|
PR PRINCIPAL CARE MGMT SVC 1ST 30 PHYS/QHP CAL MO
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 99424
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$107.90 |
| Rate for Payer: Aetna Commercial |
$95.01
|
| Rate for Payer: Aetna Medicare |
$73.74
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS MAPPO |
$70.90
|
| Rate for Payer: BCN Medicare Advantage |
$70.90
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$95.01
|
| Rate for Payer: Cofinity Commercial |
$102.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.44
|
| Rate for Payer: Nomi Health Commercial |
$85.08
|
| Rate for Payer: PACE SWMI |
$70.90
|
| Rate for Payer: PHP Medicare Advantage |
$70.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.90
|
| Rate for Payer: Priority Health Medicare |
$71.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.90
|
| Rate for Payer: UHC Exchange |
$70.90
|
| Rate for Payer: UHC Medicare Advantage |
$70.90
|
|
|
PR PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 99426
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna Commercial |
$62.58
|
| Rate for Payer: Aetna Medicare |
$48.57
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS MAPPO |
$46.70
|
| Rate for Payer: BCN Medicare Advantage |
$46.70
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$67.25
|
| Rate for Payer: Cofinity Commercial |
$62.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.03
|
| Rate for Payer: Nomi Health Commercial |
$56.04
|
| Rate for Payer: PACE SWMI |
$46.70
|
| Rate for Payer: PHP Medicare Advantage |
$46.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health Medicare |
$47.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.70
|
| Rate for Payer: UHC Exchange |
$46.70
|
| Rate for Payer: UHC Medicare Advantage |
$46.70
|
|
|
PR PRINCIPAL CARE MGMT SVC EA ADDL 30 STAFF CAL MO
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 99427
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS MAPPO |
$33.62
|
| Rate for Payer: BCN Medicare Advantage |
$33.62
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$48.41
|
| Rate for Payer: Cofinity Commercial |
$45.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.30
|
| Rate for Payer: Nomi Health Commercial |
$40.34
|
| Rate for Payer: PACE SWMI |
$33.62
|
| Rate for Payer: PHP Medicare Advantage |
$33.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Medicare |
$33.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.62
|
| Rate for Payer: UHC Exchange |
$33.62
|
| Rate for Payer: UHC Medicare Advantage |
$33.62
|
|
|
PR PRINCIPAL CARE MGMT SVC EA ADL 30 PHY/QHP CAL MO
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 99425
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$50.11
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$48.18
|
| Rate for Payer: BCN Medicare Advantage |
$48.18
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Cofinity Commercial |
$64.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.59
|
| Rate for Payer: Nomi Health Commercial |
$57.82
|
| Rate for Payer: PACE SWMI |
$48.18
|
| Rate for Payer: PHP Medicare Advantage |
$48.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$48.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.18
|
| Rate for Payer: UHC Exchange |
$48.18
|
| Rate for Payer: UHC Medicare Advantage |
$48.18
|
|
|
PR PROBE NASOLACRIMAL DUCT W/WO IRRIGATION
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 68810
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$184.60 |
| Rate for Payer: Aetna Commercial |
$158.66
|
| Rate for Payer: Aetna Medicare |
$123.14
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS MAPPO |
$118.40
|
| Rate for Payer: BCN Medicare Advantage |
$118.40
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$170.50
|
| Rate for Payer: Cofinity Commercial |
$158.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.32
|
| Rate for Payer: Nomi Health Commercial |
$142.08
|
| Rate for Payer: PACE SWMI |
$118.40
|
| Rate for Payer: PHP Medicare Advantage |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Medicare |
$119.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.40
|
| Rate for Payer: UHC Exchange |
$118.40
|
| Rate for Payer: UHC Medicare Advantage |
$118.40
|
|
|
PR PROCHLORPERAZINE INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0780
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$1.81
|
| Rate for Payer: BCN Medicare Advantage |
$1.81
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.90
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: PACE SWMI |
$1.81
|
| Rate for Payer: PHP Medicare Advantage |
$1.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.81
|
