|
PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 45331
|
| Hospital Charge Code |
45331
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$421.73 |
| Rate for Payer: Aetna Commercial |
$93.36
|
| Rate for Payer: Aetna Medicare |
$72.46
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS MAPPO |
$69.67
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: BCN Commercial |
$421.73
|
| Rate for Payer: BCN Medicare Advantage |
$69.67
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$93.36
|
| Rate for Payer: Cofinity Commercial |
$100.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.67
|
| Rate for Payer: Mclaren Medicaid |
$45.80
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.15
|
| Rate for Payer: PACE SWMI |
$69.67
|
| Rate for Payer: PHP Medicare Advantage |
$69.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.65
|
| Rate for Payer: Priority Health Medicare |
$69.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.67
|
| Rate for Payer: UHC Medicare Advantage |
$71.76
|
|
|
PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
45331
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$629.53 |
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna Medicare |
$87.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.00
|
| Rate for Payer: BCBS Complete |
$629.53
|
| Rate for Payer: BCBS MAPPO |
$84.00
|
| Rate for Payer: BCBS Trust/PPO |
$261.24
|
| Rate for Payer: BCN Commercial |
$261.24
|
| Rate for Payer: BCN Medicare Advantage |
$84.00
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$288.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$302.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.00
|
| Rate for Payer: Mclaren Medicaid |
$599.55
|
| Rate for Payer: Meridian Medicaid |
$629.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$88.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.60
|
| Rate for Payer: PACE Senior Care Partners |
$79.80
|
| Rate for Payer: PACE SWMI |
$84.00
|
| Rate for Payer: PHP Commercial |
$285.60
|
| Rate for Payer: PHP Medicare Advantage |
$84.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.32
|
| Rate for Payer: Priority Health Medicare |
$84.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.93
|
| Rate for Payer: Railroad Medicare Medicare |
$84.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.68
|
| Rate for Payer: UHC Core |
$280.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.00
|
| Rate for Payer: UHC Medicare Advantage |
$86.52
|
| Rate for Payer: VA VA |
$84.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.00
|
|
|
PR SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 45350
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$991.04 |
| Rate for Payer: Aetna Commercial |
$130.89
|
| Rate for Payer: Aetna Medicare |
$101.59
|
| Rate for Payer: BCBS Complete |
$67.10
|
| Rate for Payer: BCBS MAPPO |
$97.68
|
| Rate for Payer: BCBS Trust/PPO |
$383.02
|
| Rate for Payer: BCN Commercial |
$991.04
|
| Rate for Payer: BCN Medicare Advantage |
$97.68
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Cofinity Commercial |
$130.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.68
|
| Rate for Payer: Mclaren Medicaid |
$63.90
|
| Rate for Payer: Meridian Medicaid |
$67.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.56
|
| Rate for Payer: PACE SWMI |
$97.68
|
| Rate for Payer: PHP Medicare Advantage |
$97.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.05
|
| Rate for Payer: Priority Health Medicare |
$97.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.68
|
| Rate for Payer: UHC Medicare Advantage |
$100.61
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 45332
|
| Hospital Charge Code |
45332
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$407.06 |
| Rate for Payer: Aetna Commercial |
$136.25
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$101.68
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: BCN Commercial |
$407.06
|
| Rate for Payer: BCN Medicare Advantage |
$101.68
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$136.25
|
| Rate for Payer: Cofinity Commercial |
$146.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.68
|
| Rate for Payer: Mclaren Medicaid |
$66.67
|
| Rate for Payer: Meridian Medicaid |
$70.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.76
|
| Rate for Payer: PACE SWMI |
$101.68
|
| Rate for Payer: PHP Medicare Advantage |
$101.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.09
|
| Rate for Payer: Priority Health Medicare |
$101.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.68
|
| Rate for Payer: UHC Medicare Advantage |
$104.73
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 45332
|
| Hospital Charge Code |
45332
|
| Min. Negotiated Rate |
$311.05 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: BCBS Trust/PPO |
$394.13
|
