|
PR URINARY LEG OR ABDOMEN BAG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4358
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$11.79
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.20
|
| Rate for Payer: Nomi Health Commercial |
$9.83
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.19
|
| Rate for Payer: UHC Medicare Advantage |
$8.19
|
|
|
PR URINARY SUSPENSORY
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS A5105
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$105.39 |
| Rate for Payer: Aetna Commercial |
$76.34
|
| Rate for Payer: Aetna Medicare |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.34
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$56.97
|
| Rate for Payer: BCN Medicare Advantage |
$56.97
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Cofinity Commercial |
$76.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.97
|
| Rate for Payer: Healthscope Commercial |
$91.15
|
| Rate for Payer: Healthscope Commercial |
$105.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Nomi Health Commercial |
$68.36
|
| Rate for Payer: PACE SWMI |
$56.97
|
| Rate for Payer: PHP Medicare Advantage |
$56.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$56.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.97
|
| Rate for Payer: UHC Medicare Advantage |
$56.97
|
|
|
PR URTP W/TUBULARIZATION POST URT&/LWR BLDR
|
Professional
|
Both
|
$2,206.00
|
|
|
Service Code
|
HCPCS 53431
|
| Min. Negotiated Rate |
$882.40 |
| Max. Negotiated Rate |
$2,033.17 |
| Rate for Payer: Aetna Commercial |
$1,472.67
|
| Rate for Payer: Aetna Medicare |
$1,142.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.67
|
| Rate for Payer: BCBS Complete |
$882.40
|
| Rate for Payer: BCBS MAPPO |
$1,099.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.01
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Cofinity Commercial |
$1,582.57
|
| Rate for Payer: Cofinity Commercial |
$1,472.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.01
|
| Rate for Payer: Healthscope Commercial |
$1,758.42
|
| Rate for Payer: Healthscope Commercial |
$2,033.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,153.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.90
|
| Rate for Payer: Nomi Health Commercial |
$1,318.81
|
| Rate for Payer: PACE SWMI |
$1,099.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,433.90
|
| Rate for Payer: Priority Health Medicare |
$1,099.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.01
|
|
|
PR URTROLITHOTOMY MIDDLE ONE-THIRD URETER
|
Professional
|
Both
|
$1,626.00
|
|
|
Service Code
|
HCPCS 50620
|
| Min. Negotiated Rate |
$650.40 |
| Max. Negotiated Rate |
$1,594.27 |
| Rate for Payer: Aetna Commercial |
$1,154.77
|
| Rate for Payer: Aetna Medicare |
$896.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,240.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,154.77
|
| Rate for Payer: BCBS Complete |
$650.40
|
| Rate for Payer: BCBS MAPPO |
$861.77
|
| Rate for Payer: BCN Medicare Advantage |
$861.77
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cofinity Commercial |
$1,240.95
|
| Rate for Payer: Cofinity Commercial |
$1,154.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$861.77
|
| Rate for Payer: Healthscope Commercial |
$1,594.27
|
| Rate for Payer: Healthscope Commercial |
$1,378.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$904.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,056.90
|
| Rate for Payer: Nomi Health Commercial |
$1,034.12
|
| Rate for Payer: PACE SWMI |
$861.77
|
| Rate for Payer: PHP Medicare Advantage |
$861.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,056.90
|
| Rate for Payer: Priority Health Medicare |
$861.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$861.77
|
| Rate for Payer: UHC Medicare Advantage |
$861.77
|
|
|
PR URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 50785
|
| Min. Negotiated Rate |
$1,161.58 |
| Max. Negotiated Rate |
$3,023.80 |
| Rate for Payer: Aetna Commercial |
$1,556.52
|
| Rate for Payer: Aetna Medicare |
$1,208.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,672.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.52
|
| Rate for Payer: BCBS Complete |
$1,860.80
|
| Rate for Payer: BCBS MAPPO |
$1,161.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,161.58
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,672.68
|
| Rate for Payer: Cofinity Commercial |
$1,556.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,161.58
|
| Rate for Payer: Healthscope Commercial |
$1,858.53
|
| Rate for Payer: Healthscope Commercial |
$2,148.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,219.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,023.80
|
| Rate for Payer: Nomi Health Commercial |
$1,393.90
|
| Rate for Payer: PACE SWMI |
