|
PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 45386
|
| Hospital Charge Code |
45386
|
| Min. Negotiated Rate |
$200.44 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Aetna Commercial |
$268.59
|
| Rate for Payer: Aetna Medicare |
$200.44
|
| Rate for Payer: BCBS Complete |
$528.00
|
| Rate for Payer: BCBS MAPPO |
$200.44
|
| Rate for Payer: BCN Medicare Advantage |
$200.44
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$288.63
|
| Rate for Payer: Cofinity Commercial |
$268.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.44
|
| Rate for Payer: Healthscope Commercial |
$240.53
|
| Rate for Payer: Healthscope Whirlpool |
$240.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.46
|
| Rate for Payer: Nomi Health Commercial |
$240.53
|
| Rate for Payer: PACE SWMI |
$200.44
|
| Rate for Payer: PHP Medicare Advantage |
$200.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.00
|
| Rate for Payer: Priority Health Medicare |
$200.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.44
|
| Rate for Payer: UHC Medicare Advantage |
$200.44
|
| Rate for Payer: UHCCP DNSP |
$200.44
|
|
|
PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 45386
|
| Min. Negotiated Rate |
$200.44 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Aetna Commercial |
$268.59
|
| Rate for Payer: Aetna Medicare |
$200.44
|
| Rate for Payer: BCBS Complete |
$528.00
|
| Rate for Payer: BCBS MAPPO |
$200.44
|
| Rate for Payer: BCN Medicare Advantage |
$200.44
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$288.63
|
| Rate for Payer: Cofinity Commercial |
$268.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.44
|
| Rate for Payer: Healthscope Commercial |
$240.53
|
| Rate for Payer: Healthscope Whirlpool |
$240.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.46
|
| Rate for Payer: Nomi Health Commercial |
$240.53
|
| Rate for Payer: PACE SWMI |
$200.44
|
| Rate for Payer: PHP Medicare Advantage |
$200.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.00
|
| Rate for Payer: Priority Health Medicare |
$200.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.44
|
| Rate for Payer: UHC Medicare Advantage |
$200.44
|
| Rate for Payer: UHCCP DNSP |
$200.44
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Facility
|
OP
|
$1,406.00
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
45381
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$1,782.39 |
| Rate for Payer: Aetna Commercial |
$1,265.40
|
| Rate for Payer: Aetna Medicare |
$1,149.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: ASR ASR |
$1,363.82
|
| Rate for Payer: ASR Commercial |
$1,363.82
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.37
|
| Rate for Payer: BCN Commercial |
$1,090.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cofinity Commercial |
$1,321.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,124.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$1,406.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,363.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,149.93
|
| Rate for Payer: Mclaren Commercial |
$1,265.40
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.10
|
| Rate for Payer: Nomi Health Commercial |
$1,152.92
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,264.92
|
| Rate for Payer: PHP Medicaid |
$616.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,231.94
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health Narrow Network |
$985.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,237.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$1,782.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP DNSP |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Facility
|
IP
|
$1,406.00
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
45381
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$913.90 |
| Max. Negotiated Rate |
$1,406.00 |
| Rate for Payer: Aetna Commercial |
$1,265.40
|
| Rate for Payer: ASR ASR |
$1,363.82
|
| Rate for Payer: ASR Commercial |
$1,363.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.75
|
| Rate for Payer: BCN Commercial |
$1,090.07
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cofinity Commercial |
$1,321.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,124.80
|
| Rate for Payer: Healthscope Commercial |
$1,406.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,363.82
|
| Rate for Payer: Mclaren Commercial |
$1,265.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.10
|
| Rate for Payer: Nomi Health Commercial |
$1,152.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,237.28
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$1,406.00
|
|
|
Service Code
|
HCPCS 45381
