|
PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT 45380
|
| Hospital Charge Code |
45380
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$267.19 |
| Max. Negotiated Rate |
$1,012.50 |
| Rate for Payer: Aetna Commercial |
$956.25
|
| Rate for Payer: Aetna Medicare |
$292.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$351.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$351.56
|
| Rate for Payer: BCBS Complete |
$895.16
|
| Rate for Payer: BCBS MAPPO |
$281.25
|
| Rate for Payer: BCBS Trust/PPO |
$924.86
|
| Rate for Payer: BCN Commercial |
$874.69
|
| Rate for Payer: BCN Medicare Advantage |
$281.25
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cofinity Commercial |
$967.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.25
|
| Rate for Payer: Healthscope Commercial |
$1,012.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$843.75
|
| Rate for Payer: Mclaren Medicaid |
$852.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$295.31
|
| Rate for Payer: Meridian Medicaid |
$895.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.25
|
| Rate for Payer: Nomi Health Commercial |
$922.50
|
| Rate for Payer: PACE Senior Care Partners |
$267.19
|
| Rate for Payer: PACE SWMI |
$281.25
|
| Rate for Payer: PHP Commercial |
$956.25
|
| Rate for Payer: PHP Medicare Advantage |
$281.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$852.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.25
|
| Rate for Payer: Priority Health HMO/PPO |
$978.75
|
| Rate for Payer: Priority Health Medicare |
$284.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$753.75
|
| Rate for Payer: Railroad Medicare Medicare |
$281.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.00
|
| Rate for Payer: UHC Core |
$939.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.25
|
| Rate for Payer: UHC Exchange |
$281.25
|
| Rate for Payer: UHC Medicare Advantage |
$281.25
|
| Rate for Payer: UHCCP Medicaid |
$852.47
|
| Rate for Payer: VA VA |
$281.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$843.75
|
|
|
PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 45380
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$731.25 |
| Rate for Payer: Aetna Commercial |
$254.41
|
| Rate for Payer: Aetna Medicare |
$197.45
|
| Rate for Payer: BCBS Complete |
$450.00
|
| Rate for Payer: BCBS MAPPO |
$189.86
|
| Rate for Payer: BCN Medicare Advantage |
$189.86
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cofinity Commercial |
$254.41
|
| Rate for Payer: Cofinity Commercial |
$273.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.86
|
| 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 |
$731.25
|
| Rate for Payer: Priority Health Medicare |
$191.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.86
|
| Rate for Payer: UHC Exchange |
$189.86
|
| Rate for Payer: UHC Medicare Advantage |
$189.86
|
|
|
PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 45380
|
| Hospital Charge Code |
45380
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$731.25 |
| Rate for Payer: Aetna Commercial |
$254.41
|
| Rate for Payer: Aetna Medicare |
$197.45
|
| Rate for Payer: BCBS Complete |
$450.00
|
| Rate for Payer: BCBS MAPPO |
$189.86
|
| Rate for Payer: BCN Medicare Advantage |
$189.86
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| 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: 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 |
$731.25
|
| Rate for Payer: Priority Health Medicare |
$191.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.86
|
| Rate for Payer: UHC Exchange |
$189.86
|
| Rate for Payer: UHC Medicare Advantage |
$189.86
|
|
|
PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT 45380
|
| Hospital Charge Code |
45380
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$731.25 |
| Max. Negotiated Rate |
$1,012.50 |
| Rate for Payer: Aetna Commercial |
$956.25
|
| Rate for Payer: BCBS Trust/PPO |
$918.34
|
| Rate for Payer: BCN Commercial |
$869.40
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cofinity Commercial |
$967.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.00
|
| Rate for Payer: Healthscope Commercial |
$1,012.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$843.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.25
|
| Rate for Payer: Nomi Health Commercial |
$922.50
|
