|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
45381
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$606.32 |
| Max. Negotiated Rate |
$1,240.20 |
| Rate for Payer: Aetna American Axle |
$895.70
|
| Rate for Payer: Aetna Commercial |
$1,171.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.70
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cofinity Commercial |
$1,185.08
|
| Rate for Payer: Cofinity Commercial |
$964.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,102.40
|
| Rate for Payer: Healthscope Commercial |
$1,240.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$964.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,033.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,171.30
|
| Rate for Payer: PHP Commercial |
$1,171.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.60
|
| Rate for Payer: Priority Health SBD |
$868.14
|
| Rate for Payer: UMR Bronson Commercial |
$606.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,033.50
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$1,378.00
|
|
|
Service Code
|
HCPCS 45381
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$964.60 |
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS Trust/PPO |
$218.19
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.73
|
| Rate for Payer: Priority Health Narrow Network |
$345.73
|
| Rate for Payer: Priority Health SBD |
$345.73
|
| Rate for Payer: UMR Bronson Commercial |
$633.88
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$1,378.00
|
|
|
Service Code
|
HCPCS 45381
|
| Hospital Charge Code |
45381
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$964.60 |
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS Trust/PPO |
$218.19
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.73
|
| Rate for Payer: Priority Health Narrow Network |
$345.73
|
| Rate for Payer: Priority Health SBD |
$345.73
|
| Rate for Payer: UMR Bronson Commercial |
$633.88
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
45381
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$193.52 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna American Axle |
$895.70
|
| Rate for Payer: Aetna Commercial |
$1,171.30
|
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.70
|
| 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 |
$1,615.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cofinity Commercial |
$1,185.08
|
| Rate for Payer: Cofinity Commercial |
$964.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,102.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$1,240.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$964.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,033.50
|
| 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 |
$1,171.30
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,171.30
|
| 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 |
$964.60
|
| 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 |
$868.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$193.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: UMR Bronson Commercial |
$509.86
|
| Rate for Payer: VA VA |
$1,048.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,033.50
|
|
|
PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX
|
Professional
|
Both
|
$533.00
|
|
|
Service Code
|
HCPCS 45391
|
| Min. Negotiated Rate |
$161.67 |
| Max. Negotiated Rate |
$444.51 |
| Rate for Payer: Aetna Commercial |
$341.98
|
| Rate for Payer: BCBS Complete |
$169.75
|
| Rate for Payer: BCBS Trust/PPO |
$304.83
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Meridian Medicaid |
$169.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.51
|
| Rate for Payer: Priority Health Narrow Network |
$444.51
|
| Rate for Payer: Priority Health SBD |
$444.51
|
| Rate for Payer: UMR Bronson Commercial |
$245.18
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 45384
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$994.00 |
| Rate for Payer: Aetna Commercial |
$303.80
|
| Rate for Payer: BCBS Complete |
$150.74
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Meridian Medicaid |
$150.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.36
|
| Rate for Payer: Priority Health Narrow Network |
$393.36
|
| Rate for Payer: Priority Health SBD |
$393.36
|
| Rate for Payer: UMR Bronson Commercial |
$653.20
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$220.70 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna American Axle |
$923.00
|
| Rate for Payer: Aetna Commercial |
$1,207.00
|
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.00
|
| 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 |
$953.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$994.00
|
| Rate for Payer: Cofinity Commercial |
$1,221.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$1,278.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.00
|
| 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 |
$1,207.00
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,207.00
|
| 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 |
$994.00
|
| 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 |
