|
PR PROCTOPEXY W/SIGMOID RESCJ ABDL APPR
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 45550
|
| Min. Negotiated Rate |
$1,391.49 |
| Max. Negotiated Rate |
$2,398.50 |
| Rate for Payer: Aetna Commercial |
$1,864.60
|
| Rate for Payer: Aetna Medicare |
$1,391.49
|
| Rate for Payer: BCBS Complete |
$1,476.00
|
| Rate for Payer: BCBS MAPPO |
$1,391.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,391.49
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Cofinity Commercial |
$2,003.75
|
| Rate for Payer: Cofinity Commercial |
$1,864.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,391.49
|
| Rate for Payer: Healthscope Commercial |
$1,669.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,669.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,461.06
|
| Rate for Payer: Nomi Health Commercial |
$1,669.79
|
| Rate for Payer: PACE SWMI |
$1,391.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,391.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,398.50
|
| Rate for Payer: Priority Health Medicare |
$1,391.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,391.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,391.49
|
| Rate for Payer: UHCCP DNSP |
$1,391.49
|
|
|
PR PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 45505
|
| Min. Negotiated Rate |
$574.48 |
| Max. Negotiated Rate |
$1,096.55 |
| Rate for Payer: Aetna Commercial |
$769.80
|
| Rate for Payer: Aetna Medicare |
$574.48
|
| Rate for Payer: BCBS Complete |
$674.80
|
| Rate for Payer: BCBS MAPPO |
$574.48
|
| Rate for Payer: BCN Medicare Advantage |
$574.48
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cofinity Commercial |
$827.25
|
| Rate for Payer: Cofinity Commercial |
$769.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$574.48
|
| Rate for Payer: Healthscope Commercial |
$689.38
|
| Rate for Payer: Healthscope Whirlpool |
$689.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$603.20
|
| Rate for Payer: Nomi Health Commercial |
$689.38
|
| Rate for Payer: PACE SWMI |
$574.48
|
| Rate for Payer: PHP Medicare Advantage |
$574.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.55
|
| Rate for Payer: Priority Health Medicare |
$574.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$574.48
|
| Rate for Payer: UHC Medicare Advantage |
$574.48
|
| Rate for Payer: UHCCP DNSP |
$574.48
|
|
|
PR PROCTOPLASTY STENOSIS
|
Professional
|
Both
|
$1,140.00
|
|
|
Service Code
|
HCPCS 45500
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$793.58 |
| Rate for Payer: Aetna Commercial |
$738.47
|
| Rate for Payer: Aetna Medicare |
$551.10
|
| Rate for Payer: BCBS Complete |
$456.00
|
| Rate for Payer: BCBS MAPPO |
$551.10
|
| Rate for Payer: BCN Medicare Advantage |
$551.10
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cofinity Commercial |
$793.58
|
| Rate for Payer: Cofinity Commercial |
$738.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.10
|
| Rate for Payer: Healthscope Commercial |
$661.32
|
| Rate for Payer: Healthscope Whirlpool |
$661.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.65
|
| Rate for Payer: Nomi Health Commercial |
$661.32
|
| Rate for Payer: PACE SWMI |
$551.10
|
| Rate for Payer: PHP Medicare Advantage |
$551.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.00
|
| Rate for Payer: Priority Health Medicare |
$551.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.10
|
| Rate for Payer: UHC Medicare Advantage |
$551.10
|
| Rate for Payer: UHCCP DNSP |
$551.10
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
45300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: ASR ASR |
$191.09
|
| Rate for Payer: ASR Commercial |
$191.09
|
| Rate for Payer: BCBS Trust/PPO |
$160.54
|
| Rate for Payer: BCN Commercial |
$152.73
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$185.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.60
|
| Rate for Payer: Healthscope Commercial |
$197.00
|
| Rate for Payer: Healthscope Whirlpool |
$191.09
|
| Rate for Payer: Mclaren Commercial |
$177.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.45
|
| Rate for Payer: Nomi Health Commercial |
$161.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.36
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
45300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$1,378.21 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Medicare |
$889.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: ASR ASR |
$191.09
|