| Rate for Payer: BCN Commercial |
$394.13
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.50
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$443.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.80
|
| Rate for Payer: UHC Core |
$425.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.50
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 45332
|
| Hospital Charge Code |
45332
|
| Min. Negotiated Rate |
$121.12 |
| Max. Negotiated Rate |
$812.82 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare |
$132.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.38
|
| Rate for Payer: BCBS Complete |
$812.82
|
| Rate for Payer: BCBS MAPPO |
$127.50
|
| Rate for Payer: BCBS Trust/PPO |
$396.52
|
| Rate for Payer: BCN Commercial |
$396.52
|
| Rate for Payer: BCN Medicare Advantage |
$127.50
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.50
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.50
|
| Rate for Payer: Mclaren Medicaid |
$774.12
|
| Rate for Payer: Meridian Medicaid |
$812.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.50
|
| Rate for Payer: PACE Senior Care Partners |
$121.12
|
| Rate for Payer: PACE SWMI |
$127.50
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: PHP Medicare Advantage |
$127.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$443.70
|
| Rate for Payer: Priority Health Medicare |
$127.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.05
|
| Rate for Payer: Railroad Medicare Medicare |
$127.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.80
|
| Rate for Payer: UHC Core |
$425.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.50
|
| Rate for Payer: UHC Medicare Advantage |
$131.32
|
| Rate for Payer: VA VA |
$127.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.50
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 45332
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$407.06 |
| Rate for Payer: Aetna Commercial |
$136.25
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$101.68
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: BCN Commercial |
$407.06
|
| Rate for Payer: BCN Medicare Advantage |
$101.68
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$146.42
|
| Rate for Payer: Cofinity Commercial |
$136.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.68
|
| Rate for Payer: Mclaren Medicaid |
$66.67
|
| Rate for Payer: Meridian Medicaid |
$70.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.76
|
| Rate for Payer: PACE SWMI |
$101.68
|
| Rate for Payer: PHP Medicare Advantage |
$101.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.09
|
| Rate for Payer: Priority Health Medicare |
$101.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.68
|
| Rate for Payer: UHC Medicare Advantage |
$104.73
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
45333
|
| Min. Negotiated Rate |
$448.89 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$625.60
|
| Rate for Payer: BCBS Trust/PPO |
$568.78
|
| Rate for Payer: BCN Commercial |
$568.78
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$632.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.80
|
| Rate for Payer: Healthscope Commercial |
$662.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$625.60
|
| Rate for Payer: PHP Commercial |
$625.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$640.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.68
|
| Rate for Payer: UHC Core |
$614.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.00
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 45333
|
| Hospital Charge Code |
45333
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$122.17
|
| Rate for Payer: Aetna Medicare |
$94.82
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS MAPPO |
$91.17
|
| Rate for Payer: BCBS Trust/PPO |
$297.83
|
| Rate for Payer: BCN Commercial |
$485.26
|
| Rate for Payer: BCN Medicare Advantage |
$91.17
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$131.28
|
| Rate for Payer: Cofinity Commercial |
$122.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.17
|
| Rate for Payer: Mclaren Medicaid |
$59.64
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.73
|
| Rate for Payer: PACE SWMI |
$91.17
|
| Rate for Payer: PHP Medicare Advantage |
$91.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.28
|
| Rate for Payer: Priority Health Medicare |
$91.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.17
|
| Rate for Payer: UHC Medicare Advantage |
$93.91
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 45333
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$122.17
|
| Rate for Payer: Aetna Medicare |
$94.82
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS MAPPO |
$91.17
|
| Rate for Payer: BCBS Trust/PPO |
$297.83
|
| Rate for Payer: BCN Commercial |
$485.26
|
| Rate for Payer: BCN Medicare Advantage |
$91.17