$894.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$220.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: UMR Bronson Commercial |
$525.40
|
| Rate for Payer: VA VA |
$1,048.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.00
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
45384
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$994.00 |
| Rate for Payer: Aetna Commercial |
$303.80
|
| Rate for Payer: BCBS Complete |
$150.74
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Meridian Medicaid |
$150.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.36
|
| Rate for Payer: Priority Health Narrow Network |
$393.36
|
| Rate for Payer: Priority Health SBD |
$393.36
|
| Rate for Payer: UMR Bronson Commercial |
$653.20
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$624.80 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Aetna American Axle |
$923.00
|
| Rate for Payer: Aetna Commercial |
$1,207.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,221.20
|
| Rate for Payer: Cofinity Commercial |
$994.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.00
|
| Rate for Payer: Healthscope Commercial |
$1,278.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.00
|
| Rate for Payer: PHP Commercial |
$1,207.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health SBD |
$894.60
|
| Rate for Payer: UMR Bronson Commercial |
$624.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.00
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$624.80 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Aetna American Axle |
$923.00
|
| Rate for Payer: Aetna Commercial |
$1,207.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,221.20
|
| Rate for Payer: Cofinity Commercial |
$994.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.00
|
| Rate for Payer: Healthscope Commercial |
$1,278.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.00
|
| Rate for Payer: PHP Commercial |
$1,207.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health SBD |
$894.60
|
| Rate for Payer: UMR Bronson Commercial |
$624.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.00
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
45385
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$994.00 |
| Rate for Payer: Aetna Commercial |
$337.92
|
| Rate for Payer: BCBS Complete |
$167.52
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Meridian Medicaid |
$167.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.04
|
| Rate for Payer: Priority Health Narrow Network |
$438.04
|
| Rate for Payer: Priority Health SBD |
$438.04
|
| Rate for Payer: UMR Bronson Commercial |
$653.20
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 45385
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$994.00 |
| Rate for Payer: Aetna Commercial |
$337.92
|
| Rate for Payer: BCBS Complete |
$167.52
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Meridian Medicaid |
$167.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.04
|
| Rate for Payer: Priority Health Narrow Network |
$438.04
|
| Rate for Payer: Priority Health SBD |
$438.04
|
| Rate for Payer: UMR Bronson Commercial |
$653.20
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna American Axle |
$923.00
|
| Rate for Payer: Aetna Commercial |
$1,207.00
|
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.00
|
| 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 |
$768.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$994.00
|
| Rate for Payer: Cofinity Commercial |
$1,221.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$1,278.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.00
|
| 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 |
$1,207.00
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,207.00
|
| 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 |
$994.00
|
| 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 |
$894.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$245.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: UMR Bronson Commercial |
$525.40
|
| Rate for Payer: VA VA |
$1,048.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.00
|
|
|
PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 45392
|
| Min. Negotiated Rate |
$190.85 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$405.72
|
| Rate for Payer: BCBS Complete |
$200.39
|
| Rate for Payer: BCBS Trust/PPO |
$308.53
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Meridian Medicaid |
$200.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$524.47
|
| Rate for Payer: Priority Health Narrow Network |
$524.47
|
| Rate for Payer: Priority Health SBD |
$524.47
|
| Rate for Payer: UMR Bronson Commercial |
$448.50
|
|
|
PR COMM SVCS BY RHC/FQHC 5 MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G0071
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$1,575.92 |
| Rate for Payer: Aetna Commercial |
$23.13
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.92
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.44
|
| Rate for Payer: Priority Health Narrow Network |
$31.44
|
| Rate for Payer: Priority Health SBD |
$31.44