| Rate for Payer: ASR Commercial |
$191.09
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCBS Trust/PPO |
$161.32
|
| Rate for Payer: BCN Commercial |
$152.73
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$185.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Healthscope Commercial |
$197.00
|
| Rate for Payer: Healthscope Whirlpool |
$191.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$889.17
|
| Rate for Payer: Mclaren Commercial |
$177.30
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.45
|
| Rate for Payer: Nomi Health Commercial |
$161.54
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Commercial |
$978.09
|
| Rate for Payer: PHP Medicaid |
$476.60
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.61
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Priority Health Narrow Network |
$138.10
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Exchange |
$1,378.21
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP DNSP |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 45300
|
| Hospital Charge Code |
45300
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$128.05 |
| Rate for Payer: Aetna Commercial |
$62.22
|
| Rate for Payer: Aetna Medicare |
$46.43
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS MAPPO |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$46.43
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$62.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.43
|
| Rate for Payer: Healthscope Commercial |
$55.72
|
| Rate for Payer: Healthscope Whirlpool |
$55.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.75
|
| Rate for Payer: Nomi Health Commercial |
$55.72
|
| Rate for Payer: PACE SWMI |
$46.43
|
| Rate for Payer: PHP Medicare Advantage |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health Medicare |
$46.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.43
|
| Rate for Payer: UHC Medicare Advantage |
$46.43
|
| Rate for Payer: UHCCP DNSP |
$46.43
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 45300
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$128.05 |
| Rate for Payer: Aetna Commercial |
$62.22
|
| Rate for Payer: Aetna Medicare |
$46.43
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS MAPPO |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$46.43
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$62.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.43
|
| Rate for Payer: Healthscope Commercial |
$55.72
|
| Rate for Payer: Healthscope Whirlpool |
$55.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.75
|
| Rate for Payer: Nomi Health Commercial |
$55.72
|
| Rate for Payer: PACE SWMI |
$46.43
|
| Rate for Payer: PHP Medicare Advantage |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health Medicare |
$46.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.43
|
| Rate for Payer: UHC Medicare Advantage |
$46.43
|
| Rate for Payer: UHCCP DNSP |
$46.43
|
|
|
PR PROCTOSGMDSC RIGID ABLATION LESION
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 45320
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$313.30 |
| Rate for Payer: Aetna Commercial |
$137.44
|
| Rate for Payer: Aetna Medicare |
$102.57
|
| Rate for Payer: BCBS Complete |
$192.80
|
| Rate for Payer: BCBS MAPPO |
$102.57
|
| Rate for Payer: BCN Medicare Advantage |
$102.57
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$147.70
|
| Rate for Payer: Cofinity Commercial |
$137.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.57
|
| Rate for Payer: Healthscope Commercial |
$123.08
|
| Rate for Payer: Healthscope Whirlpool |
$123.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.70
|
| Rate for Payer: Nomi Health Commercial |
$123.08
|
| Rate for Payer: PACE SWMI |
$102.57
|
| Rate for Payer: PHP Medicare Advantage |
$102.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.30
|
| Rate for Payer: Priority Health Medicare |
$102.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.57
|
| Rate for Payer: UHC Medicare Advantage |
$102.57
|
| Rate for Payer: UHCCP DNSP |
$102.57
|
|
|
PR PROCTOSGMDSC RIGID CONTROL BLEEDING
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 45317
|
| Min. Negotiated Rate |
$105.76 |
| Max. Negotiated Rate |
$293.80 |
| Rate for Payer: Aetna Commercial |
$141.72
|
| Rate for Payer: Aetna Medicare |
$105.76
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$105.76
|
| Rate for Payer: BCN Medicare Advantage |
$105.76