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Aetna Commercial |
$254.41
|
| Rate for Payer: Aetna Medicare |
$189.86
|
| Rate for Payer: BCBS Complete |
$562.40
|
| Rate for Payer: BCBS MAPPO |
$189.86
|
| Rate for Payer: BCN Medicare Advantage |
$189.86
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cofinity Commercial |
$273.40
|
| Rate for Payer: Cofinity Commercial |
$254.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.86
|
| Rate for Payer: Healthscope Commercial |
$227.83
|
| Rate for Payer: Healthscope Whirlpool |
$227.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.35
|
| Rate for Payer: Nomi Health Commercial |
$227.83
|
| Rate for Payer: PACE SWMI |
$189.86
|
| Rate for Payer: PHP Medicare Advantage |
$189.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.90
|
| Rate for Payer: Priority Health Medicare |
$189.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.86
|
| Rate for Payer: UHC Medicare Advantage |
$189.86
|
| Rate for Payer: UHCCP DNSP |
$189.86
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$1,406.00
|
|
|
Service Code
|
HCPCS 45381
|
| Hospital Charge Code |
45381
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Aetna Commercial |
$254.41
|
| Rate for Payer: Aetna Medicare |
$189.86
|
| Rate for Payer: BCBS Complete |
$562.40
|
| Rate for Payer: BCBS MAPPO |
$189.86
|
| Rate for Payer: BCN Medicare Advantage |
$189.86
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cash Price |
$1,124.80
|
| Rate for Payer: Cofinity Commercial |
$273.40
|
| Rate for Payer: Cofinity Commercial |
$254.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.86
|
| Rate for Payer: Healthscope Commercial |
$227.83
|
| Rate for Payer: Healthscope Whirlpool |
$227.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.35
|
| Rate for Payer: Nomi Health Commercial |
$227.83
|
| Rate for Payer: PACE SWMI |
$189.86
|
| Rate for Payer: PHP Medicare Advantage |
$189.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.90
|
| Rate for Payer: Priority Health Medicare |
$189.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.86
|
| Rate for Payer: UHC Medicare Advantage |
$189.86
|
| Rate for Payer: UHCCP DNSP |
$189.86
|
|
|
PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 45391
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$353.60 |
| Rate for Payer: Aetna Commercial |
$324.52
|
| Rate for Payer: Aetna Medicare |
$242.18
|
| Rate for Payer: BCBS Complete |
$217.60
|
| Rate for Payer: BCBS MAPPO |
$242.18
|
| Rate for Payer: BCN Medicare Advantage |
$242.18
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cofinity Commercial |
$348.74
|
| Rate for Payer: Cofinity Commercial |
$324.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.18
|
| Rate for Payer: Healthscope Commercial |
$290.62
|
| Rate for Payer: Healthscope Whirlpool |
$290.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.29
|
| Rate for Payer: Nomi Health Commercial |
$290.62
|
| Rate for Payer: PACE SWMI |
$242.18
|
| Rate for Payer: PHP Medicare Advantage |
$242.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.60
|
| Rate for Payer: Priority Health Medicare |
$242.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.18
|
| Rate for Payer: UHC Medicare Advantage |
$242.18
|
| Rate for Payer: UHCCP DNSP |
$242.18
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45384
|
| Min. Negotiated Rate |
$216.55 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$290.18
|
| Rate for Payer: Aetna Medicare |
$216.55
|
| Rate for Payer: BCBS Complete |
$579.20
|
| Rate for Payer: BCBS MAPPO |
$216.55
|
| Rate for Payer: BCN Medicare Advantage |
$216.55
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$311.83
|
| Rate for Payer: Cofinity Commercial |
$290.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.55
|
| Rate for Payer: Healthscope Commercial |
$259.86
|
| Rate for Payer: Healthscope Whirlpool |
$259.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.38
|
| Rate for Payer: Nomi Health Commercial |
$259.86
|
| Rate for Payer: PACE SWMI |
$216.55
|
| Rate for Payer: PHP Medicare Advantage |
$216.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health Medicare |
$216.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.55
|
| Rate for Payer: UHC Medicare Advantage |
$216.55
|
| Rate for Payer: UHCCP DNSP |
$216.55
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
45384
|
| Min. Negotiated Rate |
$216.55 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$290.18
|
| Rate for Payer: Aetna Medicare |
$216.55
|
| Rate for Payer: BCBS Complete |
$579.20
|
| Rate for Payer: BCBS MAPPO |
$216.55
|
| Rate for Payer: BCN Medicare Advantage |