$1,161.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,161.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health Medicare |
$1,161.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,161.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,161.58
|
|
|
PR URTT/URTS XTRNL SPX PENDULOUS URETHRA
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 53000
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$261.57 |
| Rate for Payer: Aetna Commercial |
$189.46
|
| Rate for Payer: Aetna Medicare |
$147.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.46
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$141.39
|
| Rate for Payer: BCN Medicare Advantage |
$141.39
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$203.60
|
| Rate for Payer: Cofinity Commercial |
$189.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.39
|
| Rate for Payer: Healthscope Commercial |
$261.57
|
| Rate for Payer: Healthscope Commercial |
$226.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Nomi Health Commercial |
$169.67
|
| Rate for Payer: PACE SWMI |
$141.39
|
| Rate for Payer: PHP Medicare Advantage |
$141.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$141.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.39
|
| Rate for Payer: UHC Medicare Advantage |
$141.39
|
|
|
PR USE OF ECHO CONTRAST AGENT DURING STRESS ECHO
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 93352
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$58.57 |
| Rate for Payer: Aetna Commercial |
$42.42
|
| Rate for Payer: Aetna Medicare |
$32.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.42
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS MAPPO |
$31.66
|
| Rate for Payer: BCN Medicare Advantage |
$31.66
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.59
|
| Rate for Payer: Cofinity Commercial |
$42.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.66
|
| Rate for Payer: Healthscope Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$58.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.25
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: PACE SWMI |
$31.66
|
| Rate for Payer: PHP Medicare Advantage |
$31.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.25
|
| Rate for Payer: Priority Health Medicare |
$31.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.66
|
| Rate for Payer: UHC Medicare Advantage |
$31.66
|
|
|
PR USE VERTICAL ELECTRODES
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 92547
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$16.89 |
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.23
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$9.13
|
| Rate for Payer: BCN Medicare Advantage |
$9.13
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$13.15
|
| Rate for Payer: Cofinity Commercial |
$12.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.13
|
| Rate for Payer: Healthscope Commercial |
$16.89
|
| Rate for Payer: Healthscope Commercial |
$14.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Nomi Health Commercial |
$10.96
|
| Rate for Payer: PACE SWMI |
$9.13
|
| Rate for Payer: PHP Medicare Advantage |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Medicare |
$9.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.13
|
| Rate for Payer: UHC Medicare Advantage |
$9.13
|
|
|
PR UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 59870
|
| Min. Negotiated Rate |
$314.00 |
| Max. Negotiated Rate |
$948.79 |
| Rate for Payer: Aetna Commercial |
$687.23
|
| Rate for Payer: Aetna Medicare |
$533.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.23
|
| Rate for Payer: BCBS Complete |
$314.00
|
| Rate for Payer: BCBS MAPPO |
$512.86
|
| Rate for Payer: BCN Medicare Advantage |
$512.86
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cofinity Commercial |
$738.52
|
| Rate for Payer: Cofinity Commercial |
$687.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.86
|
| Rate for Payer: Healthscope Commercial |
$820.58
|
| Rate for Payer: Healthscope Commercial |
$948.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$538.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.25
|
| Rate for Payer: Nomi Health Commercial |
$615.43
|
| Rate for Payer: PACE SWMI |
$512.86
|
| Rate for Payer: PHP Medicare Advantage |
$512.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.25
|
| Rate for Payer: Priority Health Medicare |
$512.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$512.86
|
| Rate for Payer: UHC Medicare Advantage |
$512.86
|
|
|
PR UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 58400
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$813.33 |
| Rate for Payer: Aetna Commercial |
$589.12
|
| Rate for Payer: Aetna Medicare |
$457.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.12
|
| Rate for Payer: BCBS Complete |
$345.60
|
| Rate for Payer: BCBS MAPPO |
$439.64
|