| Rate for Payer: PHP Commercial |
$956.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.25
|
| Rate for Payer: Priority Health HMO/PPO |
$978.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$753.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.00
|
| Rate for Payer: UHC Core |
$939.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$843.75
|
|
|
PR COLONOSCOPY W/STENT
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS G6025
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$1,041.30 |
| Rate for Payer: Aetna Medicare |
$801.00
|
| Rate for Payer: BCBS Complete |
$640.80
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
|
|
PR COLORECTAL SCRN; HI RISK IND
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS G0105
|
| Min. Negotiated Rate |
$174.51 |
| Max. Negotiated Rate |
$770.25 |
| Rate for Payer: Aetna Commercial |
$233.84
|
| Rate for Payer: Aetna Medicare |
$181.49
|
| Rate for Payer: BCBS Complete |
$474.00
|
| Rate for Payer: BCBS MAPPO |
$174.51
|
| Rate for Payer: BCN Medicare Advantage |
$174.51
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cofinity Commercial |
$251.29
|
| Rate for Payer: Cofinity Commercial |
$233.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.24
|
| Rate for Payer: Nomi Health Commercial |
$209.41
|
| Rate for Payer: PACE SWMI |
$174.51
|
| Rate for Payer: PHP Medicare Advantage |
$174.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: Priority Health Medicare |
$176.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.51
|
| Rate for Payer: UHC Exchange |
$174.51
|
| Rate for Payer: UHC Medicare Advantage |
$174.51
|
|
|
PR COLORECTAL SCRN; HI RISK IND
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
G0105
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$281.44 |
| Max. Negotiated Rate |
$1,066.50 |
| Rate for Payer: Aetna Commercial |
$1,007.25
|
| Rate for Payer: Aetna Medicare |
$308.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.31
|
| Rate for Payer: BCBS Complete |
$692.17
|
| Rate for Payer: BCBS MAPPO |
$296.25
|
| Rate for Payer: BCBS Trust/PPO |
$974.19
|
| Rate for Payer: BCN Commercial |
$921.34
|
| Rate for Payer: BCN Medicare Advantage |
$296.25
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cofinity Commercial |
$1,019.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.25
|
| Rate for Payer: Healthscope Commercial |
$1,066.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$888.75
|
| Rate for Payer: Mclaren Medicaid |
$659.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.06
|
| Rate for Payer: Meridian Medicaid |
$692.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.25
|
| Rate for Payer: Nomi Health Commercial |
$971.70
|
| Rate for Payer: PACE Senior Care Partners |
$281.44
|
| Rate for Payer: PACE SWMI |
$296.25
|
| Rate for Payer: PHP Commercial |
$1,007.25
|
| Rate for Payer: PHP Medicare Advantage |
$296.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,030.95
|
| Rate for Payer: Priority Health Medicare |
$299.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.95
|
| Rate for Payer: Railroad Medicare Medicare |
$296.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,042.80
|
| Rate for Payer: UHC Core |
$989.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.25
|
| Rate for Payer: UHC Exchange |
$296.25
|
| Rate for Payer: UHC Medicare Advantage |
$296.25
|
| Rate for Payer: UHCCP Medicaid |
$659.17
|
| Rate for Payer: VA VA |
$296.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$888.75
|
|
|
PR COLORECTAL SCRN; HI RISK IND
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
G0105
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$770.25 |
| Max. Negotiated Rate |
$1,066.50 |
| Rate for Payer: Aetna Commercial |
$1,007.25
|
| Rate for Payer: BCBS Trust/PPO |
$967.32
|
| Rate for Payer: BCN Commercial |
$915.77
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cofinity Commercial |
$1,019.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.00
|
| Rate for Payer: Healthscope Commercial |
$1,066.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$888.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.25
|
| Rate for Payer: Nomi Health Commercial |
$971.70
|
| Rate for Payer: PHP Commercial |
$1,007.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,030.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,042.80