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$152.29
|
| Rate for Payer: Cofinity Commercial |
$141.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.76
|
| Rate for Payer: Healthscope Commercial |
$126.91
|
| Rate for Payer: Healthscope Whirlpool |
$126.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.05
|
| Rate for Payer: Nomi Health Commercial |
$126.91
|
| Rate for Payer: PACE SWMI |
$105.76
|
| Rate for Payer: PHP Medicare Advantage |
$105.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Medicare |
$105.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.76
|
| Rate for Payer: UHC Medicare Advantage |
$105.76
|
| Rate for Payer: UHCCP DNSP |
$105.76
|
|
|
PR PROCTOSGMDSC RIGID DCMPRN VOLVULUS
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 45321
|
| Min. Negotiated Rate |
$100.92 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$135.23
|
| Rate for Payer: Aetna Medicare |
$100.92
|
| Rate for Payer: BCBS Complete |
$156.80
|
| Rate for Payer: BCBS MAPPO |
$100.92
|
| Rate for Payer: BCN Medicare Advantage |
$100.92
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$145.32
|
| Rate for Payer: Cofinity Commercial |
$135.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.92
|
| Rate for Payer: Healthscope Commercial |
$121.10
|
| Rate for Payer: Healthscope Whirlpool |
$121.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.97
|
| Rate for Payer: Nomi Health Commercial |
$121.10
|
| Rate for Payer: PACE SWMI |
$100.92
|
| Rate for Payer: PHP Medicare Advantage |
$100.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health Medicare |
$100.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.92
|
| Rate for Payer: UHC Medicare Advantage |
$100.92
|
| Rate for Payer: UHCCP DNSP |
$100.92
|
|
|
PR PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 45308
|
| Min. Negotiated Rate |
$82.06 |
| Max. Negotiated Rate |
$202.15 |
| Rate for Payer: Aetna Commercial |
$109.96
|
| Rate for Payer: Aetna Medicare |
$82.06
|
| Rate for Payer: BCBS Complete |
$124.40
|
| Rate for Payer: BCBS MAPPO |
$82.06
|
| Rate for Payer: BCN Medicare Advantage |
$82.06
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$118.17
|
| Rate for Payer: Cofinity Commercial |
$109.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.06
|
| Rate for Payer: Healthscope Commercial |
$98.47
|
| Rate for Payer: Healthscope Whirlpool |
$98.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.16
|
| Rate for Payer: Nomi Health Commercial |
$98.47
|
| Rate for Payer: PACE SWMI |
$82.06
|
| Rate for Payer: PHP Medicare Advantage |
$82.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.15
|
| Rate for Payer: Priority Health Medicare |
$82.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.06
|
| Rate for Payer: UHC Medicare Advantage |
$82.06
|
| Rate for Payer: UHCCP DNSP |
$82.06
|
|
|
PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 45309
|
| Min. Negotiated Rate |
$87.23 |
| Max. Negotiated Rate |
$245.05 |
| Rate for Payer: Aetna Commercial |
$116.89
|
| Rate for Payer: Aetna Medicare |
$87.23
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$87.23
|
| Rate for Payer: BCN Medicare Advantage |
$87.23
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$125.61
|
| Rate for Payer: Cofinity Commercial |
$116.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.23
|
| Rate for Payer: Healthscope Commercial |
$104.68
|
| Rate for Payer: Healthscope Whirlpool |
$104.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.59
|
| Rate for Payer: Nomi Health Commercial |
$104.68
|
| Rate for Payer: PACE SWMI |
$87.23
|
| Rate for Payer: PHP Medicare Advantage |
$87.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$87.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.23
|
| Rate for Payer: UHC Medicare Advantage |
$87.23
|
| Rate for Payer: UHCCP DNSP |
$87.23
|
|
|
PR PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 45315
|
| Min. Negotiated Rate |
$103.21 |
| Max. Negotiated Rate |
$313.30 |
| Rate for Payer: Aetna Commercial |
$138.30
|
| Rate for Payer: Aetna Medicare |
$103.21
|
| Rate for Payer: BCBS Complete |
$192.80
|
| Rate for Payer: BCBS MAPPO |
$103.21
|
| Rate for Payer: BCN Medicare Advantage |
$103.21
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$148.62
|
| Rate for Payer: Cofinity Commercial |
$138.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.21
|
| Rate for Payer: Healthscope Commercial |
$123.85
|
| Rate for Payer: Healthscope Whirlpool |