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$122.17
|
| Rate for Payer: Cofinity Commercial |
$131.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.17
|
| Rate for Payer: Mclaren Medicaid |
$59.64
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.73
|
| Rate for Payer: PACE SWMI |
$91.17
|
| Rate for Payer: PHP Medicare Advantage |
$91.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.28
|
| Rate for Payer: Priority Health Medicare |
$91.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.17
|
| Rate for Payer: UHC Medicare Advantage |
$93.91
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
45333
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$625.60
|
| Rate for Payer: Aetna Medicare |
$191.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.00
|
| Rate for Payer: BCBS Complete |
$629.53
|
| Rate for Payer: BCBS MAPPO |
$184.00
|
| Rate for Payer: BCBS Trust/PPO |
$572.24
|
| Rate for Payer: BCN Commercial |
$572.24
|
| Rate for Payer: BCN Medicare Advantage |
$184.00
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$632.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.00
|
| Rate for Payer: Healthscope Commercial |
$662.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.00
|
| Rate for Payer: Mclaren Medicaid |
$599.55
|
| Rate for Payer: Meridian Medicaid |
$629.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$193.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$625.60
|
| Rate for Payer: PACE Senior Care Partners |
$174.80
|
| Rate for Payer: PACE SWMI |
$184.00
|
| Rate for Payer: PHP Commercial |
$625.60
|
| Rate for Payer: PHP Medicare Advantage |
$184.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$640.32
|
| Rate for Payer: Priority Health Medicare |
$184.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.89
|
| Rate for Payer: Railroad Medicare Medicare |
$184.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.68
|
| Rate for Payer: UHC Core |
$614.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.00
|
| Rate for Payer: UHC Medicare Advantage |
$189.52
|
| Rate for Payer: VA VA |
$184.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.00
|
|
|
PR SIGMOIDOSCOPY,TRANSENDOSCOPIC STENT
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 45345
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: BCBS Complete |
$129.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
|
|
PR SIGMOIDOSCOPY W/STENT
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS G6023
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: BCBS Complete |
$129.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
|
|
PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 93278
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$981.33 |
| Rate for Payer: Aetna Commercial |
$36.74
|
| Rate for Payer: Aetna Medicare |
$28.52
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$27.42
|
| Rate for Payer: BCBS Trust/PPO |
$981.33
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$27.42
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.79
|
| Rate for Payer: PACE SWMI |
$27.42
|
| Rate for Payer: PHP Medicare Advantage |
$27.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.66
|
| Rate for Payer: Priority Health Medicare |
$27.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.42
|
| Rate for Payer: UHC Medicare Advantage |
$28.24
|
|
|
PR SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 51725
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$642.41 |
| Rate for Payer: Aetna Commercial |
$291.30
|
| Rate for Payer: Aetna Medicare |
$226.09
|
| Rate for Payer: BCBS Complete |
$210.40
|
| Rate for Payer: BCBS MAPPO |
$217.39
|
| Rate for Payer: BCBS Trust/PPO |
$642.41
|
| Rate for Payer: BCN Commercial |
$335.23
|
| Rate for Payer: BCN Medicare Advantage |
$217.39
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$313.04
|
| Rate for Payer: Cofinity Commercial |
$291.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.26
|
| Rate for Payer: PACE SWMI |
$217.39
|
| Rate for Payer: PHP Medicare Advantage |
$217.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.69
|
| Rate for Payer: Priority Health Medicare |
$217.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.39
|
| Rate for Payer: UHC Medicare Advantage |
$223.91
|
|
|
PR SIMPLE IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 00522
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: BCBS Complete |
$600.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
|
|
PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$9,538.00
|
|
|
Service Code
|
HCPCS 61700
|
| Min. Negotiated Rate |
$1,257.35 |
| Max. Negotiated Rate |
$6,912.88 |
| Rate for Payer: Aetna Commercial |
$4,571.24
|
| Rate for Payer: Aetna Medicare |
$3,547.82
|
| Rate for Payer: BCBS Complete |
$2,313.43
|
| Rate for Payer: BCBS MAPPO |