| Rate for Payer: BCN Medicare Advantage |
$439.64
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$633.08
|
| Rate for Payer: Cofinity Commercial |
$589.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.64
|
| Rate for Payer: Healthscope Commercial |
$703.42
|
| Rate for Payer: Healthscope Commercial |
$813.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.60
|
| Rate for Payer: Nomi Health Commercial |
$527.57
|
| Rate for Payer: PACE SWMI |
$439.64
|
| Rate for Payer: PHP Medicare Advantage |
$439.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health Medicare |
$439.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.64
|
| Rate for Payer: UHC Medicare Advantage |
$439.64
|
|
|
PR U-TUBE HEPATICOENTEROSTOMY
|
Professional
|
Both
|
$2,734.00
|
|
|
Service Code
|
HCPCS 47802
|
| Min. Negotiated Rate |
$1,093.60 |
| Max. Negotiated Rate |
$1,777.10 |
| Rate for Payer: Aetna Medicare |
$1,367.00
|
| Rate for Payer: BCBS Complete |
$1,093.60
|
| Rate for Payer: Cash Price |
$2,187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,777.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,777.10
|
|
|
PR UVULECTOMY EXCISION UVULA
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 42140
|
| Min. Negotiated Rate |
$153.68 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$205.93
|
| Rate for Payer: Aetna Medicare |
$159.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.30
|
| Rate for Payer: BCBS Complete |
$229.20
|
| Rate for Payer: BCBS MAPPO |
$153.68
|
| Rate for Payer: BCN Medicare Advantage |
$153.68
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cofinity Commercial |
$205.93
|
| Rate for Payer: Cofinity Commercial |
$221.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.68
|
| Rate for Payer: Healthscope Commercial |
$245.89
|
| Rate for Payer: Healthscope Commercial |
$284.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.45
|
| Rate for Payer: Nomi Health Commercial |
$184.42
|
| Rate for Payer: PACE SWMI |
$153.68
|
| Rate for Payer: PHP Medicare Advantage |
$153.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health Medicare |
$153.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.68
|
| Rate for Payer: UHC Medicare Advantage |
$153.68
|
|
|
PR VAG HYST > 250 GM RMVL TUBE&/OVARY
|
Professional
|
Both
|
$3,124.00
|
|
|
Service Code
|
HCPCS 58291
|
| Min. Negotiated Rate |
$1,195.10 |
| Max. Negotiated Rate |
$2,210.93 |
| Rate for Payer: Aetna Commercial |
$1,601.43
|
| Rate for Payer: Aetna Medicare |
$1,242.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,720.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,601.43
|
| Rate for Payer: BCBS Complete |
$1,249.60
|
| Rate for Payer: BCBS MAPPO |
$1,195.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,195.10
|
| Rate for Payer: Cash Price |
$2,499.20
|
| Rate for Payer: Cash Price |
$2,499.20
|
| Rate for Payer: Cofinity Commercial |
$1,720.94
|
| Rate for Payer: Cofinity Commercial |
$1,601.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,195.10
|
| Rate for Payer: Healthscope Commercial |
$2,210.93
|
| Rate for Payer: Healthscope Commercial |
$1,912.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,254.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,030.60
|
| Rate for Payer: Nomi Health Commercial |
$1,434.12
|
| Rate for Payer: PACE SWMI |
$1,195.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,195.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,030.60
|
| Rate for Payer: Priority Health Medicare |
$1,195.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,195.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,195.10
|
|
|
PR VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE
|
Professional
|
Both
|
$3,457.00
|
|
|
Service Code
|
HCPCS 58292
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$2,329.43 |
| Rate for Payer: Aetna Commercial |
$1,687.26
|
| Rate for Payer: Aetna Medicare |
$1,309.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,813.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,687.26
|
| Rate for Payer: BCBS Complete |
$1,382.80
|
| Rate for Payer: BCBS MAPPO |
$1,259.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,259.15
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cofinity Commercial |
$1,813.18
|
| Rate for Payer: Cofinity Commercial |
$1,687.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,259.15
|
| Rate for Payer: Healthscope Commercial |
$2,014.64
|
| Rate for Payer: Healthscope Commercial |
$2,329.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,322.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,247.05
|
| Rate for Payer: Nomi Health Commercial |
$1,510.98
|
| Rate for Payer: PACE SWMI |
$1,259.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,259.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.05
|
