|
PR COLONOSCOPY THRU STOMA,LESION REMOVAL
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
HCPCS 44393
|
| Min. Negotiated Rate |
$537.60 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: BCBS Complete |
$537.60
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: UMR Bronson Commercial |
$618.24
|
|
|
PR COLONOSCOPY THRU STOMA,LESION REMOVAL
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 44393
|
| Hospital Charge Code |
44393
|
| Min. Negotiated Rate |
$497.28 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna American Axle |
$873.60
|
| Rate for Payer: Aetna Commercial |
$1,142.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.60
|
| Rate for Payer: BCBS Complete |
$537.60
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cofinity Commercial |
$1,155.84
|
| Rate for Payer: Cofinity Commercial |
$940.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.20
|
| Rate for Payer: Healthscope Commercial |
$1,209.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$940.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,142.40
|
| Rate for Payer: PHP Commercial |
$1,142.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: Priority Health SBD |
$846.72
|
| Rate for Payer: UMR Bronson Commercial |
$497.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.00
|
|
|
PR COLONOSCOPY THRU STOMA,LESION REMOVAL
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 44393
|
| Hospital Charge Code |
44393
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna American Axle |
$873.60
|
| Rate for Payer: Aetna Commercial |
$1,142.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.60
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cofinity Commercial |
$1,155.84
|
| Rate for Payer: Cofinity Commercial |
$940.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.20
|
| Rate for Payer: Healthscope Commercial |
$1,209.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$940.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,142.40
|
| Rate for Payer: PHP Commercial |
$1,142.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: Priority Health SBD |
$846.72
|
| Rate for Payer: UMR Bronson Commercial |
$591.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.00
|
|
|
PR COLONOSCOPY THRU STOMA,LESION REMOVAL
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
HCPCS 44393
|
| Hospital Charge Code |
44393
|
| Min. Negotiated Rate |
$537.60 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: BCBS Complete |
$537.60
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: UMR Bronson Commercial |
$618.24
|
|
|
PR COLONOSCOPY,TRANSENDOSCOPIC STENT
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 45387
|
| Min. Negotiated Rate |
$628.40 |
| Max. Negotiated Rate |
$1,099.70 |
| Rate for Payer: BCBS Complete |
$628.40
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: UMR Bronson Commercial |
$722.66
|
|
|
PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 45380
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$772.10 |
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: BCBS Complete |
$132.40
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Meridian Medicaid |
$132.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.32
|
| Rate for Payer: Priority Health Narrow Network |
$346.32
|
| Rate for Payer: Priority Health SBD |
$346.32
|
| Rate for Payer: UMR Bronson Commercial |
$507.38
|
|
|
PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 45380
|
| Hospital Charge Code |
45380
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna American Axle |
$716.95
|
| Rate for Payer: Aetna Commercial |
$937.55
|
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$769.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$948.58
|
| Rate for Payer: Cofinity Commercial |
$772.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$992.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.25
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$937.55
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$937.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Priority Health SBD |
$694.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$193.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: UMR Bronson Commercial |
$408.11
|
| Rate for Payer: VA VA |
$1,048.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.25
|
|
|
PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 45380
|
| Hospital Charge Code |
45380
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$772.10 |
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: BCBS Complete |
$132.40
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Meridian Medicaid |
$132.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.32
|
| Rate for Payer: Priority Health Narrow Network |
$346.32
|
| Rate for Payer: Priority Health SBD |
$346.32
|
| Rate for Payer: UMR Bronson Commercial |
$507.38
|
|
|
PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 45380
|
| Hospital Charge Code |
45380
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$485.32 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Aetna American Axle |
$716.95
|
| Rate for Payer: Aetna Commercial |
$937.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.95
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$772.10
|
| Rate for Payer: Cofinity Commercial |
$948.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.40
|
| Rate for Payer: Healthscope Commercial |
