|
PR ENDOSCOPY UPPER SMALL INTESTINE
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 44360
|
| Min. Negotiated Rate |
$134.86 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Aetna Commercial |
$180.71
|
| Rate for Payer: Aetna Medicare |
$134.86
|
| Rate for Payer: BCBS Complete |
$374.00
|
| Rate for Payer: BCBS MAPPO |
$134.86
|
| Rate for Payer: BCN Medicare Advantage |
$134.86
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$194.20
|
| Rate for Payer: Cofinity Commercial |
$180.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$161.83
|
| Rate for Payer: Healthscope Whirlpool |
$161.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.60
|
| Rate for Payer: Nomi Health Commercial |
$161.83
|
| Rate for Payer: PACE SWMI |
$134.86
|
| Rate for Payer: PHP Medicare Advantage |
$134.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.75
|
| Rate for Payer: Priority Health Medicare |
$134.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.86
|
| Rate for Payer: UHC Medicare Advantage |
$134.86
|
| Rate for Payer: UHCCP DNSP |
$134.86
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 44361
|
| Min. Negotiated Rate |
$149.27 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna Commercial |
$200.02
|
| Rate for Payer: Aetna Medicare |
$149.27
|
| Rate for Payer: BCBS Complete |
$395.20
|
| Rate for Payer: BCBS MAPPO |
$149.27
|
| Rate for Payer: BCN Medicare Advantage |
$149.27
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cofinity Commercial |
$214.95
|
| Rate for Payer: Cofinity Commercial |
$200.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.27
|
| Rate for Payer: Healthscope Commercial |
$179.12
|
| Rate for Payer: Healthscope Whirlpool |
$179.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.73
|
| Rate for Payer: Nomi Health Commercial |
$179.12
|
| Rate for Payer: PACE SWMI |
$149.27
|
| Rate for Payer: PHP Medicare Advantage |
$149.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.20
|
| Rate for Payer: Priority Health Medicare |
$149.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.27
|
| Rate for Payer: UHC Medicare Advantage |
$149.27
|
| Rate for Payer: UHCCP DNSP |
$149.27
|
|
|
PR ENDOVASC ABDO REPAIR W/PROS
|
Professional
|
Both
|
$5,333.00
|
|
|
Service Code
|
HCPCS 34805
|
| Min. Negotiated Rate |
$2,133.20 |
| Max. Negotiated Rate |
$3,466.45 |
| Rate for Payer: Aetna Medicare |
$2,666.50
|
| Rate for Payer: BCBS Complete |
$2,133.20
|
| Rate for Payer: Cash Price |
$4,266.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,466.45
|
|
|
PR ENDOVASCULAR REPAIR ILIAC ARTERY W ILIO-ILIAC PROSTHESIS
|
Professional
|
Both
|
$1,766.00
|
|
|
Service Code
|
HCPCS 34900
|
| Min. Negotiated Rate |
$706.40 |
| Max. Negotiated Rate |
$1,147.90 |
| Rate for Payer: Aetna Medicare |
$883.00
|
| Rate for Payer: BCBS Complete |
$706.40
|
| Rate for Payer: Cash Price |
$1,412.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.90
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Professional
|
Both
|
$2,741.00
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
36478
|
| Min. Negotiated Rate |
$265.37 |
| Max. Negotiated Rate |
$1,781.65 |
| Rate for Payer: Aetna Commercial |
$355.60
|
| Rate for Payer: Aetna Medicare |
$265.37
|
| Rate for Payer: BCBS Complete |
$1,096.40
|
| Rate for Payer: BCBS MAPPO |
$265.37
|
| Rate for Payer: BCN Medicare Advantage |
$265.37
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$382.13
|
| Rate for Payer: Cofinity Commercial |
$355.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.37
|
| Rate for Payer: Healthscope Commercial |
$318.44
|
| Rate for Payer: Healthscope Whirlpool |
$318.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.64
|
| Rate for Payer: Nomi Health Commercial |
$318.44
|
| Rate for Payer: PACE SWMI |
$265.37
|
| Rate for Payer: PHP Medicare Advantage |
$265.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health Medicare |
$265.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.37
|
| Rate for Payer: UHC Medicare Advantage |
$265.37
|
| Rate for Payer: UHCCP DNSP |
$265.37
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Facility
|
OP
|
$2,741.00
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
36478
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$2,466.90
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$2,658.77
|
| Rate for Payer: ASR Commercial |
$2,658.77
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,244.60
|