|
| Rate for Payer: UHC Core |
$989.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$888.75
|
|
|
PR COLORECTAL SCRN; HI RISK IND
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
G0105
|
| Min. Negotiated Rate |
$174.51 |
| Max. Negotiated Rate |
$770.25 |
| Rate for Payer: Aetna Commercial |
$233.84
|
| Rate for Payer: Aetna Medicare |
$181.49
|
| Rate for Payer: BCBS Complete |
$474.00
|
| Rate for Payer: BCBS MAPPO |
$174.51
|
| Rate for Payer: BCN Medicare Advantage |
$174.51
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cofinity Commercial |
$251.29
|
| Rate for Payer: Cofinity Commercial |
$233.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.24
|
| Rate for Payer: Nomi Health Commercial |
$209.41
|
| Rate for Payer: PACE SWMI |
$174.51
|
| Rate for Payer: PHP Medicare Advantage |
$174.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: Priority Health Medicare |
$176.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.51
|
| Rate for Payer: UHC Exchange |
$174.51
|
| Rate for Payer: UHC Medicare Advantage |
$174.51
|
|
|
PR COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 92283
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$70.11 |
| Rate for Payer: Aetna Commercial |
$65.24
|
| Rate for Payer: Aetna Medicare |
$50.64
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: BCBS MAPPO |
$48.69
|
| Rate for Payer: BCN Medicare Advantage |
$48.69
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$65.24
|
| Rate for Payer: Cofinity Commercial |
$70.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.12
|
| Rate for Payer: Nomi Health Commercial |
$58.43
|
| Rate for Payer: PACE SWMI |
$48.69
|
| Rate for Payer: PHP Medicare Advantage |
$48.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
| Rate for Payer: Priority Health Medicare |
$49.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.69
|
| Rate for Payer: UHC Exchange |
$48.69
|
| Rate for Payer: UHC Medicare Advantage |
$48.69
|
|
|
PR COLOSTOMY/SKIN LEVEL CECOSTOMY
|
Professional
|
Both
|
$2,695.00
|
|
|
Service Code
|
HCPCS 44320
|
| Min. Negotiated Rate |
$1,078.00 |
| Max. Negotiated Rate |
$1,751.75 |
| Rate for Payer: Aetna Commercial |
$1,553.42
|
| Rate for Payer: Aetna Medicare |
$1,205.64
|
| Rate for Payer: BCBS Complete |
$1,078.00
|
| Rate for Payer: BCBS MAPPO |
$1,159.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,159.27
|
| Rate for Payer: Cash Price |
$2,156.00
|
| Rate for Payer: Cash Price |
$2,156.00
|
| Rate for Payer: Cofinity Commercial |
$1,669.35
|
| Rate for Payer: Cofinity Commercial |
$1,553.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,159.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,217.23
|
| Rate for Payer: Nomi Health Commercial |
$1,391.12
|
| Rate for Payer: PACE SWMI |
$1,159.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,159.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,751.75
|
| Rate for Payer: Priority Health Medicare |
$1,170.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,159.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,159.27
|
| Rate for Payer: UHC Exchange |
$1,159.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,159.27
|
|
|
PR COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX
|
Professional
|
Both
|
$2,766.00
|
|
|
Service Code
|
HCPCS 44322
|
| Min. Negotiated Rate |
$959.53 |
| Max. Negotiated Rate |
$1,797.90 |
| Rate for Payer: Aetna Commercial |
$1,285.77
|
| Rate for Payer: Aetna Medicare |
$997.91
|
| Rate for Payer: BCBS Complete |
$1,106.40
|
| Rate for Payer: BCBS MAPPO |
$959.53
|
| Rate for Payer: BCN Medicare Advantage |
$959.53
|
| Rate for Payer: Cash Price |
$2,212.80
|
| Rate for Payer: Cash Price |
$2,212.80
|
| Rate for Payer: Cofinity Commercial |
$1,381.72
|
| Rate for Payer: Cofinity Commercial |
$1,285.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$959.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,007.51
|
| Rate for Payer: Nomi Health Commercial |
$1,151.44
|
| Rate for Payer: PACE SWMI |
$959.53
|
| Rate for Payer: PHP Medicare Advantage |
$959.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.90
|
| Rate for Payer: Priority Health Medicare |
$969.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$959.53
|
| Rate for Payer: UHC Exchange |
$959.53
|
| Rate for Payer: UHC Medicare Advantage |