$3,411.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,257.35
|
| Rate for Payer: BCN Commercial |
$6,912.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,411.37
|
| Rate for Payer: Cash Price |
$7,630.40
|
| Rate for Payer: Cash Price |
$7,630.40
|
| Rate for Payer: Cofinity Commercial |
$4,912.37
|
| Rate for Payer: Cofinity Commercial |
$4,571.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,411.37
|
| Rate for Payer: Mclaren Medicaid |
$2,203.27
|
| Rate for Payer: Meridian Medicaid |
$2,313.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,581.94
|
| Rate for Payer: PACE SWMI |
$3,411.37
|
| Rate for Payer: PHP Medicare Advantage |
$3,411.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,203.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,676.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,773.78
|
| Rate for Payer: Priority Health Medicare |
$3,411.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,773.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,411.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,411.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,513.71
|
|
|
PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$8,499.00
|
|
|
Service Code
|
HCPCS 61702
|
| Min. Negotiated Rate |
$1,072.45 |
| Max. Negotiated Rate |
$8,192.82 |
| Rate for Payer: Aetna Commercial |
$5,424.12
|
| Rate for Payer: Aetna Medicare |
$4,209.76
|
| Rate for Payer: BCBS Complete |
$2,722.04
|
| Rate for Payer: BCBS MAPPO |
$4,047.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.45
|
| Rate for Payer: BCN Commercial |
$8,192.82
|
| Rate for Payer: BCN Medicare Advantage |
$4,047.85
|
| Rate for Payer: Cash Price |
$6,799.20
|
| Rate for Payer: Cash Price |
$6,799.20
|
| Rate for Payer: Cofinity Commercial |
$5,828.90
|
| Rate for Payer: Cofinity Commercial |
$5,424.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,047.85
|
| Rate for Payer: Mclaren Medicaid |
$2,592.42
|
| Rate for Payer: Meridian Medicaid |
$2,722.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,250.24
|
| Rate for Payer: PACE SWMI |
$4,047.85
|
| Rate for Payer: PHP Medicare Advantage |
$4,047.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,949.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,842.81
|
| Rate for Payer: Priority Health Medicare |
$4,047.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,842.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,047.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,047.85
|
| Rate for Payer: UHC Medicare Advantage |
$4,169.29
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 12016
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$171.86
|
| Rate for Payer: Aetna Medicare |
$133.38
|
| Rate for Payer: BCBS Complete |
$85.21
|
| Rate for Payer: BCBS MAPPO |
$128.25
|
| Rate for Payer: BCBS Trust/PPO |
$117.56
|
| Rate for Payer: BCN Commercial |
$322.53
|
| Rate for Payer: BCN Medicare Advantage |
$128.25
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cofinity Commercial |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$171.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.25
|
| Rate for Payer: Mclaren Medicaid |
$81.15
|
| Rate for Payer: Meridian Medicaid |
$85.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.66
|
| Rate for Payer: PACE SWMI |
$128.25
|
| Rate for Payer: PHP Medicare Advantage |
$128.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.19
|
| Rate for Payer: Priority Health Medicare |
$128.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.25
|
| Rate for Payer: UHC Medicare Advantage |
$132.10
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 12017
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$223.32 |
| Rate for Payer: Aetna Commercial |
$206.84
|
| Rate for Payer: Aetna Medicare |
$160.53
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: BCBS MAPPO |
$154.36
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$223.32
|
| Rate for Payer: BCN Medicare Advantage |
$154.36
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$222.28
|
| Rate for Payer: Cofinity Commercial |
$206.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.36
|
| Rate for Payer: Mclaren Medicaid |
$97.98
|
| Rate for Payer: Meridian Medicaid |
$102.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$162.08
|
| Rate for Payer: PACE SWMI |
$154.36
|
| Rate for Payer: PHP Medicare Advantage |
$154.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.84
|
| Rate for Payer: Priority Health Medicare |
$154.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.36
|
| Rate for Payer: UHC Medicare Advantage |
$158.99
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 12011
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$73.66
|
| Rate for Payer: Aetna Medicare |
$57.17
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS MAPPO |
$54.97