| Rate for Payer: BCN Commercial |
$2,125.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$2,576.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$2,741.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,658.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$2,466.90
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,329.85
|
| Rate for Payer: Nomi Health Commercial |
$2,247.62
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,401.66
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,921.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,412.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Professional
|
Both
|
$2,741.00
|
|
|
Service Code
|
HCPCS 36478
|
| Min. Negotiated Rate |
$265.37 |
| Max. Negotiated Rate |
$1,781.65 |
| Rate for Payer: Aetna Commercial |
$355.60
|
| Rate for Payer: Aetna Medicare |
$265.37
|
| Rate for Payer: BCBS Complete |
$1,096.40
|
| Rate for Payer: BCBS MAPPO |
$265.37
|
| Rate for Payer: BCN Medicare Advantage |
$265.37
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$382.13
|
| Rate for Payer: Cofinity Commercial |
$355.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.37
|
| Rate for Payer: Healthscope Commercial |
$318.44
|
| Rate for Payer: Healthscope Whirlpool |
$318.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.64
|
| Rate for Payer: Nomi Health Commercial |
$318.44
|
| Rate for Payer: PACE SWMI |
$265.37
|
| Rate for Payer: PHP Medicare Advantage |
$265.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health Medicare |
$265.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.37
|
| Rate for Payer: UHC Medicare Advantage |
$265.37
|
| Rate for Payer: UHCCP DNSP |
$265.37
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Facility
|
IP
|
$2,741.00
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
36478
|
| Min. Negotiated Rate |
$1,781.65 |
| Max. Negotiated Rate |
$2,741.00 |
| Rate for Payer: Aetna Commercial |
$2,466.90
|
| Rate for Payer: ASR ASR |
$2,658.77
|
| Rate for Payer: ASR Commercial |
$2,658.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,233.64
|
| Rate for Payer: BCN Commercial |
$2,125.10
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$2,576.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,192.80
|
| Rate for Payer: Healthscope Commercial |
$2,741.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,658.77
|
| Rate for Payer: Mclaren Commercial |
$2,466.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,329.85
|
| Rate for Payer: Nomi Health Commercial |
$2,247.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,412.08
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Professional
|
Both
|
$3,149.00
|
|
|
Service Code
|
HCPCS 36475
|
| Min. Negotiated Rate |
$265.46 |
| Max. Negotiated Rate |
$2,046.85 |
| Rate for Payer: Aetna Commercial |
$355.72
|
| Rate for Payer: Aetna Medicare |
$265.46
|
| Rate for Payer: BCBS Complete |
$1,259.60
|
| Rate for Payer: BCBS MAPPO |
$265.46
|
| Rate for Payer: BCN Medicare Advantage |
$265.46
|
| Rate for Payer: Cash Price |
$2,519.20
|
| Rate for Payer: Cash Price |
$2,519.20
|
| Rate for Payer: Cofinity Commercial |
$382.26
|
| Rate for Payer: Cofinity Commercial |
$355.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.46
|
| Rate for Payer: Healthscope Commercial |
$318.55
|
| Rate for Payer: Healthscope Whirlpool |
$318.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.73
|
| Rate for Payer: Nomi Health Commercial |
$318.55
|
| Rate for Payer: PACE SWMI |
$265.46
|
| Rate for Payer: PHP Medicare Advantage |
$265.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,046.85
|
| Rate for Payer: Priority Health Medicare |
$265.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.46
|
| Rate for Payer: UHC Medicare Advantage |
$265.46
|
| Rate for Payer: UHCCP DNSP |
$265.46
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 36476
|
| Min. Negotiated Rate |
$128.35 |
| Max. Negotiated Rate |
$211.90 |
| Rate for Payer: Aetna Commercial |
$171.99
|
| Rate for Payer: Aetna Medicare |
$128.35
|
| Rate for Payer: BCBS Complete |
$130.40
|
| Rate for Payer: BCBS MAPPO |
$128.35
|
| Rate for Payer: BCN Medicare Advantage |
$128.35
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cofinity Commercial |
$184.82
|
| Rate for Payer: Cofinity Commercial |
$171.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.35
|
| Rate for Payer: Healthscope Commercial |
$154.02
|
| Rate for Payer: Healthscope Whirlpool |