$123.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.37
|
| Rate for Payer: Nomi Health Commercial |
$123.85
|
| Rate for Payer: PACE SWMI |
$103.21
|
| Rate for Payer: PHP Medicare Advantage |
$103.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.30
|
| Rate for Payer: Priority Health Medicare |
$103.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.21
|
| Rate for Payer: UHC Medicare Advantage |
$103.21
|
| Rate for Payer: UHCCP DNSP |
$103.21
|
|
|
PR PROCTOSGMDSC RIGID TNDSC STENT PLMT
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 45327
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$164.62 |
| Rate for Payer: Aetna Commercial |
$153.19
|
| Rate for Payer: Aetna Medicare |
$114.32
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$114.32
|
| Rate for Payer: BCN Medicare Advantage |
$114.32
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$164.62
|
| Rate for Payer: Cofinity Commercial |
$153.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.32
|
| Rate for Payer: Healthscope Commercial |
$137.18
|
| Rate for Payer: Healthscope Whirlpool |
$137.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.04
|
| Rate for Payer: Nomi Health Commercial |
$137.18
|
| Rate for Payer: PACE SWMI |
$114.32
|
| Rate for Payer: PHP Medicare Advantage |
$114.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$114.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.32
|
| Rate for Payer: UHC Medicare Advantage |
$114.32
|
| Rate for Payer: UHCCP DNSP |
$114.32
|
|
|
PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 45305
|
| Min. Negotiated Rate |
$69.83 |
| Max. Negotiated Rate |
$193.05 |
| Rate for Payer: Aetna Commercial |
$93.57
|
| Rate for Payer: Aetna Medicare |
$69.83
|
| Rate for Payer: BCBS Complete |
$118.80
|
| Rate for Payer: BCBS MAPPO |
$69.83
|
| Rate for Payer: BCN Medicare Advantage |
$69.83
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cofinity Commercial |
$93.57
|
| Rate for Payer: Cofinity Commercial |
$100.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.83
|
| Rate for Payer: Healthscope Commercial |
$83.80
|
| Rate for Payer: Healthscope Whirlpool |
$83.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.32
|
| Rate for Payer: Nomi Health Commercial |
$83.80
|
| Rate for Payer: PACE SWMI |
$69.83
|
| Rate for Payer: PHP Medicare Advantage |
$69.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.05
|
| Rate for Payer: Priority Health Medicare |
$69.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.83
|
| Rate for Payer: UHC Medicare Advantage |
$69.83
|
| Rate for Payer: UHCCP DNSP |
$69.83
|
|
|
PR PROCTOSGMDSC RIGID W/DILATION
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 45303
|
| Min. Negotiated Rate |
$81.33 |
| Max. Negotiated Rate |
$135.20 |
| Rate for Payer: Aetna Commercial |
$108.98
|
| Rate for Payer: Aetna Medicare |
$81.33
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS MAPPO |
$81.33
|
| Rate for Payer: BCN Medicare Advantage |
$81.33
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$97.60
|
| Rate for Payer: Healthscope Whirlpool |
$97.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.40
|
| Rate for Payer: Nomi Health Commercial |
$97.60
|
| Rate for Payer: PACE SWMI |
$81.33
|
| Rate for Payer: PHP Medicare Advantage |
$81.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health Medicare |
$81.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.33
|
| Rate for Payer: UHC Medicare Advantage |
$81.33
|
| Rate for Payer: UHCCP DNSP |
$81.33
|
|
|
PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 45307
|
| Min. Negotiated Rate |
$97.58 |
| Max. Negotiated Rate |
$220.35 |
| Rate for Payer: Aetna Commercial |
$130.76
|
| Rate for Payer: Aetna Medicare |
$97.58
|
| Rate for Payer: BCBS Complete |
$135.60
|
| Rate for Payer: BCBS MAPPO |
$97.58
|
| Rate for Payer: BCN Medicare Advantage |
$97.58
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$140.52
|
| Rate for Payer: Cofinity Commercial |
$130.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.58
|
| Rate for Payer: Healthscope Commercial |
$117.10
|
| Rate for Payer: Healthscope Whirlpool |
$117.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.46
|
| Rate for Payer: Nomi Health Commercial |
$117.10
|
| Rate for Payer: PACE SWMI |
$97.58
|
| Rate for Payer: PHP Medicare Advantage |
$97.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Medicare |
$97.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.58