$959.53
|
|
|
PR COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,872.00
|
|
|
Service Code
|
HCPCS 44025
|
| Min. Negotiated Rate |
$953.96 |
| Max. Negotiated Rate |
$1,866.80 |
| Rate for Payer: Aetna Commercial |
$1,278.31
|
| Rate for Payer: Aetna Medicare |
$992.12
|
| Rate for Payer: BCBS Complete |
$1,148.80
|
| Rate for Payer: BCBS MAPPO |
$953.96
|
| Rate for Payer: BCN Medicare Advantage |
$953.96
|
| Rate for Payer: Cash Price |
$2,297.60
|
| Rate for Payer: Cash Price |
$2,297.60
|
| Rate for Payer: Cofinity Commercial |
$1,373.70
|
| Rate for Payer: Cofinity Commercial |
$1,278.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,001.66
|
| Rate for Payer: Nomi Health Commercial |
$1,144.75
|
| Rate for Payer: PACE SWMI |
$953.96
|
| Rate for Payer: PHP Medicare Advantage |
$953.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,866.80
|
| Rate for Payer: Priority Health Medicare |
$963.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$953.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$953.96
|
| Rate for Payer: UHC Exchange |
$953.96
|
| Rate for Payer: UHC Medicare Advantage |
$953.96
|
|
|
PR COLPOCENTESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 57020
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Commercial |
$102.22
|
| Rate for Payer: Aetna Medicare |
$79.33
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: BCBS MAPPO |
$76.28
|
| Rate for Payer: BCN Medicare Advantage |
$76.28
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$109.84
|
| Rate for Payer: Cofinity Commercial |
$102.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.09
|
| Rate for Payer: Nomi Health Commercial |
$91.54
|
| Rate for Payer: PACE SWMI |
$76.28
|
| Rate for Payer: PHP Medicare Advantage |
$76.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health Medicare |
$77.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.28
|
| Rate for Payer: UHC Exchange |
$76.28
|
| Rate for Payer: UHC Medicare Advantage |
$76.28
|
|
|
PR COLPOCLEISIS LE FORT TYPE
|
Professional
|
Both
|
$2,636.00
|
|
|
Service Code
|
HCPCS 57120
|
| Min. Negotiated Rate |
$506.72 |
| Max. Negotiated Rate |
$1,713.40 |
| Rate for Payer: Aetna Commercial |
$679.00
|
| Rate for Payer: Aetna Medicare |
$526.99
|
| Rate for Payer: BCBS Complete |
$1,054.40
|
| Rate for Payer: BCBS MAPPO |
$506.72
|
| Rate for Payer: BCN Medicare Advantage |
$506.72
|
| Rate for Payer: Cash Price |
$2,108.80
|
| Rate for Payer: Cash Price |
$2,108.80
|
| Rate for Payer: Cofinity Commercial |
$729.68
|
| Rate for Payer: Cofinity Commercial |
$679.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$532.06
|
| Rate for Payer: Nomi Health Commercial |
$608.06
|
| Rate for Payer: PACE SWMI |
$506.72
|
| Rate for Payer: PHP Medicare Advantage |
$506.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,713.40
|
| Rate for Payer: Priority Health Medicare |
$511.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.72
|
| Rate for Payer: UHC Exchange |
$506.72
|
| Rate for Payer: UHC Medicare Advantage |
$506.72
|
|
|
PR COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU
|
Professional
|
Both
|
$1,079.00
|
|
|
Service Code
|
HCPCS 57210
|
| Min. Negotiated Rate |
$373.72 |
| Max. Negotiated Rate |
$701.35 |
| Rate for Payer: Aetna Commercial |
$500.78
|
| Rate for Payer: Aetna Medicare |
$388.67
|
| Rate for Payer: BCBS Complete |
$431.60
|
| Rate for Payer: BCBS MAPPO |
$373.72
|
| Rate for Payer: BCN Medicare Advantage |
$373.72
|
| Rate for Payer: Cash Price |
$863.20
|
| Rate for Payer: Cash Price |
$863.20
|
| Rate for Payer: Cofinity Commercial |
$538.16
|
| Rate for Payer: Cofinity Commercial |
$500.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.41
|
| Rate for Payer: Nomi Health Commercial |
$448.46
|
| Rate for Payer: PACE SWMI |
$373.72
|
| Rate for Payer: PHP Medicare Advantage |
$373.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$701.35
|
| Rate for Payer: Priority Health Medicare |
$377.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.72
|
| Rate for Payer: UHC Exchange |
$373.72
|
| Rate for Payer: UHC Medicare Advantage |
$373.72
|
|
|
PR COLPOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 57280
|
| Min. Negotiated Rate |
$841.20 |
| Max. Negotiated Rate |
$1,366.95 |
| Rate for Payer: Aetna Commercial |
