|
PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 45340
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$221.20 |
| Rate for Payer: Aetna Commercial |
$102.74
|
| Rate for Payer: BCBS Complete |
$52.11
|
| Rate for Payer: BCBS Trust/PPO |
$96.68
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Meridian Medicaid |
$52.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.82
|
| Rate for Payer: Priority Health Narrow Network |
$135.82
|
| Rate for Payer: Priority Health SBD |
$135.82
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX
|
Professional
|
Both
|
$791.00
|
|
|
Service Code
|
HCPCS 45342
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$553.70 |
| Rate for Payer: Aetna Commercial |
$225.51
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCBS Trust/PPO |
$269.43
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.16
|
| Rate for Payer: Priority Health Narrow Network |
$295.16
|
| Rate for Payer: Priority Health SBD |
$295.16
|
| Rate for Payer: UMR Bronson Commercial |
$363.86
|
|
|
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 |
$302.72 |
| Rate for Payer: Aetna Commercial |
$94.92
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| 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 Narrow Network |
$124.65
|
| Rate for Payer: Priority Health SBD |
$124.65
|
| Rate for Payer: UMR Bronson Commercial |
$154.56
|
|
|
PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
45331
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna American Axle |
$218.40
|
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.40
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$288.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.80
|
| Rate for Payer: Healthscope Commercial |
$302.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.60
|
| Rate for Payer: PHP Commercial |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.20
|
| Rate for Payer: Priority Health SBD |
$211.68
|
| Rate for Payer: UMR Bronson Commercial |
$147.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.00
|
|
|
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 |
$70.40 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna American Axle |
$218.40
|
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.89
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$288.96
|
| Rate for Payer: Cofinity Commercial |
$235.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$302.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.00
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.60
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$285.60
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Priority Health SBD |
$211.68
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: UMR Bronson Commercial |
$124.32
|
| Rate for Payer: VA VA |
$812.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.00
|
|
|
PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 45331
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$302.72 |
| Rate for Payer: Aetna Commercial |
$94.92
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| 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 Narrow Network |
$124.65
|
| Rate for Payer: Priority Health SBD |
$124.65
|
| Rate for Payer: UMR Bronson Commercial |
$154.56
|
|
|
PR SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 45350
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$383.02 |
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: BCBS Complete |
$67.10
|
| Rate for Payer: BCBS Trust/PPO |
$383.02
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Meridian Medicaid |
$67.10
|
| 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 Narrow Network |
$174.05
|
| Rate for Payer: Priority Health SBD |
$174.05
|
| Rate for Payer: UMR Bronson Commercial |
$200.10
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 45332
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$138.97
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Meridian Medicaid |
$70.00
|
| 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 Narrow Network |
$181.09
|
| Rate for Payer: Priority Health SBD |
$181.09
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
|
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 |
$357.00 |
| Rate for Payer: Aetna Commercial |
$138.97
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Meridian Medicaid |
$70.00
|
| 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 Narrow Network |
$181.09
|
| Rate for Payer: Priority Health SBD |
$181.09
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 45332
|
| Hospital Charge Code |
45332
|
| Min. Negotiated Rate |
$102.49 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna American Axle |
$331.50
|
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$704.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| 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 |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.50
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.50
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Priority Health SBD |
$321.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$102.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: UMR Bronson Commercial |
$188.70
|
| Rate for Payer: VA VA |
$1,048.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.50
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 45332
|
| Hospital Charge Code |
45332
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna American Axle |
$331.50
|
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$357.00
|
| 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 SBD |
$321.30
|
| Rate for Payer: UMR Bronson Commercial |