|
| Rate for Payer: UHC Medicare Advantage |
$97.58
|
| Rate for Payer: UHCCP DNSP |
$97.58
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 95115
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: Aetna Medicare |
$9.51
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$9.51
|
| Rate for Payer: BCN Medicare Advantage |
$9.51
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Cofinity Commercial |
$12.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.51
|
| Rate for Payer: Healthscope Commercial |
$11.41
|
| Rate for Payer: Healthscope Whirlpool |
$11.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.99
|
| Rate for Payer: Nomi Health Commercial |
$11.41
|
| Rate for Payer: PACE SWMI |
$9.51
|
| Rate for Payer: PHP Medicare Advantage |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$9.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.51
|
| Rate for Payer: UHC Medicare Advantage |
$9.51
|
| Rate for Payer: UHCCP DNSP |
$9.51
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 95117
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Commercial |
$14.73
|
| Rate for Payer: Aetna Medicare |
$10.99
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$10.99
|
| Rate for Payer: BCN Medicare Advantage |
$10.99
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Commercial |
$14.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.99
|
| Rate for Payer: Healthscope Commercial |
$13.19
|
| Rate for Payer: Healthscope Whirlpool |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.54
|
| Rate for Payer: Nomi Health Commercial |
$13.19
|
| Rate for Payer: PACE SWMI |
$10.99
|
| Rate for Payer: PHP Medicare Advantage |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health Medicare |
$10.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.99
|
| Rate for Payer: UHC Medicare Advantage |
$10.99
|
| Rate for Payer: UHCCP DNSP |
$10.99
|
|
|
PR PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 0389T
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 93280
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna Commercial |
$94.93
|
| Rate for Payer: Aetna Medicare |
$70.84
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS MAPPO |
$70.84
|
| Rate for Payer: BCN Medicare Advantage |
$70.84
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$94.93
|
| Rate for Payer: Cofinity Commercial |
$102.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.84
|
| Rate for Payer: Healthscope Commercial |
$85.01
|
| Rate for Payer: Healthscope Whirlpool |
$85.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.38
|
| Rate for Payer: Nomi Health Commercial |
$85.01
|
| Rate for Payer: PACE SWMI |
$70.84
|
| Rate for Payer: PHP Medicare Advantage |
$70.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: Priority Health Medicare |
$70.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.84
|
| Rate for Payer: UHC Medicare Advantage |
$70.84
|
| Rate for Payer: UHCCP DNSP |
$70.84
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 93281
|
| Min. Negotiated Rate |
$75.57 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$101.26
|
| Rate for Payer: Aetna Medicare |
$75.57
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$75.57
|
| Rate for Payer: BCN Medicare Advantage |
$75.57
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$108.82
|
| Rate for Payer: Cofinity Commercial |
$101.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.57
|
| Rate for Payer: Healthscope Commercial |
$90.68
|
| Rate for Payer: Healthscope Whirlpool |
$90.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.35
|
| Rate for Payer: Nomi Health Commercial |
$90.68
|
| Rate for Payer: PACE SWMI |
$75.57
|
| Rate for Payer: PHP Medicare Advantage |
$75.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$75.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.57
|
| Rate for Payer: UHC Medicare Advantage |
$75.57
|
| Rate for Payer: UHCCP DNSP |
$75.57
|
|
|
PR PROGRAMMED STIMJ & PACG AFTER IV DRUG INFUSION
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 93623
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$216.45 |
| Rate for Payer: Aetna Medicare |
$166.50
|
| Rate for Payer: Aetna Medicare |
$121.50
|
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.56
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.69
|
| Rate for Payer: Priority Health Narrow Network |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