| Rate for Payer: UHC Exchange |
$1.81
|
| Rate for Payer: UHC Medicare Advantage |
$1.81
|
|
|
PR PROCTOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$3,082.00
|
|
|
Service Code
|
HCPCS 45540
|
| Min. Negotiated Rate |
$1,005.44 |
| Max. Negotiated Rate |
$2,003.30 |
| Rate for Payer: Aetna Commercial |
$1,347.29
|
| Rate for Payer: Aetna Medicare |
$1,045.66
|
| Rate for Payer: BCBS Complete |
$1,232.80
|
| Rate for Payer: BCBS MAPPO |
$1,005.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.44
|
| Rate for Payer: Cash Price |
$2,465.60
|
| Rate for Payer: Cash Price |
$2,465.60
|
| Rate for Payer: Cofinity Commercial |
$1,447.83
|
| Rate for Payer: Cofinity Commercial |
$1,347.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,055.71
|
| Rate for Payer: Nomi Health Commercial |
$1,206.53
|
| Rate for Payer: PACE SWMI |
$1,005.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,003.30
|
| Rate for Payer: Priority Health Medicare |
$1,015.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,005.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,005.44
|
| Rate for Payer: UHC Exchange |
$1,005.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,005.44
|
|
|
PR PROCTOPEXY PERINEAL APPROACH
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 45541
|
| Min. Negotiated Rate |
$663.20 |
| Max. Negotiated Rate |
$1,298.48 |
| Rate for Payer: Aetna Commercial |
$1,208.30
|
| Rate for Payer: Aetna Medicare |
$937.79
|
| Rate for Payer: BCBS Complete |
$663.20
|
| Rate for Payer: BCBS MAPPO |
$901.72
|
| Rate for Payer: BCN Medicare Advantage |
$901.72
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cofinity Commercial |
$1,298.48
|
| Rate for Payer: Cofinity Commercial |
$1,208.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$901.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$946.81
|
| Rate for Payer: Nomi Health Commercial |
$1,082.06
|
| Rate for Payer: PACE SWMI |
$901.72
|
| Rate for Payer: PHP Medicare Advantage |
$901.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health Medicare |
$910.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$901.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$901.72
|
| Rate for Payer: UHC Exchange |
$901.72
|
| Rate for Payer: UHC Medicare Advantage |
$901.72
|
|
|
PR PROCTOPEXY W/SIGMOID RESCJ ABDL APPR
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 45550
|
| Min. Negotiated Rate |
$1,391.49 |
| Max. Negotiated Rate |
$2,398.50 |
| Rate for Payer: Aetna Commercial |
$1,864.60
|
| Rate for Payer: Aetna Medicare |
$1,447.15
|
| Rate for Payer: BCBS Complete |
$1,476.00
|
| Rate for Payer: BCBS MAPPO |
$1,391.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,391.49
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Cofinity Commercial |
$2,003.75
|
| Rate for Payer: Cofinity Commercial |
$1,864.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,391.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,461.06
|
| Rate for Payer: Nomi Health Commercial |
$1,669.79
|
| Rate for Payer: PACE SWMI |
$1,391.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,391.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,398.50
|
| Rate for Payer: Priority Health Medicare |
$1,405.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,391.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,391.49
|
| Rate for Payer: UHC Exchange |
$1,391.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,391.49
|
|
|
PR PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 45505
|
| Min. Negotiated Rate |
$574.48 |
| Max. Negotiated Rate |
$1,096.55 |
| Rate for Payer: Aetna Commercial |
$769.80
|
| Rate for Payer: Aetna Medicare |
$597.46
|
| Rate for Payer: BCBS Complete |
$674.80
|
| Rate for Payer: BCBS MAPPO |
$574.48
|
| Rate for Payer: BCN Medicare Advantage |
$574.48
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cofinity Commercial |
$827.25
|
| Rate for Payer: Cofinity Commercial |
$769.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$574.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$603.20
|
| Rate for Payer: Nomi Health Commercial |
$689.38
|
| Rate for Payer: PACE SWMI |
$574.48
|
| Rate for Payer: PHP Medicare Advantage |
$574.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.55
|
| Rate for Payer: Priority Health Medicare |
$580.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$574.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$574.48
|
| Rate for Payer: UHC Exchange |
$574.48
|
| Rate for Payer: UHC Medicare Advantage |
$574.48
|
|
|
PR PROCTOPLASTY STENOSIS
|
Professional
|
Both
|
$1,140.00
|
|
|
Service Code
|
HCPCS 45500
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$793.58 |