$1,240.60
|
| Rate for Payer: Aetna Medicare |
$962.85
|
| Rate for Payer: BCBS Complete |
$841.20
|
| Rate for Payer: BCBS MAPPO |
$925.82
|
| Rate for Payer: BCN Medicare Advantage |
$925.82
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$1,333.18
|
| Rate for Payer: Cofinity Commercial |
$1,240.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$925.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.11
|
| Rate for Payer: Nomi Health Commercial |
$1,110.98
|
| Rate for Payer: PACE SWMI |
$925.82
|
| Rate for Payer: PHP Medicare Advantage |
$925.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health Medicare |
$935.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$925.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$925.82
|
| Rate for Payer: UHC Exchange |
$925.82
|
| Rate for Payer: UHC Medicare Advantage |
$925.82
|
|
|
PR COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH
|
Professional
|
Both
|
$2,128.00
|
|
|
Service Code
|
HCPCS 57282
|
| Min. Negotiated Rate |
$664.31 |
| Max. Negotiated Rate |
$1,383.20 |
| Rate for Payer: Aetna Commercial |
$890.18
|
| Rate for Payer: Aetna Medicare |
$690.88
|
| Rate for Payer: BCBS Complete |
$851.20
|
| Rate for Payer: BCBS MAPPO |
$664.31
|
| Rate for Payer: BCN Medicare Advantage |
$664.31
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cofinity Commercial |
$956.61
|
| Rate for Payer: Cofinity Commercial |
$890.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.53
|
| Rate for Payer: Nomi Health Commercial |
$797.17
|
| Rate for Payer: PACE SWMI |
$664.31
|
| Rate for Payer: PHP Medicare Advantage |
$664.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.20
|
| Rate for Payer: Priority Health Medicare |
$670.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$664.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$664.31
|
| Rate for Payer: UHC Exchange |
$664.31
|
| Rate for Payer: UHC Medicare Advantage |
$664.31
|
|
|
PR COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH
|
Professional
|
Both
|
$1,164.00
|
|
|
Service Code
|
HCPCS 57283
|
| Min. Negotiated Rate |
$465.60 |
| Max. Negotiated Rate |
$965.17 |
| Rate for Payer: Aetna Commercial |
$898.15
|
| Rate for Payer: Aetna Medicare |
$697.07
|
| Rate for Payer: BCBS Complete |
$465.60
|
| Rate for Payer: BCBS MAPPO |
$670.26
|
| Rate for Payer: BCN Medicare Advantage |
$670.26
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cofinity Commercial |
$965.17
|
| Rate for Payer: Cofinity Commercial |
$898.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$670.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$703.77
|
| Rate for Payer: Nomi Health Commercial |
$804.31
|
| Rate for Payer: PACE SWMI |
$670.26
|
| Rate for Payer: PHP Medicare Advantage |
$670.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.60
|
| Rate for Payer: Priority Health Medicare |
$676.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$670.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$670.26
|
| Rate for Payer: UHC Exchange |
$670.26
|
| Rate for Payer: UHC Medicare Advantage |
$670.26
|
|
|
PR COLPORRHAPHY SUTURE INJURY VAGINA
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 57200
|
| Min. Negotiated Rate |
$314.77 |
| Max. Negotiated Rate |
$568.75 |
| Rate for Payer: Aetna Commercial |
$421.79
|
| Rate for Payer: Aetna Medicare |
$327.36
|
| Rate for Payer: BCBS Complete |
$350.00
|
| Rate for Payer: BCBS MAPPO |
$314.77
|
| Rate for Payer: BCN Medicare Advantage |
$314.77
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$453.27
|
| Rate for Payer: Cofinity Commercial |
$421.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.51
|
| Rate for Payer: Nomi Health Commercial |
$377.72
|
| Rate for Payer: PACE SWMI |
$314.77
|
| Rate for Payer: PHP Medicare Advantage |
$314.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.75
|
| Rate for Payer: Priority Health Medicare |
$317.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.77
|
| Rate for Payer: UHC Exchange |
$314.77
|
| Rate for Payer: UHC Medicare Advantage |
$314.77
|
|
|
PR COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 57454
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Commercial |
$172.15
|
| Rate for Payer: Aetna Medicare |
$133.61
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: BCBS MAPPO |
$128.47
|