$224.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.50
|
|
|
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 |
$91.68 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna American Axle |
$478.40
|
| Rate for Payer: Aetna Commercial |
$625.60
|
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$535.79
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$632.96
|
| Rate for Payer: Cofinity Commercial |
$515.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$662.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.00
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$625.60
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$625.60
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Priority Health SBD |
$463.68
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$91.68
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: UMR Bronson Commercial |
$272.32
|
| Rate for Payer: VA VA |
$812.40
|
| 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 |
$124.32
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$297.83
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| 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 Narrow Network |
$162.28
|
| Rate for Payer: Priority Health SBD |
$162.28
|
| Rate for Payer: UMR Bronson Commercial |
$338.56
|
|
|
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 |
$323.84 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna American Axle |
$478.40
|
| Rate for Payer: Aetna Commercial |
$625.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.40
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$515.20
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$515.20
|
| 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 SBD |
$463.68
|
| Rate for Payer: UMR Bronson Commercial |
$323.84
|
| 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
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$124.32
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$297.83
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| 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 Narrow Network |
$162.28
|
| Rate for Payer: Priority Health SBD |
$162.28
|
| Rate for Payer: UMR Bronson Commercial |
$338.56
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$149.04
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$149.04
|
|
|
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 |
$38.45
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$981.33
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.02
|
| Rate for Payer: Priority Health Narrow Network |
$17.02
|
| Rate for Payer: Priority Health SBD |
$40.66
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
PR SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 51725
|
| Min. Negotiated Rate |
$121.04 |
| Max. Negotiated Rate |
$642.41 |
| Rate for Payer: Aetna Commercial |
$283.90
|
| Rate for Payer: BCBS Complete |
$210.40
|
| Rate for Payer: BCBS Trust/PPO |
$642.41
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.04
|
| Rate for Payer: Priority Health Narrow Network |
$121.04
|
| Rate for Payer: Priority Health SBD |
$370.69
|
| Rate for Payer: UMR Bronson Commercial |
$241.96
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$690.00
|
|
|
PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$9,538.00
|
|
|
Service Code
|
HCPCS 61700
|
| Min. Negotiated Rate |
$1,257.35 |
| Max. Negotiated Rate |
$6,676.60 |
| Rate for Payer: Aetna Commercial |
$4,404.66
|
| Rate for Payer: BCBS Complete |
$2,313.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,257.35
|
| Rate for Payer: Cash Price |
$7,630.40
|
| Rate for Payer: Cash Price |
$7,630.40
|
| Rate for Payer: Meridian Medicaid |
$2,313.43
|
| 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 Narrow Network |
$5,773.78
|
| Rate for Payer: Priority Health SBD |
$5,773.78
|
| Rate for Payer: UMR Bronson Commercial |
$4,387.48
|
|
|
PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$8,499.00
|
|
|
Service Code
|
HCPCS 61702
|
| Min. Negotiated Rate |
$1,072.45 |
| Max. Negotiated Rate |
$6,842.81 |
| Rate for Payer: Aetna Commercial |
$5,197.31
|
| Rate for Payer: BCBS Complete |
$2,722.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.45
|
| Rate for Payer: Cash Price |
$6,799.20
|
| Rate for Payer: Cash Price |
$6,799.20
|
| Rate for Payer: Meridian Medicaid |
$2,722.04
|
| 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 Narrow Network |
$6,842.81
|
| Rate for Payer: Priority Health SBD |
$6,842.81
|
| Rate for Payer: UMR Bronson Commercial |
$3,909.54
|
|
|
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 |
$142.66
|
| Rate for Payer: BCBS Complete |
$85.21
|
| Rate for Payer: BCBS Trust/PPO |
$117.56
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Meridian Medicaid |
$85.21
|
| 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 Narrow Network |
$156.19
|
| Rate for Payer: Priority Health SBD |
$156.19
|
| Rate for Payer: UMR Bronson Commercial |
$299.46
|
|
|
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 |
$223.30 |
| Rate for Payer: Aetna Commercial |
$169.53
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Meridian Medicaid |
$102.88
|
| 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 Narrow Network |
$187.84
|
| Rate for Payer: Priority Health SBD |
$187.84
|
| Rate for Payer: UMR Bronson Commercial |
$146.74
|
|
|
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 |
$61.20
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| 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 Narrow Network |
$67.42
|
| Rate for Payer: Priority Health SBD |
$67.42
|
| Rate for Payer: UMR Bronson Commercial |
$138.00
|
|