| Rate for Payer: Aetna Commercial |
$738.47
|
| Rate for Payer: Aetna Medicare |
$573.14
|
| Rate for Payer: BCBS Complete |
$456.00
|
| Rate for Payer: BCBS MAPPO |
$551.10
|
| Rate for Payer: BCN Medicare Advantage |
$551.10
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cofinity Commercial |
$793.58
|
| Rate for Payer: Cofinity Commercial |
$738.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.65
|
| Rate for Payer: Nomi Health Commercial |
$661.32
|
| Rate for Payer: PACE SWMI |
$551.10
|
| Rate for Payer: PHP Medicare Advantage |
$551.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.00
|
| Rate for Payer: Priority Health Medicare |
$556.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.10
|
| Rate for Payer: UHC Exchange |
$551.10
|
| Rate for Payer: UHC Medicare Advantage |
$551.10
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 45300
|
| Hospital Charge Code |
45300
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$128.05 |
| Rate for Payer: Aetna Commercial |
$62.22
|
| Rate for Payer: Aetna Medicare |
$48.29
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS MAPPO |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$46.43
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$62.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.75
|
| Rate for Payer: Nomi Health Commercial |
$55.72
|
| Rate for Payer: PACE SWMI |
$46.43
|
| Rate for Payer: PHP Medicare Advantage |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health Medicare |
$46.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.43
|
| Rate for Payer: UHC Exchange |
$46.43
|
| Rate for Payer: UHC Medicare Advantage |
$46.43
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 45300
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$128.05 |
| Rate for Payer: Aetna Commercial |
$62.22
|
| Rate for Payer: Aetna Medicare |
$48.29
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS MAPPO |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$46.43
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$62.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.75
|
| Rate for Payer: Nomi Health Commercial |
$55.72
|
| Rate for Payer: PACE SWMI |
$46.43
|
| Rate for Payer: PHP Medicare Advantage |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health Medicare |
$46.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.43
|
| Rate for Payer: UHC Exchange |
$46.43
|
| Rate for Payer: UHC Medicare Advantage |
$46.43
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
45300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: BCBS Trust/PPO |
$160.81
|
| Rate for Payer: BCN Commercial |
$152.24
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$169.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.60
|
| Rate for Payer: Healthscope Commercial |
$177.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.45
|
| Rate for Payer: Nomi Health Commercial |
$161.54
|
| Rate for Payer: PHP Commercial |
$167.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO |
$171.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.36
|
| Rate for Payer: UHC Core |
$164.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.75
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
45300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.79 |
| Max. Negotiated Rate |
$692.17 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: Aetna Medicare |
$51.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.56
|
| Rate for Payer: BCBS Complete |
$692.17
|
| Rate for Payer: BCBS MAPPO |
$49.25
|
| Rate for Payer: BCBS Trust/PPO |
$161.95
|
| Rate for Payer: BCN Commercial |
$153.17
|
| Rate for Payer: BCN Medicare Advantage |
$49.25
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$169.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.25
|
| Rate for Payer: Healthscope Commercial |
$177.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.75
|
| Rate for Payer: Mclaren Medicaid |
$659.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.71
|
| Rate for Payer: Meridian Medicaid |
$692.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.45
|
| Rate for Payer: Nomi Health Commercial |
$161.54
|
| Rate for Payer: PACE Senior Care Partners |
$46.79
|
| Rate for Payer: PACE SWMI |
$49.25
|
| Rate for Payer: PHP Commercial |
$167.45
|
| Rate for Payer: PHP Medicare Advantage |
$49.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO |
$171.39
|
| Rate for Payer: Priority Health Medicare |
$49.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.99
|
| Rate for Payer: Railroad Medicare Medicare |
$49.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.36
|
| Rate for Payer: UHC Core |