| Rate for Payer: Priority Health Medicare |
$1,259.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,259.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,259.15
|
|
|
PR VAG HYST 250 GM/< W/RMVL TUBE&/OVARY
|
Professional
|
Both
|
$2,973.00
|
|
|
Service Code
|
HCPCS 58262
|
| Min. Negotiated Rate |
$890.83 |
| Max. Negotiated Rate |
$1,932.45 |
| Rate for Payer: Aetna Commercial |
$1,193.71
|
| Rate for Payer: Aetna Medicare |
$926.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,282.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.71
|
| Rate for Payer: BCBS Complete |
$1,189.20
|
| Rate for Payer: BCBS MAPPO |
$890.83
|
| Rate for Payer: BCN Medicare Advantage |
$890.83
|
| Rate for Payer: Cash Price |
$2,378.40
|
| Rate for Payer: Cash Price |
$2,378.40
|
| Rate for Payer: Cofinity Commercial |
$1,282.80
|
| Rate for Payer: Cofinity Commercial |
$1,193.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.83
|
| Rate for Payer: Healthscope Commercial |
$1,648.04
|
| Rate for Payer: Healthscope Commercial |
$1,425.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$935.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,932.45
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE SWMI |
$890.83
|
| Rate for Payer: PHP Medicare Advantage |
$890.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,932.45
|
| Rate for Payer: Priority Health Medicare |
$890.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.83
|
| Rate for Payer: UHC Medicare Advantage |
$890.83
|
|
|
PR VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL
|
Professional
|
Both
|
$3,245.00
|
|
|
Service Code
|
HCPCS 58263
|
| Min. Negotiated Rate |
$956.48 |
| Max. Negotiated Rate |
$2,109.25 |
| Rate for Payer: Aetna Commercial |
$1,281.68
|
| Rate for Payer: Aetna Medicare |
$994.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,377.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,281.68
|
| Rate for Payer: BCBS Complete |
$1,298.00
|
| Rate for Payer: BCBS MAPPO |
$956.48
|
| Rate for Payer: BCN Medicare Advantage |
$956.48
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cofinity Commercial |
$1,377.33
|
| Rate for Payer: Cofinity Commercial |
$1,281.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.48
|
| Rate for Payer: Healthscope Commercial |
$1,530.37
|
| Rate for Payer: Healthscope Commercial |
$1,769.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,109.25
|
| Rate for Payer: Nomi Health Commercial |
$1,147.78
|
| Rate for Payer: PACE SWMI |
$956.48
|
| Rate for Payer: PHP Medicare Advantage |
$956.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,109.25
|
| Rate for Payer: Priority Health Medicare |
$956.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.48
|
| Rate for Payer: UHC Medicare Advantage |
$956.48
|
|
|
PR VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE
|
Professional
|
Both
|
$3,732.00
|
|
|
Service Code
|
HCPCS 58280
|
| Min. Negotiated Rate |
$1,017.16 |
| Max. Negotiated Rate |
$2,425.80 |
| Rate for Payer: Aetna Commercial |
$1,362.99
|
| Rate for Payer: Aetna Medicare |
$1,057.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,464.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,362.99
|
| Rate for Payer: BCBS Complete |
$1,492.80
|
| Rate for Payer: BCBS MAPPO |
$1,017.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,017.16
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Cofinity Commercial |
$1,464.71
|
| Rate for Payer: Cofinity Commercial |
$1,362.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,017.16
|
| Rate for Payer: Healthscope Commercial |
$1,881.75
|
| Rate for Payer: Healthscope Commercial |
$1,627.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,425.80
|
| Rate for Payer: Nomi Health Commercial |
$1,220.59
|
| Rate for Payer: PACE SWMI |
$1,017.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,017.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,425.80
|
| Rate for Payer: Priority Health Medicare |
$1,017.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,017.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,017.16
|
|
|
PR VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$2,145.00
|
|
|
Service Code
|
HCPCS 59612
|
| Min. Negotiated Rate |
$858.00 |
| Max. Negotiated Rate |
$1,644.63 |
| Rate for Payer: Aetna Commercial |
$1,191.25
|
| Rate for Payer: Aetna Medicare |
$924.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,280.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,191.25
|
| Rate for Payer: BCBS Complete |
$858.00
|
| Rate for Payer: BCBS MAPPO |
$888.99
|
| Rate for Payer: BCN Medicare Advantage |
$888.99
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cofinity Commercial |
$1,280.15
|
| Rate for Payer: Cofinity Commercial |
$1,191.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$888.99
|
| Rate for Payer: Healthscope Commercial |
