|
PR ANNUAL GYNECOLOGICAL EXAMINA
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS S0612
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$55.00
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Trust/PPO |
$176.98
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
PR ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 99170
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$820.45 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS Trust/PPO |
$820.45
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.74
|
| Rate for Payer: Priority Health Narrow Network |
$112.74
|
| Rate for Payer: Priority Health SBD |
$112.74
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
PR ANOPLASTY PLASTIC OPERATION STRICTURE ADULT
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
HCPCS 46700
|
| Min. Negotiated Rate |
$272.07 |
| Max. Negotiated Rate |
$1,153.61 |
| Rate for Payer: Aetna Commercial |
$877.26
|
| Rate for Payer: BCBS Complete |
$439.70
|
| Rate for Payer: BCBS Trust/PPO |
$272.07
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Meridian Medicaid |
$439.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$926.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,153.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,153.61
|
| Rate for Payer: Priority Health SBD |
$1,153.61
|
| Rate for Payer: UMR Bronson Commercial |
$608.58
|
|
|
PR ANOPLASTY PLASTIC OPERATION STRICTURE INFANT
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 46705
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,012.49 |
| Rate for Payer: Aetna Commercial |
$764.79
|
| Rate for Payer: BCBS Complete |
$386.69
|
| Rate for Payer: BCBS Trust/PPO |
$137.36
|
| Rate for Payer: Cash Price |
$1,117.60
|
| Rate for Payer: Cash Price |
$1,117.60
|
| Rate for Payer: Meridian Medicaid |
$386.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$977.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,012.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.49
|
| Rate for Payer: Priority Health SBD |
$1,012.49
|
| Rate for Payer: UMR Bronson Commercial |
$642.62
|
|
|
PR ANORECTAL MANOMETRY
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 91122
|
| Min. Negotiated Rate |
$115.88 |
| Max. Negotiated Rate |
$1,146.94 |
| Rate for Payer: Aetna Commercial |
$290.91
|
| Rate for Payer: BCBS Complete |
$154.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,146.94
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.88
|
| Rate for Payer: Priority Health Narrow Network |
$115.88
|
| Rate for Payer: Priority Health SBD |
$369.19
|
| Rate for Payer: UMR Bronson Commercial |
$177.10
|
|
|
PR ANORECTAL MYOMECTOMY
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 45108
|
| Min. Negotiated Rate |
$241.97 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$499.66
|
| Rate for Payer: BCBS Complete |
$254.07
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Meridian Medicaid |
$254.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$660.88
|
| Rate for Payer: Priority Health Narrow Network |
$660.88
|
| Rate for Payer: Priority Health SBD |
$660.88
|
| Rate for Payer: UMR Bronson Commercial |
$750.72
|
|
|
PR ANOSCOPY ABLATION LESION
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 46615
|
| Min. Negotiated Rate |
$57.72 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: BCBS Complete |
$60.61
|
| Rate for Payer: BCBS Trust/PPO |
$245.13
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Meridian Medicaid |
$60.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.99
|
| Rate for Payer: Priority Health Narrow Network |
$156.99
|
| Rate for Payer: Priority Health SBD |
$156.99
|
| Rate for Payer: UMR Bronson Commercial |
$302.22
|
|
|
PR ANOSCOPY CONTROL BLEEDING
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 46614
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$438.20 |
| Rate for Payer: Aetna Commercial |
$84.49
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS Trust/PPO |
$241.96
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.88
|
| Rate for Payer: Priority Health Narrow Network |
$112.88
|
| Rate for Payer: Priority Health SBD |
$112.88
|
| Rate for Payer: UMR Bronson Commercial |
$287.96
|
|
|
PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 46600
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$2,291.24 |
| Rate for Payer: Aetna Commercial |
$53.23
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,291.24
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.32
|
| Rate for Payer: Priority Health Narrow Network |
$72.32
|
| Rate for Payer: Priority Health SBD |
$72.32
|
| Rate for Payer: UMR Bronson Commercial |
$83.26
|
|
|
PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 46601
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$375.62 |
| Rate for Payer: Aetna Commercial |
$126.71
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$375.62