$164.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.25
|
| Rate for Payer: UHC Exchange |
$49.25
|
| Rate for Payer: UHC Medicare Advantage |
$49.25
|
| Rate for Payer: UHCCP Medicaid |
$659.17
|
| Rate for Payer: VA VA |
$49.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.75
|
|
|
PR PROCTOSGMDSC RIGID ABLATION LESION
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 45320
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$313.30 |
| Rate for Payer: Aetna Commercial |
$137.44
|
| Rate for Payer: Aetna Medicare |
$106.67
|
| Rate for Payer: BCBS Complete |
$192.80
|
| Rate for Payer: BCBS MAPPO |
$102.57
|
| Rate for Payer: BCN Medicare Advantage |
$102.57
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$147.70
|
| Rate for Payer: Cofinity Commercial |
$137.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.70
|
| Rate for Payer: Nomi Health Commercial |
$123.08
|
| Rate for Payer: PACE SWMI |
$102.57
|
| Rate for Payer: PHP Medicare Advantage |
$102.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.30
|
| Rate for Payer: Priority Health Medicare |
$103.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.57
|
| Rate for Payer: UHC Exchange |
$102.57
|
| Rate for Payer: UHC Medicare Advantage |
$102.57
|
|
|
PR PROCTOSGMDSC RIGID CONTROL BLEEDING
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 45317
|
| Min. Negotiated Rate |
$105.76 |
| Max. Negotiated Rate |
$293.80 |
| Rate for Payer: Aetna Commercial |
$141.72
|
| Rate for Payer: Aetna Medicare |
$109.99
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$105.76
|
| Rate for Payer: BCN Medicare Advantage |
$105.76
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$152.29
|
| Rate for Payer: Cofinity Commercial |
$141.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.05
|
| Rate for Payer: Nomi Health Commercial |
$126.91
|
| Rate for Payer: PACE SWMI |
$105.76
|
| Rate for Payer: PHP Medicare Advantage |
$105.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Medicare |
$106.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.76
|
| Rate for Payer: UHC Exchange |
$105.76
|
| Rate for Payer: UHC Medicare Advantage |
$105.76
|
|
|
PR PROCTOSGMDSC RIGID DCMPRN VOLVULUS
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 45321
|
| Min. Negotiated Rate |
$100.92 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$135.23
|
| Rate for Payer: Aetna Medicare |
$104.96
|
| Rate for Payer: BCBS Complete |
$156.80
|
| Rate for Payer: BCBS MAPPO |
$100.92
|
| Rate for Payer: BCN Medicare Advantage |
$100.92
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$145.32
|
| Rate for Payer: Cofinity Commercial |
$135.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.97
|
| Rate for Payer: Nomi Health Commercial |
$121.10
|
| Rate for Payer: PACE SWMI |
$100.92
|
| Rate for Payer: PHP Medicare Advantage |
$100.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health Medicare |
$101.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.92
|
| Rate for Payer: UHC Exchange |
$100.92
|
| Rate for Payer: UHC Medicare Advantage |
$100.92
|
|
|
PR PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 45308
|
| Min. Negotiated Rate |
$82.06 |
| Max. Negotiated Rate |
$202.15 |
| Rate for Payer: Aetna Commercial |
$109.96
|
| Rate for Payer: Aetna Medicare |
$85.34
|
| Rate for Payer: BCBS Complete |
$124.40
|
| Rate for Payer: BCBS MAPPO |
$82.06
|
| Rate for Payer: BCN Medicare Advantage |
$82.06
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$118.17
|
| Rate for Payer: Cofinity Commercial |
$109.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.16
|
| Rate for Payer: Nomi Health Commercial |
$98.47
|
| Rate for Payer: PACE SWMI |
$82.06
|
| Rate for Payer: PHP Medicare Advantage |
$82.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.15
|
| Rate for Payer: Priority Health Medicare |
$82.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.06
|
| Rate for Payer: UHC Exchange |
$82.06
|
| Rate for Payer: UHC Medicare Advantage |
$82.06
|
|
|
PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 45309
|
| Min. Negotiated Rate |
$87.23 |
| Max. Negotiated Rate |
$245.05 |
| Rate for Payer: Aetna Commercial |
$116.89
|
| Rate for Payer: Aetna Medicare |
$90.72
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$87.23
|
| Rate for Payer: BCN Medicare Advantage |
$87.23
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$125.61
|
| Rate for Payer: Cofinity Commercial |
$116.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.59
|
| Rate for Payer: Nomi Health Commercial |
$104.68
|
| Rate for Payer: PACE SWMI |
$87.23
|
| Rate for Payer: PHP Medicare Advantage |
