash Price |
$2,652.80
|
| Rate for Payer: Cofinity Commercial |
$1,709.01
|
| Rate for Payer: Cofinity Commercial |
$1,590.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,186.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,246.15
|
| Rate for Payer: Nomi Health Commercial |
$1,424.17
|
| Rate for Payer: PACE SWMI |
$1,186.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,186.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,155.40
|
| Rate for Payer: Priority Health Medicare |
$1,198.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,186.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,186.81
|
| Rate for Payer: UHC Exchange |
$1,186.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,186.81
|
|
|
PR EO W/O JOINTS CF
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS L3702
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$455.96 |
| Rate for Payer: Aetna Commercial |
$424.30
|
| Rate for Payer: Aetna Medicare |
$329.31
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS MAPPO |
$316.64
|
| Rate for Payer: BCN Medicare Advantage |
$316.64
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$455.96
|
| Rate for Payer: Cofinity Commercial |
$424.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.47
|
| Rate for Payer: Nomi Health Commercial |
$379.97
|
| Rate for Payer: PACE SWMI |
$316.64
|
| Rate for Payer: PHP Medicare Advantage |
$316.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$319.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.64
|
| Rate for Payer: UHC Exchange |
$316.64
|
| Rate for Payer: UHC Medicare Advantage |
$316.64
|
|
|
PR EPDRM AGRFT T/A/L EA ADD 100 SQCM/EA 1%INFT/CHLD
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 15111
|
| Min. Negotiated Rate |
$98.85 |
| Max. Negotiated Rate |
$165.10 |
| Rate for Payer: Aetna Commercial |
$132.46
|
| Rate for Payer: Aetna Medicare |
$102.80
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS MAPPO |
$98.85
|
| Rate for Payer: BCN Medicare Advantage |
$98.85
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$142.34
|
| Rate for Payer: Cofinity Commercial |
$132.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.79
|
| Rate for Payer: Nomi Health Commercial |
$118.62
|
| Rate for Payer: PACE SWMI |
$98.85
|
| Rate for Payer: PHP Medicare Advantage |
$98.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.10
|
| Rate for Payer: Priority Health Medicare |
$99.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.85
|
| Rate for Payer: UHC Exchange |
$98.85
|
| Rate for Payer: UHC Medicare Advantage |
$98.85
|
|
|
PR EP EVAL 1/2CHMB PACG CVDFB LDS TSTG OF PULSE GEN
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 93641
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Medicare |
$268.50
|
| Rate for Payer: BCBS Complete |
$214.80
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.05
|
|
|
PR EP EVAL 1/2 CHMB TRANSVNS PAC CVDFB
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 93642
|
| Min. Negotiated Rate |
$309.44 |
| Max. Negotiated Rate |
$1,127.10 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Medicare |
$321.82
|
| Rate for Payer: BCBS Complete |
$693.60
|
| Rate for Payer: BCBS MAPPO |
$309.44
|
| Rate for Payer: BCN Medicare Advantage |
$309.44
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$445.59
|
| Rate for Payer: Cofinity Commercial |
$414.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.91
|
| Rate for Payer: Nomi Health Commercial |
$371.33
|
| Rate for Payer: PACE SWMI |
$309.44
|
| Rate for Payer: PHP Medicare Advantage |
$309.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health Medicare |
$312.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.44
|
| Rate for Payer: UHC Exchange |
$309.44
|
| Rate for Payer: UHC Medicare Advantage |
$309.44
|
|
|
PR EPIDERMAL AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/<
|
Professional
|
Both
|
$1,468.00
|
|
|
Service Code
|
HCPCS 15115
|
| Min. Negotiated Rate |
$587.20 |
| Max. Negotiated Rate |
$966.20 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Medicare |
$697.81
|
| Rate for Payer: BCBS Complete |
$587.20
|
| Rate for Payer: BCBS MAPPO |
$670.97
|
| Rate for Payer: BCN Medicare Advantage |
$670.97
|
| Rate for Payer: Cash Price |
$1,174.40
|
| Rate for Payer: Cash Price |
$1,174.40
|
| Rate for Payer: Cofinity Commercial |
$966.20
|
| Rate for Payer: Cofinity Commercial |
$899.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$670.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$704.52
|
| Rate for Payer: Nomi Health Commercial |
$805.16
|
| Rate for Payer: PACE SWMI |
$670.97
|
| Rate for Payer: PHP Medicare Advantage |
$670.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.20
|
| Rate for Payer: Priority Health Medicare |
$677.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$670.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$670.97
|
| Rate for Payer: UHC Exchange |
$670.97
|
| Rate for Payer: UHC Medicare Advantage |
$670.97
|
|
|
PR EPIDERMAL AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 15116
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$217.10 |
| Rate for Payer: Aetna Commercial |
$179.08
|
| Rate for Payer: Aetna Medicare |
$138.99
|
| Rate for Payer: BCBS Complete |
$133.60
|
| Rate for Payer: BCBS MAPPO |
$133.64
|
| Rate for Payer: BCN Medicare Advantage |
$133.64
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cofinity Commercial |
$192.44
|
| Rate for Payer: Cofinity Commercial |