$1,422.38
|
| Rate for Payer: Healthscope Commercial |
$1,644.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,394.25
|
| Rate for Payer: Nomi Health Commercial |
$1,066.79
|
| Rate for Payer: PACE SWMI |
$888.99
|
| Rate for Payer: PHP Medicare Advantage |
$888.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.25
|
| Rate for Payer: Priority Health Medicare |
$888.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$888.99
|
| Rate for Payer: UHC Medicare Advantage |
$888.99
|
|
|
PR VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$1,970.00
|
|
|
Service Code
|
HCPCS 59409
|
| Min. Negotiated Rate |
$781.01 |
| Max. Negotiated Rate |
$1,444.87 |
| Rate for Payer: Aetna Commercial |
$1,046.55
|
| Rate for Payer: Aetna Medicare |
$812.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,124.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,046.55
|
| Rate for Payer: BCBS Complete |
$788.00
|
| Rate for Payer: BCBS MAPPO |
$781.01
|
| Rate for Payer: BCN Medicare Advantage |
$781.01
|
| Rate for Payer: Cash Price |
$1,576.00
|
| Rate for Payer: Cash Price |
$1,576.00
|
| Rate for Payer: Cofinity Commercial |
$1,124.65
|
| Rate for Payer: Cofinity Commercial |
$1,046.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.01
|
| Rate for Payer: Healthscope Commercial |
$1,444.87
|
| Rate for Payer: Healthscope Commercial |
$1,249.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.50
|
| Rate for Payer: Nomi Health Commercial |
$937.21
|
| Rate for Payer: PACE SWMI |
$781.01
|
| Rate for Payer: PHP Medicare Advantage |
$781.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,280.50
|
| Rate for Payer: Priority Health Medicare |
$781.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$781.01
|
| Rate for Payer: UHC Medicare Advantage |
$781.01
|
|
|
PR VAGINAL DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,242.00
|
|
|
Service Code
|
HCPCS 59410
|
| Min. Negotiated Rate |
$896.80 |
| Max. Negotiated Rate |
$1,951.38 |
| Rate for Payer: Aetna Commercial |
$1,413.43
|
| Rate for Payer: Aetna Medicare |
$1,096.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.43
|
| Rate for Payer: BCBS Complete |
$896.80
|
| Rate for Payer: BCBS MAPPO |
$1,054.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,054.80
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cofinity Commercial |
$1,518.91
|
| Rate for Payer: Cofinity Commercial |
$1,413.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,054.80
|
| Rate for Payer: Healthscope Commercial |
$1,687.68
|
| Rate for Payer: Healthscope Commercial |
$1,951.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,107.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,457.30
|
| Rate for Payer: Nomi Health Commercial |
$1,265.76
|
| Rate for Payer: PACE SWMI |
$1,054.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,054.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.30
|
| Rate for Payer: Priority Health Medicare |
$1,054.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,054.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,054.80
|
|
|
PR VAGINAL DELIVERY & POSTPARTUM CARE VBAC
|
Professional
|
Both
|
$2,417.00
|
|
|
Service Code
|
HCPCS 59614
|
| Min. Negotiated Rate |
$966.80 |
| Max. Negotiated Rate |
$2,122.41 |
| Rate for Payer: Aetna Commercial |
$1,537.32
|
| Rate for Payer: Aetna Medicare |
$1,193.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,652.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.32
|
| Rate for Payer: BCBS Complete |
$966.80
|
| Rate for Payer: BCBS MAPPO |
$1,147.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,147.25
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Cofinity Commercial |
$1,652.04
|
| Rate for Payer: Cofinity Commercial |
$1,537.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,147.25
|
| Rate for Payer: Healthscope Commercial |
$2,122.41
|
| Rate for Payer: Healthscope Commercial |
$1,835.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,204.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,571.05
|
| Rate for Payer: Nomi Health Commercial |
$1,376.70
|
| Rate for Payer: PACE SWMI |
$1,147.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,147.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.05
|
| Rate for Payer: Priority Health Medicare |
$1,147.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,147.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,147.25
|
|
|
PR VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE
|
Professional
|
Both
|
$2,238.00
|
|
|
Service Code
|
HCPCS 58294
|
| Min. Negotiated Rate |
$895.20 |
| Max. Negotiated Rate |
$2,163.91 |
| Rate for Payer: Aetna Commercial |
$1,567.37
|
| Rate for Payer: Aetna Medicare |
$1,216.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,684.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,567.37