$87.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$88.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.23
|
| Rate for Payer: UHC Exchange |
$87.23
|
| Rate for Payer: UHC Medicare Advantage |
$87.23
|
|
|
PR PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 45315
|
| Min. Negotiated Rate |
$103.21 |
| Max. Negotiated Rate |
$313.30 |
| Rate for Payer: Aetna Commercial |
$138.30
|
| Rate for Payer: Aetna Medicare |
$107.34
|
| Rate for Payer: BCBS Complete |
$192.80
|
| Rate for Payer: BCBS MAPPO |
$103.21
|
| Rate for Payer: BCN Medicare Advantage |
$103.21
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$148.62
|
| Rate for Payer: Cofinity Commercial |
$138.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.37
|
| Rate for Payer: Nomi Health Commercial |
$123.85
|
| Rate for Payer: PACE SWMI |
$103.21
|
| Rate for Payer: PHP Medicare Advantage |
$103.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.30
|
| Rate for Payer: Priority Health Medicare |
$104.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.21
|
| Rate for Payer: UHC Exchange |
$103.21
|
| Rate for Payer: UHC Medicare Advantage |
$103.21
|
|
|
PR PROCTOSGMDSC RIGID TNDSC STENT PLMT
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 45327
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$164.62 |
| Rate for Payer: Aetna Commercial |
$153.19
|
| Rate for Payer: Aetna Medicare |
$118.89
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$114.32
|
| Rate for Payer: BCN Medicare Advantage |
$114.32
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$164.62
|
| Rate for Payer: Cofinity Commercial |
$153.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.04
|
| Rate for Payer: Nomi Health Commercial |
$137.18
|
| Rate for Payer: PACE SWMI |
$114.32
|
| Rate for Payer: PHP Medicare Advantage |
$114.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$115.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.32
|
| Rate for Payer: UHC Exchange |
$114.32
|
| Rate for Payer: UHC Medicare Advantage |
$114.32
|
|
|
PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 45305
|
| Min. Negotiated Rate |
$69.83 |
| Max. Negotiated Rate |
$193.05 |
| Rate for Payer: Aetna Commercial |
$93.57
|
| Rate for Payer: Aetna Medicare |
$72.62
|
| Rate for Payer: BCBS Complete |
$118.80
|
| Rate for Payer: BCBS MAPPO |
$69.83
|
| Rate for Payer: BCN Medicare Advantage |
$69.83
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cofinity Commercial |
$93.57
|
| Rate for Payer: Cofinity Commercial |
$100.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.32
|
| Rate for Payer: Nomi Health Commercial |
$83.80
|
| Rate for Payer: PACE SWMI |
$69.83
|
| Rate for Payer: PHP Medicare Advantage |
$69.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.05
|
| Rate for Payer: Priority Health Medicare |
$70.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.83
|
| Rate for Payer: UHC Exchange |
$69.83
|
| Rate for Payer: UHC Medicare Advantage |
$69.83
|
|
|
PR PROCTOSGMDSC RIGID W/DILATION
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 45303
|
| Min. Negotiated Rate |
$81.33 |
| Max. Negotiated Rate |
$135.20 |
| Rate for Payer: Aetna Commercial |
$108.98
|
| Rate for Payer: Aetna Medicare |
$84.58
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS MAPPO |
$81.33
|
| Rate for Payer: BCN Medicare Advantage |
$81.33
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.40
|
| Rate for Payer: Nomi Health Commercial |
$97.60
|
| Rate for Payer: PACE SWMI |
$81.33
|
| Rate for Payer: PHP Medicare Advantage |
$81.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health Medicare |
$82.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.33
|
| Rate for Payer: UHC Exchange |
$81.33
|
| Rate for Payer: UHC Medicare Advantage |
$81.33
|
|
|
PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 45307
|
| Min. Negotiated Rate |
$97.58 |
| Max. Negotiated Rate |
$220.35 |
| Rate for Payer: Aetna Commercial |
$130.76
|
| Rate for Payer: Aetna Medicare |
$101.48
|
| Rate for Payer: BCBS Complete |
$135.60
|
| Rate for Payer: BCBS MAPPO |
$97.58
|
| Rate for Payer: BCN Medicare Advantage |
$97.58
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$140.52
|
| Rate for Payer: Cofinity Commercial |
$130.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.46
|
| Rate for Payer: Nomi Health Commercial |
$117.10
|
| Rate for Payer: PACE SWMI |
$97.58
|
| Rate for Payer: PHP Medicare Advantage |
$97.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Medicare |
$98.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.58
|
| Rate for Payer: UHC Exchange |
$97.58
|
| Rate for Payer: UHC Medicare Advantage |
$97.58
|
|