$154.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.77
|
| Rate for Payer: Nomi Health Commercial |
$154.02
|
| Rate for Payer: PACE SWMI |
$128.35
|
| Rate for Payer: PHP Medicare Advantage |
$128.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.90
|
| Rate for Payer: Priority Health Medicare |
$128.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.35
|
| Rate for Payer: UHC Medicare Advantage |
$128.35
|
| Rate for Payer: UHCCP DNSP |
$128.35
|
|
|
PR ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
HCPCS 44121
|
| Min. Negotiated Rate |
$232.88 |
| Max. Negotiated Rate |
$1,078.35 |
| Rate for Payer: Aetna Commercial |
$312.06
|
| Rate for Payer: Aetna Medicare |
$232.88
|
| Rate for Payer: BCBS Complete |
$663.60
|
| Rate for Payer: BCBS MAPPO |
$232.88
|
| Rate for Payer: BCN Medicare Advantage |
$232.88
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cofinity Commercial |
$335.35
|
| Rate for Payer: Cofinity Commercial |
$312.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.88
|
| Rate for Payer: Healthscope Commercial |
$279.46
|
| Rate for Payer: Healthscope Whirlpool |
$279.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.52
|
| Rate for Payer: Nomi Health Commercial |
$279.46
|
| Rate for Payer: PACE SWMI |
$232.88
|
| Rate for Payer: PHP Medicare Advantage |
$232.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,078.35
|
| Rate for Payer: Priority Health Medicare |
$232.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$232.88
|
| Rate for Payer: UHC Medicare Advantage |
$232.88
|
| Rate for Payer: UHCCP DNSP |
$232.88
|
|
|
PR ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY
|
Professional
|
Both
|
$3,497.00
|
|
|
Service Code
|
HCPCS 44125
|
| Min. Negotiated Rate |
$1,139.29 |
| Max. Negotiated Rate |
$2,273.05 |
| Rate for Payer: Aetna Commercial |
$1,526.65
|
| Rate for Payer: Aetna Medicare |
$1,139.29
|
| Rate for Payer: BCBS Complete |
$1,398.80
|
| Rate for Payer: BCBS MAPPO |
$1,139.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,139.29
|
| Rate for Payer: Cash Price |
$2,797.60
|
| Rate for Payer: Cash Price |
$2,797.60
|
| Rate for Payer: Cofinity Commercial |
$1,640.58
|
| Rate for Payer: Cofinity Commercial |
$1,526.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,139.29
|
| Rate for Payer: Healthscope Commercial |
$1,367.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,367.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,196.25
|
| Rate for Payer: Nomi Health Commercial |
$1,367.15
|
| Rate for Payer: PACE SWMI |
$1,139.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,139.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,273.05
|
| Rate for Payer: Priority Health Medicare |
$1,139.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,139.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,139.29
|
| Rate for Payer: UHCCP DNSP |
$1,139.29
|
|
|
PR ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS
|
Professional
|
Both
|
$2,877.00
|
|
|
Service Code
|
HCPCS 51960
|
| Min. Negotiated Rate |
$1,150.80 |
| Max. Negotiated Rate |
$1,898.84 |
| Rate for Payer: Aetna Commercial |
$1,766.98
|
| Rate for Payer: Aetna Medicare |
$1,318.64
|
| Rate for Payer: BCBS Complete |
$1,150.80
|
| Rate for Payer: BCBS MAPPO |
$1,318.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,318.64
|
| Rate for Payer: Cash Price |
$2,301.60
|
| Rate for Payer: Cash Price |
$2,301.60
|
| Rate for Payer: Cofinity Commercial |
$1,898.84
|
| Rate for Payer: Cofinity Commercial |
$1,766.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,318.64
|
| Rate for Payer: Healthscope Commercial |
$1,582.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,582.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,384.57
|
| Rate for Payer: Nomi Health Commercial |
$1,582.37
|
| Rate for Payer: PACE SWMI |
$1,318.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,318.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,870.05
|
| Rate for Payer: Priority Health Medicare |
$1,318.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,318.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,318.64
|
| Rate for Payer: UHCCP DNSP |
$1,318.64
|
|
|
PR ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS 44130
|
| Min. Negotiated Rate |
$1,268.80 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Commercial |
$1,711.41
|
| Rate for Payer: Aetna Medicare |
$1,277.17
|
| Rate for Payer: BCBS Complete |
$1,268.80
|