$216.55
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$311.83
|
| Rate for Payer: Cofinity Commercial |
$290.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.55
|
| Rate for Payer: Healthscope Commercial |
$259.86
|
| Rate for Payer: Healthscope Whirlpool |
$259.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.38
|
| Rate for Payer: Nomi Health Commercial |
$259.86
|
| Rate for Payer: PACE SWMI |
$216.55
|
| Rate for Payer: PHP Medicare Advantage |
$216.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health Medicare |
$216.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.55
|
| Rate for Payer: UHC Medicare Advantage |
$216.55
|
| Rate for Payer: UHCCP DNSP |
$216.55
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$1,782.39 |
| Rate for Payer: Aetna Commercial |
$1,303.20
|
| Rate for Payer: Aetna Medicare |
$1,149.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: ASR ASR |
$1,404.56
|
| Rate for Payer: ASR Commercial |
$1,404.56
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,185.77
|
| Rate for Payer: BCN Commercial |
$1,122.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$1,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,149.93
|
| Rate for Payer: Mclaren Commercial |
$1,303.20
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,264.92
|
| Rate for Payer: PHP Medicaid |
$616.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,268.74
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,015.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,274.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$1,782.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP DNSP |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$941.20 |
| Max. Negotiated Rate |
$1,448.00 |
| Rate for Payer: Aetna Commercial |
$1,303.20
|
| Rate for Payer: ASR ASR |
$1,404.56
|
| Rate for Payer: ASR Commercial |
$1,404.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.98
|
| Rate for Payer: BCN Commercial |
$1,122.63
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Healthscope Commercial |
$1,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.56
|
| Rate for Payer: Mclaren Commercial |
$1,303.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,274.24
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45385
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$320.53
|
| Rate for Payer: Aetna Medicare |
$239.20
|
| Rate for Payer: BCBS Complete |
$579.20
|
| Rate for Payer: BCBS MAPPO |
$239.20
|
| Rate for Payer: BCN Medicare Advantage |
$239.20
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$344.45
|
| Rate for Payer: Cofinity Commercial |
$320.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$287.04
|
| Rate for Payer: Healthscope Whirlpool |
$287.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.16
|
| Rate for Payer: Nomi Health Commercial |
$287.04
|
| Rate for Payer: PACE SWMI |
$239.20
|
| Rate for Payer: PHP Medicare Advantage |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health Medicare |
$239.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.20
|
| Rate for Payer: UHC Medicare Advantage |
$239.20
|
| Rate for Payer: UHCCP DNSP |
$239.20
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
45385
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$320.53
|
| Rate for Payer: Aetna Medicare |
$239.20
|
| Rate for Payer: BCBS Complete |
$579.20
|
| Rate for Payer: BCBS MAPPO |
$239.20
|
| Rate for Payer: BCN Medicare Advantage |
$239.20
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$344.45
|
| Rate for Payer: Cofinity Commercial |
$320.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$287.04
|
| Rate for Payer: Healthscope Whirlpool |
$287.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.16
|
| Rate for Payer: Nomi Health Commercial |
$287.04
|
| Rate for Payer: PACE SWMI |
$239.20
|
| Rate for Payer: PHP Medicare Advantage |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health Medicare |
$239.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.20
|
| Rate for Payer: UHC Medicare Advantage |
$239.20
|
| Rate for Payer: UHCCP DNSP |
$239.20
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$1,782.39 |
| Rate for Payer: Aetna Commercial |
$1,303.20
|
| Rate for Payer: Aetna Medicare |
$1,149.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: ASR ASR |
$1,404.56
|
| Rate for Payer: ASR Commercial |
$1,404.56
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,185.77
|
| Rate for Payer: BCN Commercial |
$1,122.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$1,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,149.93
|
| Rate for Payer: Mclaren Commercial |
$1,303.20