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.28
|
| Rate for Payer: Priority Health Narrow Network |
$162.28
|
| Rate for Payer: Priority Health SBD |
$162.28
|
| Rate for Payer: UMR Bronson Commercial |
$122.82
|
|
|
PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 46607
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,451.24 |
| Rate for Payer: Aetna Commercial |
$170.74
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,451.24
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Meridian Medicaid |
$83.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.37
|
| Rate for Payer: Priority Health Narrow Network |
$216.37
|
| Rate for Payer: Priority Health SBD |
$216.37
|
| Rate for Payer: UMR Bronson Commercial |
$129.72
|
|
|
PR ANOSCOPY W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 46606
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$3,172.97 |
| Rate for Payer: Aetna Commercial |
$100.54
|
| Rate for Payer: BCBS Complete |
$50.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,172.97
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Meridian Medicaid |
$50.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.12
|
| Rate for Payer: Priority Health Narrow Network |
$131.12
|
| Rate for Payer: Priority Health SBD |
$131.12
|
| Rate for Payer: UMR Bronson Commercial |
$165.60
|
|
|
PR ANOSCOPY W/DILATION
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 46604
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$2,787.84 |
| Rate for Payer: Aetna Commercial |
$86.80
|
| Rate for Payer: BCBS Complete |
$44.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,787.84
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Meridian Medicaid |
$44.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$690.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.24
|
| Rate for Payer: Priority Health Narrow Network |
$115.24
|
| Rate for Payer: Priority Health SBD |
$115.24
|
| Rate for Payer: UMR Bronson Commercial |
$453.56
|
|
|
PR ANOSCOPY W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 46608
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$244.30 |
| Rate for Payer: Aetna Commercial |
$112.47
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS Trust/PPO |
$241.96
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Meridian Medicaid |
$56.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.18
|
| Rate for Payer: Priority Health Narrow Network |
$148.18
|
| Rate for Payer: Priority Health SBD |
$148.18
|
| Rate for Payer: UMR Bronson Commercial |
$160.54
|
|
|
PR ANOSCOPY W/RMVL LESION CAUTERY
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 46610
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$394.10 |
| Rate for Payer: Aetna Commercial |
$106.52
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS Trust/PPO |
$241.96
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.52
|
| Rate for Payer: Priority Health Narrow Network |
$140.52
|
| Rate for Payer: Priority Health SBD |
$140.52
|
| Rate for Payer: UMR Bronson Commercial |
$258.98
|
|
|
PR ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 46611
|
| Min. Negotiated Rate |
$51.33 |
| Max. Negotiated Rate |
$2,682.71 |
| Rate for Payer: Aetna Commercial |
$106.48
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,682.71
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Meridian Medicaid |
$53.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.93
|
| Rate for Payer: Priority Health Narrow Network |
$139.93
|
| Rate for Payer: Priority Health SBD |
$139.93
|
| Rate for Payer: UMR Bronson Commercial |
$258.98
|
|
|
PR ANOSC RMVL MULT TUMORS CAUTERY/SNARE
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 46612
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna Commercial |
$127.63
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS Trust/PPO |
$316.98
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.81
|
| Rate for Payer: Priority Health Narrow Network |
$165.81
|
| Rate for Payer: Priority Health SBD |
$165.81
|
| Rate for Payer: UMR Bronson Commercial |
$302.22
|
|
|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 45990
|
| Hospital Charge Code |
45990
|
| Min. Negotiated Rate |
$139.04 |
| Max. Negotiated Rate |
$284.40 |
| Rate for Payer: Aetna American Axle |
$205.40
|
| Rate for Payer: Aetna Commercial |
$268.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.40
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$221.20
|
| Rate for Payer: Cofinity Commercial |
$271.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.80
|
| Rate for Payer: Healthscope Commercial |
$284.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$221.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.60
|
| Rate for Payer: PHP Commercial |
$268.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.20
|
| Rate for Payer: Priority Health SBD |