|
| Rate for Payer: BCBS Complete |
$895.20
|
| Rate for Payer: BCBS MAPPO |
$1,169.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,169.68
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cofinity Commercial |
$1,684.34
|
| Rate for Payer: Cofinity Commercial |
$1,567.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,169.68
|
| Rate for Payer: Healthscope Commercial |
$1,871.49
|
| Rate for Payer: Healthscope Commercial |
$2,163.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,228.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,454.70
|
| Rate for Payer: Nomi Health Commercial |
$1,403.62
|
| Rate for Payer: PACE SWMI |
$1,169.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,169.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,454.70
|
| Rate for Payer: Priority Health Medicare |
$1,169.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,169.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,169.68
|
|
|
PR VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE
|
Professional
|
Both
|
$2,757.00
|
|
|
Service Code
|
HCPCS 58270
|
| Min. Negotiated Rate |
$858.59 |
| Max. Negotiated Rate |
$1,792.05 |
| Rate for Payer: Aetna Commercial |
$1,150.51
|
| Rate for Payer: Aetna Medicare |
$892.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.51
|
| Rate for Payer: BCBS Complete |
$1,102.80
|
| Rate for Payer: BCBS MAPPO |
$858.59
|
| Rate for Payer: BCN Medicare Advantage |
$858.59
|
| Rate for Payer: Cash Price |
$2,205.60
|
| Rate for Payer: Cash Price |
$2,205.60
|
| Rate for Payer: Cofinity Commercial |
$1,236.37
|
| Rate for Payer: Cofinity Commercial |
$1,150.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.59
|
| Rate for Payer: Healthscope Commercial |
$1,588.39
|
| Rate for Payer: Healthscope Commercial |
$1,373.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,792.05
|
| Rate for Payer: Nomi Health Commercial |
$1,030.31
|
| Rate for Payer: PACE SWMI |
$858.59
|
| Rate for Payer: PHP Medicare Advantage |
$858.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,792.05
|
| Rate for Payer: Priority Health Medicare |
$858.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.59
|
| Rate for Payer: UHC Medicare Advantage |
$858.59
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS > 250 GM
|
Professional
|
Both
|
$2,917.00
|
|
|
Service Code
|
HCPCS 58290
|
| Min. Negotiated Rate |
$1,106.24 |
| Max. Negotiated Rate |
$2,046.54 |
| Rate for Payer: Aetna Commercial |
$1,482.36
|
| Rate for Payer: Aetna Medicare |
$1,150.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,592.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,482.36
|
| Rate for Payer: BCBS Complete |
$1,166.80
|
| Rate for Payer: BCBS MAPPO |
$1,106.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,106.24
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cofinity Commercial |
$1,592.99
|
| Rate for Payer: Cofinity Commercial |
$1,482.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,106.24
|
| Rate for Payer: Healthscope Commercial |
$1,769.98
|
| Rate for Payer: Healthscope Commercial |
$2,046.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,161.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,896.05
|
| Rate for Payer: Nomi Health Commercial |
$1,327.49
|
| Rate for Payer: PACE SWMI |
$1,106.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,106.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,896.05
|
| Rate for Payer: Priority Health Medicare |
$1,106.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,106.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,106.24
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,684.00
|
|
|
Service Code
|
HCPCS 58260
|
| Min. Negotiated Rate |
$804.92 |
| Max. Negotiated Rate |
$1,744.60 |
| Rate for Payer: Aetna Commercial |
$1,078.59
|
| Rate for Payer: Aetna Medicare |
$837.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.59
|
| Rate for Payer: BCBS Complete |
$1,073.60
|
| Rate for Payer: BCBS MAPPO |
$804.92
|
| Rate for Payer: BCN Medicare Advantage |
$804.92
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cofinity Commercial |
$1,159.08
|
| Rate for Payer: Cofinity Commercial |
$1,078.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.92
|
| Rate for Payer: Healthscope Commercial |
$1,489.10
|
| Rate for Payer: Healthscope Commercial |
$1,287.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$845.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,744.60
|
| Rate for Payer: Nomi Health Commercial |
$965.90
|
| Rate for Payer: PACE SWMI |
$804.92
|
| Rate for Payer: PHP Medicare Advantage |
$804.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.60
|
| Rate for Payer: Priority Health Medicare |
$804.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$804.92
|
| Rate for Payer: UHC Medicare Advantage |
$804.92
|
|