| Rate for Payer: BCBS MAPPO |
$1,277.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,277.17
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cofinity Commercial |
$1,839.12
|
| Rate for Payer: Cofinity Commercial |
$1,711.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,277.17
|
| Rate for Payer: Healthscope Commercial |
$1,532.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,532.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,341.03
|
| Rate for Payer: Nomi Health Commercial |
$1,532.60
|
| Rate for Payer: PACE SWMI |
$1,277.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,277.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health Medicare |
$1,277.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,277.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,277.17
|
| Rate for Payer: UHCCP DNSP |
$1,277.17
|
|
|
PR ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Facility
|
OP
|
$2,816.00
|
|
|
Service Code
|
CPT 44005
|
| Hospital Charge Code |
44005
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$2,816.00 |
| Rate for Payer: Aetna Commercial |
$2,534.40
|
| Rate for Payer: Aetna Medicare |
$1,408.00
|
| Rate for Payer: ASR ASR |
$2,731.52
|
| Rate for Payer: ASR Commercial |
$2,731.52
|
| Rate for Payer: BCBS Complete |
$1,126.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,306.02
|
| Rate for Payer: BCN Commercial |
$2,183.24
|
| Rate for Payer: Cash Price |
$2,252.80
|
| Rate for Payer: Cofinity Commercial |
$2,647.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,252.80
|
| Rate for Payer: Healthscope Commercial |
$2,816.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,731.52
|
| Rate for Payer: Mclaren Commercial |
$2,534.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,393.60
|
| Rate for Payer: Nomi Health Commercial |
$2,309.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,830.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,467.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,974.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,478.08
|
|
|
PR ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Facility
|
IP
|
$2,816.00
|
|
|
Service Code
|
CPT 44005
|
| Hospital Charge Code |
44005
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,830.40 |
| Max. Negotiated Rate |
$2,816.00 |
| Rate for Payer: Aetna Commercial |
$2,534.40
|
| Rate for Payer: ASR ASR |
$2,731.52
|
| Rate for Payer: ASR Commercial |
$2,731.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,294.76
|
| Rate for Payer: BCN Commercial |
$2,183.24
|
| Rate for Payer: Cash Price |
$2,252.80
|
| Rate for Payer: Cofinity Commercial |
$2,647.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,252.80
|
| Rate for Payer: Healthscope Commercial |
$2,816.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,731.52
|
| Rate for Payer: Mclaren Commercial |
$2,534.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,393.60
|
| Rate for Payer: Nomi Health Commercial |
$2,309.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,830.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,478.08
|
|
|
PR ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$2,816.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
44005
|
| Min. Negotiated Rate |
$1,059.79 |
| Max. Negotiated Rate |
$1,830.40 |
| Rate for Payer: Aetna Commercial |
$1,420.12
|
| Rate for Payer: Aetna Medicare |
$1,059.79
|
| Rate for Payer: BCBS Complete |
$1,126.40
|
| Rate for Payer: BCBS MAPPO |
$1,059.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,059.79
|
| Rate for Payer: Cash Price |
$2,252.80
|
| Rate for Payer: Cash Price |
$2,252.80
|
| Rate for Payer: Cofinity Commercial |
$1,526.10
|
| Rate for Payer: Cofinity Commercial |
$1,420.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,059.79
|
| Rate for Payer: Healthscope Commercial |
$1,271.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,271.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,112.78
|
| Rate for Payer: Nomi Health Commercial |
$1,271.75
|
| Rate for Payer: PACE SWMI |
$1,059.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,059.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,830.40
|
| Rate for Payer: Priority Health Medicare |
$1,059.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,059.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,059.79
|
| Rate for Payer: UHCCP DNSP |
$1,059.79
|
|
|
PR ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$2,816.00
|
|
|
Service Code