| Rate for Payer: BCN Medicare Advantage |
$128.47
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$185.00
|
| Rate for Payer: Cofinity Commercial |
$172.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.89
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: PACE SWMI |
$128.47
|
| Rate for Payer: PHP Medicare Advantage |
$128.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health Medicare |
$129.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.47
|
| Rate for Payer: UHC Exchange |
$128.47
|
| Rate for Payer: UHC Medicare Advantage |
$128.47
|
|
|
PR COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 57456
|
| Min. Negotiated Rate |
$96.48 |
| Max. Negotiated Rate |
$236.60 |
| Rate for Payer: Aetna Commercial |
$129.28
|
| Rate for Payer: Aetna Medicare |
$100.34
|
| Rate for Payer: BCBS Complete |
$145.60
|
| Rate for Payer: BCBS MAPPO |
$96.48
|
| Rate for Payer: BCN Medicare Advantage |
$96.48
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$138.93
|
| Rate for Payer: Cofinity Commercial |
$129.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.30
|
| Rate for Payer: Nomi Health Commercial |
$115.78
|
| Rate for Payer: PACE SWMI |
$96.48
|
| Rate for Payer: PHP Medicare Advantage |
$96.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.60
|
| Rate for Payer: Priority Health Medicare |
$97.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.48
|
| Rate for Payer: UHC Exchange |
$96.48
|
| Rate for Payer: UHC Medicare Advantage |
$96.48
|
|
|
PR COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 57452
|
| Min. Negotiated Rate |
$87.09 |
| Max. Negotiated Rate |
$181.35 |
| Rate for Payer: Aetna Commercial |
$116.70
|
| Rate for Payer: Aetna Medicare |
$90.57
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCBS MAPPO |
$87.09
|
| Rate for Payer: BCN Medicare Advantage |
$87.09
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cofinity Commercial |
$125.41
|
| Rate for Payer: Cofinity Commercial |
$116.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.44
|
| Rate for Payer: Nomi Health Commercial |
$104.51
|
| Rate for Payer: PACE SWMI |
$87.09
|
| Rate for Payer: PHP Medicare Advantage |
$87.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.35
|
| Rate for Payer: Priority Health Medicare |
$87.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.09
|
| Rate for Payer: UHC Exchange |
$87.09
|
| Rate for Payer: UHC Medicare Advantage |
$87.09
|
|
|
PR COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 57455
|
| Min. Negotiated Rate |
$104.97 |
| Max. Negotiated Rate |
$236.60 |
| Rate for Payer: Aetna Commercial |
$140.66
|
| Rate for Payer: Aetna Medicare |
$109.17
|
| Rate for Payer: BCBS Complete |
$145.60
|
| Rate for Payer: BCBS MAPPO |
$104.97
|
| Rate for Payer: BCN Medicare Advantage |
$104.97
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$151.16
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.22
|
| Rate for Payer: Nomi Health Commercial |
$125.96
|
| Rate for Payer: PACE SWMI |
$104.97
|
| Rate for Payer: PHP Medicare Advantage |
$104.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.60
|
| Rate for Payer: Priority Health Medicare |
$106.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.97
|
| Rate for Payer: UHC Exchange |
$104.97
|
| Rate for Payer: UHC Medicare Advantage |
$104.97
|
|
|
PR COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX
|
Professional
|
Both
|
$960.00
|
|
|
Service Code
|
HCPCS 57461
|
| Min. Negotiated Rate |
$176.86 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$236.99
|
| Rate for Payer: Aetna Medicare |
$183.93
|
| Rate for Payer: BCBS Complete |
$384.00
|
| Rate for Payer: BCBS MAPPO |
$176.86
|
| Rate for Payer: BCN Medicare Advantage |
$176.86
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cofinity Commercial |
$254.68
|
| Rate for Payer: Cofinity Commercial |
$236.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.70
|
| Rate for Payer: Nomi Health Commercial |
$212.23
|
| Rate for Payer: PACE SWMI |
$176.86
|
| Rate for Payer: PHP Medicare Advantage |
$176.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.00
|
| Rate for Payer: Priority Health Medicare |
$178.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.86
|
| Rate for Payer: UHC Exchange |
$176.86
|
| Rate for Payer: UHC Medicare Advantage |
$176.86
|
|