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
PR COMPLETE REPLACEMENT PICC RS&I
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 36584
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$275.80 |
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS Trust/PPO |
$79.77
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.50
|
| Rate for Payer: Priority Health Narrow Network |
$91.50
|
| Rate for Payer: Priority Health SBD |
$91.50
|
| Rate for Payer: UMR Bronson Commercial |
$181.24
|
|
|
PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 93303
|
| Min. Negotiated Rate |
$85.12 |
| Max. Negotiated Rate |
$1,712.22 |
| Rate for Payer: Aetna Commercial |
$298.31
|
| Rate for Payer: BCBS Complete |
$142.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,712.22
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.12
|
| Rate for Payer: Priority Health Narrow Network |
$85.12
|
| Rate for Payer: Priority Health SBD |
$311.62
|
| Rate for Payer: UMR Bronson Commercial |
$163.76
|
|
|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$49.68 |
| Max. Negotiated Rate |
$2,901.95 |
| Rate for Payer: Aetna Commercial |
$50.45
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,901.95
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Meridian Medicaid |
$59.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.79
|
| Rate for Payer: Priority Health Narrow Network |
$114.79
|
| Rate for Payer: Priority Health SBD |
$114.79
|
| Rate for Payer: UMR Bronson Commercial |
$49.68
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 51727
|
| Min. Negotiated Rate |
$168.05 |
| Max. Negotiated Rate |
$3,367.38 |
| Rate for Payer: Aetna Commercial |
$457.56
|
| Rate for Payer: BCBS Complete |
$268.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,367.38
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.05
|
| Rate for Payer: Priority Health Narrow Network |
$168.05
|
| Rate for Payer: Priority Health SBD |
$592.77
|
| Rate for Payer: UMR Bronson Commercial |
$309.12
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 51728
|
| Min. Negotiated Rate |
$164.27 |
| Max. Negotiated Rate |
$2,796.82 |
| Rate for Payer: Aetna Commercial |
$461.60
|
| Rate for Payer: BCBS Complete |
$258.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,796.82
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.27
|
| Rate for Payer: Priority Health Narrow Network |
$164.27
|
| Rate for Payer: Priority Health SBD |
$591.16
|
| Rate for Payer: UMR Bronson Commercial |
$297.62
|
|
|
PR COMPLEX IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$4,220.00
|
|
|
Service Code
|
HCPCS 00564
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,688.00 |
| Max. Negotiated Rate |
$2,954.00 |
| Rate for Payer: BCBS Complete |
$1,688.00
|
| Rate for Payer: Cash Price |
$3,376.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,954.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,941.20
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$2,933.12 |
| Rate for Payer: Aetna Commercial |
$17.72
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,933.12
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.18
|
| Rate for Payer: Priority Health Narrow Network |
$9.18
|
| Rate for Payer: Priority Health SBD |
$22.69
|
| Rate for Payer: UMR Bronson Commercial |
$76.82
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 51729
|
| Min. Negotiated Rate |
$199.39 |
| Max. Negotiated Rate |
$2,879.24 |
| Rate for Payer: Aetna Commercial |
$491.15
|
| Rate for Payer: BCBS Complete |
$280.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,879.24
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.39
|
| Rate for Payer: Priority Health Narrow Network |
$199.39
|
| Rate for Payer: Priority Health SBD |
$625.73
|
| Rate for Payer: UMR Bronson Commercial |
$322.92
|
|
|
PR COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$10,100.00
|
|
|
Service Code
|
HCPCS 61697
|
| Min. Negotiated Rate |
$736.98 |
| Max. Negotiated Rate |
$7,191.03 |
| Rate for Payer: Aetna Commercial |
$5,432.97
|
| Rate for Payer: BCBS Complete |
$2,859.59
|
| Rate for Payer: BCBS Trust/PPO |
$736.98
|
| Rate for Payer: Cash Price |
$8,080.00
|
| Rate for Payer: Cash Price |
$8,080.00
|
| Rate for Payer: Meridian Medicaid |
$2,859.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,723.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,070.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,191.03
|
| Rate for Payer: Priority Health Narrow Network |
$7,191.03
|
| Rate for Payer: Priority Health SBD |
$7,191.03
|
| Rate for Payer: UMR Bronson Commercial |
$4,646.00
|
|
|
PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92557
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$36.02
|
| Rate for Payer: BCBS Complete |
$21.02
|
| Rate for Payer: BCBS Trust/PPO |
$196.00
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Meridian Medicaid |
$21.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.21
|
| Rate for Payer: Priority Health Narrow Network |
$42.21
|
| Rate for Payer: Priority Health SBD |
$42.21
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