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$165.18
|
| Rate for Payer: BCN Medicare Advantage |
$54.97
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$79.16
|
| Rate for Payer: Cofinity Commercial |
$73.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.97
|
| Rate for Payer: Mclaren Medicaid |
$35.36
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.72
|
| Rate for Payer: PACE SWMI |
$54.97
|
| Rate for Payer: PHP Medicare Advantage |
$54.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.42
|
| Rate for Payer: Priority Health Medicare |
$54.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.97
|
| Rate for Payer: UHC Medicare Advantage |
$56.62
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 12013
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$351.25 |
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: Aetna Medicare |
$61.14
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$58.79
|
| Rate for Payer: BCBS Trust/PPO |
$351.25
|
| Rate for Payer: BCN Commercial |
$172.99
|
| Rate for Payer: BCN Medicare Advantage |
$58.79
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cofinity Commercial |
$84.66
|
| Rate for Payer: Cofinity Commercial |
$78.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.79
|
| Rate for Payer: Mclaren Medicaid |
$36.85
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.73
|
| Rate for Payer: PACE SWMI |
$58.79
|
| Rate for Payer: PHP Medicare Advantage |
$58.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.52
|
| Rate for Payer: Priority Health Medicare |
$58.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.79
|
| Rate for Payer: UHC Medicare Advantage |
$60.55
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM
|
Professional
|
Both
|
$1,333.00
|
|
|
Service Code
|
HCPCS 12018
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$933.10 |
| Rate for Payer: Aetna Commercial |
$233.67
|
| Rate for Payer: Aetna Medicare |
$181.36
|
| Rate for Payer: BCBS Complete |
$115.85
|
| Rate for Payer: BCBS MAPPO |
$174.38
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$252.16
|
| Rate for Payer: BCN Medicare Advantage |
$174.38
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$251.11
|
| Rate for Payer: Cofinity Commercial |
$233.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.38
|
| Rate for Payer: Mclaren Medicaid |
$110.33
|
| Rate for Payer: Meridian Medicaid |
$115.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$183.10
|
| Rate for Payer: PACE SWMI |
$174.38
|
| Rate for Payer: PHP Medicare Advantage |
$174.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.10
|
| Rate for Payer: Priority Health Medicare |
$174.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.38
|
| Rate for Payer: UHC Medicare Advantage |
$179.61
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 12014
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$336.70 |
| Rate for Payer: Aetna Commercial |
$100.43
|
| Rate for Payer: Aetna Medicare |
$77.95
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS MAPPO |
$74.95
|
| Rate for Payer: BCBS Trust/PPO |
$117.56
|
| Rate for Payer: BCN Commercial |
$210.13
|
| Rate for Payer: BCN Medicare Advantage |
$74.95
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cofinity Commercial |
$100.43
|
| Rate for Payer: Cofinity Commercial |
$107.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.95
|
| Rate for Payer: Mclaren Medicaid |
$47.71
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.70
|
| Rate for Payer: PACE SWMI |
$74.95
|
| Rate for Payer: PHP Medicare Advantage |
$74.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.25
|
| Rate for Payer: Priority Health Medicare |
$74.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.95
|
| Rate for Payer: UHC Medicare Advantage |
$77.20
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 12015
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$435.40 |
| Rate for Payer: Aetna Commercial |
$126.68
|
| Rate for Payer: Aetna Medicare |
$98.32
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS MAPPO |
$94.54
|
| Rate for Payer: BCBS Trust/PPO |
$117.56
|
| Rate for Payer: BCN Commercial |
$253.14
|
| Rate for Payer: BCN Medicare Advantage |
$94.54
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$126.68
|
| Rate for Payer: Cofinity Commercial |
$136.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.54
|
| Rate for Payer: Mclaren Medicaid |
$59.85
|
| Rate for Payer: Meridian Medicaid |
$62.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.27
|
| Rate for Payer: PACE SWMI |
$94.54
|
| Rate for Payer: PHP Medicare Advantage |
$94.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.09
|
| Rate for Payer: Priority Health Medicare |
$94.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.54
|
| Rate for Payer: UHC Medicare Advantage |
$97.38
|
|