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,264.92
|
| Rate for Payer: PHP Medicaid |
$616.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,268.74
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,015.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,274.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$1,782.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP DNSP |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$941.20 |
| Max. Negotiated Rate |
$1,448.00 |
| Rate for Payer: Aetna Commercial |
$1,303.20
|
| Rate for Payer: ASR ASR |
$1,404.56
|
| Rate for Payer: ASR Commercial |
$1,404.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.98
|
| Rate for Payer: BCN Commercial |
$1,122.63
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Healthscope Commercial |
$1,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.56
|
| Rate for Payer: Mclaren Commercial |
$1,303.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,274.24
|
|
|
PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 45392
|
| Min. Negotiated Rate |
$285.58 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$382.68
|
| Rate for Payer: Aetna Medicare |
$285.58
|
| Rate for Payer: BCBS Complete |
$398.00
|
| Rate for Payer: BCBS MAPPO |
$285.58
|
| Rate for Payer: BCN Medicare Advantage |
$285.58
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cofinity Commercial |
$411.24
|
| Rate for Payer: Cofinity Commercial |
$382.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.58
|
| Rate for Payer: Healthscope Commercial |
$342.70
|
| Rate for Payer: Healthscope Whirlpool |
$342.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.86
|
| Rate for Payer: Nomi Health Commercial |
$342.70
|
| Rate for Payer: PACE SWMI |
$285.58
|
| Rate for Payer: PHP Medicare Advantage |
$285.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health Medicare |
$285.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.58
|
| Rate for Payer: UHC Medicare Advantage |
$285.58
|
| Rate for Payer: UHCCP DNSP |
$285.58
|
|
|
PR COMM SVCS BY RHC/FQHC 5 MIN
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS G0071
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
|
|
PR COMPLETE REPLACEMENT PICC RS&I
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 36584
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$261.30 |
| Rate for Payer: Aetna Commercial |
$74.81
|
| Rate for Payer: Aetna Medicare |
$55.83
|
| Rate for Payer: BCBS Complete |
$160.80
|
| Rate for Payer: BCBS MAPPO |
$55.83
|
| Rate for Payer: BCN Medicare Advantage |
$55.83
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$80.40
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.83
|
| Rate for Payer: Healthscope Commercial |
$67.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.62
|
| Rate for Payer: Nomi Health Commercial |
$67.00
|
| Rate for Payer: PACE SWMI |
$55.83
|
| Rate for Payer: PHP Medicare Advantage |
$55.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health Medicare |
$55.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.83
|
| Rate for Payer: UHC Medicare Advantage |
$55.83
|
| Rate for Payer: UHCCP DNSP |
$55.83
|
|
|
PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 93303
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$279.94 |
| Rate for Payer: Aetna Commercial |
$260.50
|
| Rate for Payer: Aetna Medicare |
$194.40
|
| Rate for Payer: BCBS Complete |
$145.20
|
| Rate for Payer: BCBS MAPPO |
$194.40
|
| Rate for Payer: BCN Medicare Advantage |
$194.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cofinity Commercial |
$279.94
|
| Rate for Payer: Cofinity Commercial |
$260.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.40
|
| Rate for Payer: Healthscope Commercial |
$233.28
|
| Rate for Payer: Healthscope Whirlpool |
$233.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.12
|
| Rate for Payer: Nomi Health Commercial |
$233.28
|
| Rate for Payer: PACE SWMI |
$194.40
|
| Rate for Payer: PHP Medicare Advantage |
$194.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.95
|
| Rate for Payer: Priority Health Medicare |
$194.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.40
|
| Rate for Payer: UHC Medicare Advantage |
$194.40
|
| Rate for Payer: UHCCP DNSP |
$194.40
|
|
|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$123.24 |
| Rate for Payer: Aetna Commercial |
$114.68
|
| Rate for Payer: Aetna Medicare |
$85.58
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$85.58
|
| Rate for Payer: BCN Medicare Advantage |
$85.58
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$123.24
|
| Rate for Payer: Cofinity Commercial |
$114.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.58