$992.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$937.55
|
| Rate for Payer: PHP Commercial |
$937.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.10
|
| Rate for Payer: Priority Health SBD |
$694.89
|
| Rate for Payer: UMR Bronson Commercial |
$485.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.25
|
|
|
PR COLONOSCOPY W/STENT
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS G6025
|
| Min. Negotiated Rate |
$628.40 |
| Max. Negotiated Rate |
$1,099.70 |
| Rate for Payer: BCBS Complete |
$628.40
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: UMR Bronson Commercial |
$722.66
|
|
|
PR COLORECTAL SCRN; HI RISK IND
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
G0105
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$511.28 |
| Max. Negotiated Rate |
$1,045.80 |
| Rate for Payer: Aetna American Axle |
$755.30
|
| Rate for Payer: Aetna Commercial |
$987.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.30
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: Cofinity Commercial |
$813.40
|
| Rate for Payer: Cofinity Commercial |
$999.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.60
|
| Rate for Payer: Healthscope Commercial |
$1,045.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$813.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$871.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$987.70
|
| Rate for Payer: PHP Commercial |
$987.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.40
|
| Rate for Payer: Priority Health SBD |
$732.06
|
| Rate for Payer: UMR Bronson Commercial |
$511.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$871.50
|
|
|
PR COLORECTAL SCRN; HI RISK IND
|
Professional
|
Both
|
$1,162.00
|
|
|
Service Code
|
HCPCS G0105
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$2,245.28 |
| Rate for Payer: Aetna Commercial |
$184.58
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,245.28
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.68
|
| Rate for Payer: Priority Health Narrow Network |
$318.68
|
| Rate for Payer: Priority Health SBD |
$318.68
|
| Rate for Payer: UMR Bronson Commercial |
$534.52
|
|
|
PR COLORECTAL SCRN; HI RISK IND
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
G0105
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna American Axle |
$755.30
|
| Rate for Payer: Aetna Commercial |
$987.70
|
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$714.42
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: Cofinity Commercial |
$813.40
|
| Rate for Payer: Cofinity Commercial |
$999.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$1,045.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$813.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$871.50
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$987.70
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$987.70
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Priority Health SBD |
$732.06
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$178.46
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: UMR Bronson Commercial |
$429.94
|
| Rate for Payer: VA VA |
$812.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$871.50
|
|
|
PR COLORECTAL SCRN; HI RISK IND
|
Professional
|
Both
|
$1,162.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
G0105
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$2,245.28 |
| Rate for Payer: Aetna Commercial |
$184.58
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,245.28
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.68
|
| Rate for Payer: Priority Health Narrow Network |
$318.68
|
| Rate for Payer: Priority Health SBD |
$318.68
|
| Rate for Payer: UMR Bronson Commercial |
$534.52
|
|
|
PR COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 92283
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$1,441.20 |
| Rate for Payer: Aetna Commercial |
$56.23
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,441.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.44
|
| Rate for Payer: Priority Health Narrow Network |
$10.44
|
| Rate for Payer: Priority Health SBD |
$64.64
|
| Rate for Payer: UMR Bronson Commercial |
$43.24
|
|
|
PR COLOSTOMY/SKIN LEVEL CECOSTOMY
|
Professional
|
Both
|
$2,642.00
|
|
|
Service Code
|
HCPCS 44320
|
| Min. Negotiated Rate |
$262.57 |
| Max. Negotiated Rate |
$2,100.24 |
| Rate for Payer: Aetna Commercial |
$1,615.18
|
| Rate for Payer: BCBS Complete |
$804.03
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: Cash Price |
$2,113.60
|
| Rate for Payer: Cash Price |
$2,113.60
|
| Rate for Payer: Meridian Medicaid |
$804.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$765.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,849.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,100.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,100.24
|
| Rate for Payer: Priority Health SBD |
$2,100.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,215.32
|
|
|
PR COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX
|
Professional
|
Both
|
$2,712.00
|
|
|
Service Code
|
HCPCS 44322
|
| Min. Negotiated Rate |
$643.69 |
| Max. Negotiated Rate |
$1,898.40 |
| Rate for Payer: Aetna Commercial |
$1,358.01
|
| Rate for Payer: BCBS Complete |
$675.87
|
| Rate for Payer: BCBS Trust/PPO |
$955.17
|
| Rate for Payer: Cash Price |
$2,169.60
|
| Rate for Payer: Cash Price |
$2,169.60
|
| Rate for Payer: Meridian Medicaid |