|
HCPCS 44005
|
| Min. Negotiated Rate |
$1,059.79 |
| Max. Negotiated Rate |
$1,830.40 |
| Rate for Payer: Aetna Commercial |
$1,420.12
|
| Rate for Payer: Aetna Medicare |
$1,059.79
|
| Rate for Payer: BCBS Complete |
$1,126.40
|
| Rate for Payer: BCBS MAPPO |
$1,059.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,059.79
|
| Rate for Payer: Cash Price |
$2,252.80
|
| Rate for Payer: Cash Price |
$2,252.80
|
| Rate for Payer: Cofinity Commercial |
$1,526.10
|
| Rate for Payer: Cofinity Commercial |
$1,420.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,059.79
|
| Rate for Payer: Healthscope Commercial |
$1,271.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,271.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,112.78
|
| Rate for Payer: Nomi Health Commercial |
$1,271.75
|
| Rate for Payer: PACE SWMI |
$1,059.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,059.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,830.40
|
| Rate for Payer: Priority Health Medicare |
$1,059.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,059.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,059.79
|
| Rate for Payer: UHCCP DNSP |
$1,059.79
|
|
|
PR ENTERORRHAPHY MULTIPLE PERFORATIONS
|
Professional
|
Both
|
$3,081.00
|
|
|
Service Code
|
HCPCS 44603
|
| Min. Negotiated Rate |
$1,232.40 |
| Max. Negotiated Rate |
$2,254.81 |
| Rate for Payer: Aetna Commercial |
$2,098.23
|
| Rate for Payer: Aetna Medicare |
$1,565.84
|
| Rate for Payer: BCBS Complete |
$1,232.40
|
| Rate for Payer: BCBS MAPPO |
$1,565.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,565.84
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Cofinity Commercial |
$2,254.81
|
| Rate for Payer: Cofinity Commercial |
$2,098.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,565.84
|
| Rate for Payer: Healthscope Commercial |
$1,879.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,879.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,644.13
|
| Rate for Payer: Nomi Health Commercial |
$1,879.01
|
| Rate for Payer: PACE SWMI |
$1,565.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,565.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.65
|
| Rate for Payer: Priority Health Medicare |
$1,565.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,565.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,565.84
|
| Rate for Payer: UHCCP DNSP |
$1,565.84
|
|
|
PR ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$2,425.00
|
|
|
Service Code
|
HCPCS 44602
|
| Min. Negotiated Rate |
$970.00 |
| Max. Negotiated Rate |
$1,962.73 |
| Rate for Payer: Aetna Commercial |
$1,826.43
|
| Rate for Payer: Aetna Medicare |
$1,363.01
|
| Rate for Payer: BCBS Complete |
$970.00
|
| Rate for Payer: BCBS MAPPO |
$1,363.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,363.01
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cofinity Commercial |
$1,962.73
|
| Rate for Payer: Cofinity Commercial |
$1,826.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,363.01
|
| Rate for Payer: Healthscope Commercial |
$1,635.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,635.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,431.16
|
| Rate for Payer: Nomi Health Commercial |
$1,635.61
|
| Rate for Payer: PACE SWMI |
$1,363.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,363.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,576.25
|
| Rate for Payer: Priority Health Medicare |
$1,363.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,363.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,363.01
|
| Rate for Payer: UHCCP DNSP |
$1,363.01
|
|
|
PR ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
HCPCS 44377
|
| Min. Negotiated Rate |
$280.26 |
| Max. Negotiated Rate |
$738.40 |
| Rate for Payer: Aetna Commercial |
$375.55
|
| Rate for Payer: Aetna Medicare |
$280.26
|
| Rate for Payer: BCBS Complete |
$454.40
|
| Rate for Payer: BCBS MAPPO |
$280.26
|
| Rate for Payer: BCN Medicare Advantage |
$280.26
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cofinity Commercial |
$403.57
|
| Rate for Payer: Cofinity Commercial |
$375.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.26
|
| Rate for Payer: Healthscope Commercial |
$336.31
|
| Rate for Payer: Healthscope Whirlpool |
$336.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.27
|
| Rate for Payer: Nomi Health Commercial |
$336.31
|
| Rate for Payer: PACE SWMI |
$280.26
|
| Rate for Payer: PHP Medicare Advantage |