$179.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.32
|
| Rate for Payer: Nomi Health Commercial |
$160.37
|
| Rate for Payer: PACE SWMI |
$133.64
|
| Rate for Payer: PHP Medicare Advantage |
$133.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.10
|
| Rate for Payer: Priority Health Medicare |
$134.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.64
|
| Rate for Payer: UHC Exchange |
$133.64
|
| Rate for Payer: UHC Medicare Advantage |
$133.64
|
|
|
PR EPIDIDYMECTOMY BILATERAL
|
Professional
|
Both
|
$1,072.00
|
|
|
Service Code
|
HCPCS 54861
|
| Min. Negotiated Rate |
$428.80 |
| Max. Negotiated Rate |
$782.11 |
| Rate for Payer: Aetna Commercial |
$727.79
|
| Rate for Payer: Aetna Medicare |
$564.86
|
| Rate for Payer: BCBS Complete |
$428.80
|
| Rate for Payer: BCBS MAPPO |
$543.13
|
| Rate for Payer: BCN Medicare Advantage |
$543.13
|
| Rate for Payer: Cash Price |
$857.60
|
| Rate for Payer: Cash Price |
$857.60
|
| Rate for Payer: Cofinity Commercial |
$782.11
|
| Rate for Payer: Cofinity Commercial |
$727.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$570.29
|
| Rate for Payer: Nomi Health Commercial |
$651.76
|
| Rate for Payer: PACE SWMI |
$543.13
|
| Rate for Payer: PHP Medicare Advantage |
$543.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.80
|
| Rate for Payer: Priority Health Medicare |
$548.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$543.13
|
| Rate for Payer: UHC Exchange |
$543.13
|
| Rate for Payer: UHC Medicare Advantage |
$543.13
|
|
|
PR EPIDIDYMECTOMY UNILATERAL
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 54860
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$577.43 |
| Rate for Payer: Aetna Commercial |
$537.33
|
| Rate for Payer: Aetna Medicare |
$417.03
|
| Rate for Payer: BCBS Complete |
$302.40
|
| Rate for Payer: BCBS MAPPO |
$400.99
|
| Rate for Payer: BCN Medicare Advantage |
$400.99
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$577.43
|
| Rate for Payer: Cofinity Commercial |
$537.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$400.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$421.04
|
| Rate for Payer: Nomi Health Commercial |
$481.19
|
| Rate for Payer: PACE SWMI |
$400.99
|
| Rate for Payer: PHP Medicare Advantage |
$400.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health Medicare |
$405.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$400.99
|
| Rate for Payer: UHC Exchange |
$400.99
|
| Rate for Payer: UHC Medicare Advantage |
$400.99
|
|
|
PR EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 54900
|
| Min. Negotiated Rate |
$688.80 |
| Max. Negotiated Rate |
$1,119.30 |
| Rate for Payer: Aetna Commercial |
$1,025.54
|
| Rate for Payer: Aetna Medicare |
$795.94
|
| Rate for Payer: BCBS Complete |
$688.80
|
| Rate for Payer: BCBS MAPPO |
$765.33
|
| Rate for Payer: BCN Medicare Advantage |
$765.33
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cofinity Commercial |
$1,102.08
|
| Rate for Payer: Cofinity Commercial |
$1,025.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$803.60
|
| Rate for Payer: Nomi Health Commercial |
$918.40
|
| Rate for Payer: PACE SWMI |
$765.33
|
| Rate for Payer: PHP Medicare Advantage |
$765.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,119.30
|
| Rate for Payer: Priority Health Medicare |
$772.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.33
|
| Rate for Payer: UHC Exchange |
$765.33
|
| Rate for Payer: UHC Medicare Advantage |
$765.33
|
|
|
PR EPIDRM AGRFT T/A/L 1ST 100 SQCM/</1% INFT/CHLD
|
Professional
|
Both
|
$1,608.00
|
|
|
Service Code
|
HCPCS 15110
|
| Min. Negotiated Rate |
$643.20 |
| Max. Negotiated Rate |
$1,045.20 |
| Rate for Payer: Aetna Commercial |
$918.62
|
| Rate for Payer: Aetna Medicare |
$712.96
|
| Rate for Payer: BCBS Complete |
$643.20
|
| Rate for Payer: BCBS MAPPO |
$685.54
|
| Rate for Payer: BCN Medicare Advantage |
$685.54
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cofinity Commercial |
$987.18
|
| Rate for Payer: Cofinity Commercial |
$918.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.82
|
| Rate for Payer: Nomi Health Commercial |
$822.65
|
| Rate for Payer: PACE SWMI |
$685.54
|
| Rate for Payer: PHP Medicare Advantage |
$685.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,045.20
|
| Rate for Payer: Priority Health Medicare |
$692.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$685.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.54
|
| Rate for Payer: UHC Exchange |
$685.54
|
| Rate for Payer: UHC Medicare Advantage |
$685.54
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/ULNA
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 25450
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$862.76 |
| Rate for Payer: Aetna Commercial |
$802.85
|
| Rate for Payer: Aetna Medicare |
$623.11
|
| Rate for Payer: BCBS Complete |
$504.00
|
| Rate for Payer: BCBS MAPPO |
$599.14
|
| Rate for Payer: BCN Medicare Advantage |
$599.14
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cofinity Commercial |
$862.76
|
| Rate for Payer: Cofinity Commercial |
$802.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.10
|
| Rate for Payer: Nomi Health Commercial |
$718.97
|
| Rate for Payer: PACE SWMI |
$599.14
|
| Rate for Payer: PHP Medicare Advantage |
$599.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health Medicare |
$605.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.14
|
| Rate for Payer: UHC Exchange |
$599.14
|
| Rate for Payer: UHC Medicare Advantage |
$599.14
|
|