$199.08
|
| Rate for Payer: UMR Bronson Commercial |
$139.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.00
|
|
|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 45990
|
| Hospital Charge Code |
45990
|
| Min. Negotiated Rate |
$103.47 |
| Max. Negotiated Rate |
$7,856.86 |
| Rate for Payer: Aetna American Axle |
$205.40
|
| Rate for Payer: Aetna Commercial |
$268.60
|
| Rate for Payer: Aetna Medicare |
$2,595.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,715.72
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$221.20
|
| Rate for Payer: Cofinity Commercial |
$271.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Healthscope Commercial |
$284.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$221.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.00
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.60
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Commercial |
$268.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,856.86
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$6,285.49
|
| Rate for Payer: Priority Health SBD |
$199.08
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,495.78
|
| Rate for Payer: UHC Exchange |
$103.47
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: UMR Bronson Commercial |
$116.92
|
| Rate for Payer: VA VA |
$2,495.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.00
|
|
|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 45990
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$1,244.67 |
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,244.67
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.86
|
| Rate for Payer: Priority Health Narrow Network |
$182.86
|
| Rate for Payer: Priority Health SBD |
$182.86
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 45990
|
| Hospital Charge Code |
45990
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$1,244.67 |
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,244.67
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.86
|
| Rate for Payer: Priority Health Narrow Network |
$182.86
|
| Rate for Payer: Priority Health SBD |
$182.86
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR ANTEPARTUM CARE ONLY 4-6 VISITS
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 59425
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$793.10 |
| Rate for Payer: Aetna Commercial |
$479.68
|
| Rate for Payer: BCBS Complete |
$422.12
|
| Rate for Payer: BCBS Trust/PPO |
$94.57
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Meridian Medicaid |
$422.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$612.89
|
| Rate for Payer: Priority Health Narrow Network |
$612.89
|
| Rate for Payer: Priority Health SBD |
$612.89
|
| Rate for Payer: UMR Bronson Commercial |
$521.18
|
|
|
PR ANTEPARTUM CARE ONLY 7/> VISITS
|
Professional
|
Both
|
$1,558.00
|
|
|
Service Code
|
HCPCS 59426
|
| Min. Negotiated Rate |
$55.47 |
| Max. Negotiated Rate |
$1,125.66 |
| Rate for Payer: Aetna Commercial |
$878.78
|
| Rate for Payer: BCBS Complete |
$775.40
|
| Rate for Payer: BCBS Trust/PPO |
$55.47
|
| Rate for Payer: Cash Price |
$1,246.40
|
| Rate for Payer: Cash Price |
$1,246.40
|
| Rate for Payer: Meridian Medicaid |
$775.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$738.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,125.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,125.66
|
| Rate for Payer: Priority Health SBD |
$1,125.66
|
| Rate for Payer: UMR Bronson Commercial |
$716.68
|
|
|
PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Professional
|
Both
|
$1,523.00
|
|
|
Service Code
|
HCPCS 57240
|
| Min. Negotiated Rate |
$394.26 |
| Max. Negotiated Rate |
$2,162.33 |
| Rate for Payer: Aetna Commercial |
$727.57
|
| Rate for Payer: BCBS Complete |
$413.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,162.33
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Meridian Medicaid |
$413.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$871.57
|
| Rate for Payer: Priority Health Narrow Network |
$871.57
|
| Rate for Payer: Priority Health SBD |
$871.57
|
| Rate for Payer: UMR Bronson Commercial |
$700.58
|
|
|
PR ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$3,805.00
|
|
|
Service Code
|
HCPCS 22845
|
| Min. Negotiated Rate |
$92.54 |
| Max. Negotiated Rate |
$2,663.50 |
| Rate for Payer: Aetna Commercial |
$979.87
|
| Rate for Payer: BCBS Complete |
$485.77
|
| Rate for Payer: BCBS Trust/PPO |
$92.54
|
| Rate for Payer: Cash Price |
$3,044.00
|
| Rate for Payer: Cash Price |
$3,044.00
|
| Rate for Payer: Meridian Medicaid |
$485.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,663.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,105.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,105.05
|
| Rate for Payer: Priority Health SBD |
$1,105.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,750.30
|
|