$280.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.40
|
| Rate for Payer: Priority Health Medicare |
$280.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.26
|
| Rate for Payer: UHC Medicare Advantage |
$280.26
|
| Rate for Payer: UHCCP DNSP |
$280.26
|
|
|
PR ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX
|
Professional
|
Both
|
$1,036.00
|
|
|
Service Code
|
HCPCS 44376
|
| Min. Negotiated Rate |
$267.14 |
| Max. Negotiated Rate |
$673.40 |
| Rate for Payer: Aetna Commercial |
$357.97
|
| Rate for Payer: Aetna Medicare |
$267.14
|
| Rate for Payer: BCBS Complete |
$414.40
|
| Rate for Payer: BCBS MAPPO |
$267.14
|
| Rate for Payer: BCN Medicare Advantage |
$267.14
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cofinity Commercial |
$384.68
|
| Rate for Payer: Cofinity Commercial |
$357.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.14
|
| Rate for Payer: Healthscope Commercial |
$320.57
|
| Rate for Payer: Healthscope Whirlpool |
$320.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.50
|
| Rate for Payer: Nomi Health Commercial |
$320.57
|
| Rate for Payer: PACE SWMI |
$267.14
|
| Rate for Payer: PHP Medicare Advantage |
$267.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.40
|
| Rate for Payer: Priority Health Medicare |
$267.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.14
|
| Rate for Payer: UHC Medicare Advantage |
$267.14
|
| Rate for Payer: UHCCP DNSP |
$267.14
|
|
|
PR ENTEROSCOPY > 2ND PRTN ABLTJ LESION
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 44369
|
| Min. Negotiated Rate |
$230.66 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$309.08
|
| Rate for Payer: Aetna Medicare |
$230.66
|
| Rate for Payer: BCBS Complete |
$448.00
|
| Rate for Payer: BCBS MAPPO |
$230.66
|
| Rate for Payer: BCN Medicare Advantage |
$230.66
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$332.15
|
| Rate for Payer: Cofinity Commercial |
$309.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.66
|
| Rate for Payer: Healthscope Commercial |
$276.79
|
| Rate for Payer: Healthscope Whirlpool |
$276.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.19
|
| Rate for Payer: Nomi Health Commercial |
$276.79
|
| Rate for Payer: PACE SWMI |
$230.66
|
| Rate for Payer: PHP Medicare Advantage |
$230.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.00
|
| Rate for Payer: Priority Health Medicare |
$230.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.66
|
| Rate for Payer: UHC Medicare Advantage |
$230.66
|
| Rate for Payer: UHCCP DNSP |
$230.66
|
|
|
PR ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE
|
Professional
|
Both
|
$922.00
|
|
|
Service Code
|
HCPCS 44373
|
| Min. Negotiated Rate |
$181.71 |
| Max. Negotiated Rate |
$599.30 |
| Rate for Payer: Aetna Commercial |
$243.49
|
| Rate for Payer: Aetna Medicare |
$181.71
|
| Rate for Payer: BCBS Complete |
$368.80
|
| Rate for Payer: BCBS MAPPO |
$181.71
|
| Rate for Payer: BCN Medicare Advantage |
$181.71
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cofinity Commercial |
$261.66
|
| Rate for Payer: Cofinity Commercial |
$243.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.71
|
| Rate for Payer: Healthscope Commercial |
$218.05
|
| Rate for Payer: Healthscope Whirlpool |
$218.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$190.80
|
| Rate for Payer: Nomi Health Commercial |
$218.05
|
| Rate for Payer: PACE SWMI |
$181.71
|
| Rate for Payer: PHP Medicare Advantage |
$181.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$181.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.71
|
| Rate for Payer: UHC Medicare Advantage |
$181.71
|
| Rate for Payer: UHCCP DNSP |
$181.71
|
|
|
PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING
|
Facility
|
IP
|
$1,548.00
|
|
|
Service Code
|
CPT 44378
|
| Hospital Charge Code |
44378
|
| Min. Negotiated Rate |
$1,006.20 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Aetna Commercial |
$1,393.20
|
| Rate for Payer: ASR ASR |
$1,501.56
|
| Rate for Payer: ASR Commercial |
$1,501.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.47
|
| Rate for Payer: BCN Commercial |
$1,200.16
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,455.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Healthscope Commercial |
$1,548.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,501.56
|
| Rate for Payer: Mclaren Commercial |
$1,393.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,362.24
|
|