|
| Rate for Payer: Healthscope Commercial |
$94.14
|
| Rate for Payer: Healthscope Whirlpool |
$94.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.86
|
| Rate for Payer: Nomi Health Commercial |
$102.70
|
| Rate for Payer: PACE SWMI |
$85.58
|
| Rate for Payer: PHP Medicare Advantage |
$85.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$85.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.58
|
| Rate for Payer: UHC Medicare Advantage |
$85.58
|
| Rate for Payer: UHCCP DNSP |
$85.58
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 51727
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$445.25 |
| Rate for Payer: Aetna Commercial |
$414.02
|
| Rate for Payer: Aetna Medicare |
$308.97
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCBS MAPPO |
$308.97
|
| Rate for Payer: BCN Medicare Advantage |
$308.97
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$444.92
|
| Rate for Payer: Cofinity Commercial |
$414.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$370.76
|
| Rate for Payer: Healthscope Whirlpool |
$370.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.42
|
| Rate for Payer: Nomi Health Commercial |
$370.76
|
| Rate for Payer: PACE SWMI |
$308.97
|
| Rate for Payer: PHP Medicare Advantage |
$308.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.25
|
| Rate for Payer: Priority Health Medicare |
$308.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.97
|
| Rate for Payer: UHC Medicare Advantage |
$308.97
|
| Rate for Payer: UHCCP DNSP |
$308.97
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 51728
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$442.31 |
| Rate for Payer: Aetna Commercial |
$411.59
|
| Rate for Payer: Aetna Medicare |
$307.16
|
| Rate for Payer: BCBS Complete |
$264.00
|
| Rate for Payer: BCBS MAPPO |
$307.16
|
| Rate for Payer: BCN Medicare Advantage |
$307.16
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$442.31
|
| Rate for Payer: Cofinity Commercial |
$411.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.16
|
| Rate for Payer: Healthscope Commercial |
$368.59
|
| Rate for Payer: Healthscope Whirlpool |
$368.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$322.52
|
| Rate for Payer: Nomi Health Commercial |
$368.59
|
| Rate for Payer: PACE SWMI |
$307.16
|
| Rate for Payer: PHP Medicare Advantage |
$307.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.00
|
| Rate for Payer: Priority Health Medicare |
$307.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$307.16
|
| Rate for Payer: UHC Medicare Advantage |
$307.16
|
| Rate for Payer: UHCCP DNSP |
$307.16
|
|
|
PR COMPLEX E/M VISIT ADD ON
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G2211
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Aetna Medicare |
$15.26
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$15.26
|
| Rate for Payer: BCN Medicare Advantage |
$15.26
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$21.97
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.26
|
| Rate for Payer: Healthscope Commercial |
$18.31
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.02
|
| Rate for Payer: Nomi Health Commercial |
$18.31
|
| Rate for Payer: PACE SWMI |
$15.26
|
| Rate for Payer: PHP Medicare Advantage |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$15.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.26
|
| Rate for Payer: UHC Medicare Advantage |
$15.26
|
| Rate for Payer: UHCCP DNSP |
$15.26
|
|
|
PR COMPLEX IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$4,304.00
|
|
|
Service Code
|
HCPCS 00564
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,721.60 |
| Max. Negotiated Rate |
$2,797.60 |
| Rate for Payer: Aetna Medicare |
$2,152.00
|
| Rate for Payer: BCBS Complete |
$1,721.60
|
| Rate for Payer: Cash Price |
$3,443.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.60
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Medicare |
$13.41
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$13.41
|
| Rate for Payer: BCN Medicare Advantage |
$13.41
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Cofinity Commercial |
$17.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.41
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Whirlpool |
$16.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.08
|
| Rate for Payer: Nomi Health Commercial |
$16.09
|
| Rate for Payer: PACE SWMI |
$13.41
|
| Rate for Payer: PHP Medicare Advantage |
$13.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$13.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.41
|
| Rate for Payer: UHC Medicare Advantage |
$13.41
|
| Rate for Payer: UHCCP DNSP |
$13.41
|
|