$675.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,898.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,770.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,770.38
|
| Rate for Payer: Priority Health SBD |
$1,770.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,247.52
|
|
|
PR COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,816.00
|
|
|
Service Code
|
HCPCS 44025
|
| Min. Negotiated Rate |
$627.07 |
| Max. Negotiated Rate |
$2,143.84 |
| Rate for Payer: Aetna Commercial |
$1,320.54
|
| Rate for Payer: BCBS Complete |
$658.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,143.84
|
| Rate for Payer: Cash Price |
$2,252.80
|
| Rate for Payer: Cash Price |
$2,252.80
|
| Rate for Payer: Meridian Medicaid |
$658.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,971.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,718.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,718.05
|
| Rate for Payer: Priority Health SBD |
$1,718.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,295.36
|
|
|
PR COLPOCENTESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 57020
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$2,675.31 |
| Rate for Payer: Aetna Commercial |
$96.32
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.31
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.20
|
| Rate for Payer: Priority Health Narrow Network |
$112.20
|
| Rate for Payer: Priority Health SBD |
$112.20
|
| Rate for Payer: UMR Bronson Commercial |
$77.74
|
|
|
PR COLPOCLEISIS LE FORT TYPE
|
Professional
|
Both
|
$2,584.00
|
|
|
Service Code
|
HCPCS 57120
|
| Min. Negotiated Rate |
$341.87 |
| Max. Negotiated Rate |
$1,901.88 |
| Rate for Payer: Aetna Commercial |
$629.10
|
| Rate for Payer: BCBS Complete |
$358.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,901.88
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Meridian Medicaid |
$358.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,808.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.59
|
| Rate for Payer: Priority Health Narrow Network |
$755.59
|
| Rate for Payer: Priority Health SBD |
$755.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,188.64
|
|
|
PR COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
HCPCS 57210
|
| Min. Negotiated Rate |
$253.90 |
| Max. Negotiated Rate |
$2,571.24 |
| Rate for Payer: Aetna Commercial |
$464.42
|
| Rate for Payer: BCBS Complete |
$266.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,571.24
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Meridian Medicaid |
$266.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.07
|
| Rate for Payer: Priority Health Narrow Network |
$560.07
|
| Rate for Payer: Priority Health SBD |
$560.07
|
| Rate for Payer: UMR Bronson Commercial |
$486.68
|
|
|
PR COLPOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
HCPCS 57280
|
| Min. Negotiated Rate |
$618.55 |
| Max. Negotiated Rate |
$2,847.01 |
| Rate for Payer: Aetna Commercial |
$1,153.81
|
| Rate for Payer: BCBS Complete |
$649.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,847.01
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Meridian Medicaid |
$649.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$618.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,443.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,368.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,368.20
|
| Rate for Payer: Priority Health SBD |
$1,368.20
|
| Rate for Payer: UMR Bronson Commercial |
$948.52
|
|
|
PR COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH
|
Professional
|
Both
|
$2,086.00
|
|
|
Service Code
|
HCPCS 57282
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$2,780.44 |
| Rate for Payer: Aetna Commercial |
$827.22
|
| Rate for Payer: BCBS Complete |
$467.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,780.44
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Meridian Medicaid |
$467.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,460.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$985.67
|
| Rate for Payer: Priority Health Narrow Network |
$985.67
|
| Rate for Payer: Priority Health SBD |
$985.67
|
| Rate for Payer: UMR Bronson Commercial |
$959.56
|
|
|
PR COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 57283
|
| Min. Negotiated Rate |
$448.79 |
| Max. Negotiated Rate |
$3,053.05 |
| Rate for Payer: Aetna Commercial |
$832.81
|
| Rate for Payer: BCBS Complete |
$471.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,053.05
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Meridian Medicaid |
$471.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$994.19
|
| Rate for Payer: Priority Health Narrow Network |
$994.19
|
| Rate for Payer: Priority Health SBD |
$994.19
|
| Rate for Payer: UMR Bronson Commercial |
$524.86
|
|
|
PR COLPORRHAPHY SUTURE INJURY VAGINA
|
Professional
|
Both
|
$858.00
|
|
|
Service Code
|
HCPCS 57200
|
| Min. Negotiated Rate |
$214.92 |
| Max. Negotiated Rate |
$2,224.14 |
| Rate for Payer: Aetna Commercial |
$387.33
|
| Rate for Payer: BCBS Complete |
$225.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,224.14
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Meridian Medicaid |
$225.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.47
|
| Rate for Payer: Priority Health Narrow Network |
$472.47
|
| Rate for Payer: Priority Health SBD |
$472.47
|
| Rate for Payer: UMR Bronson Commercial |
$394.68
|
|
