|
PR VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY
|
Professional
|
Both
|
$2,416.00
|
|
|
Service Code
|
HCPCS 58275
|
| Min. Negotiated Rate |
$953.00 |
| Max. Negotiated Rate |
$1,763.05 |
| Rate for Payer: Aetna Commercial |
$1,277.02
|
| Rate for Payer: Aetna Medicare |
$991.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,372.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,277.02
|
| Rate for Payer: BCBS Complete |
$966.40
|
| Rate for Payer: BCBS MAPPO |
$953.00
|
| Rate for Payer: BCN Medicare Advantage |
$953.00
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cofinity Commercial |
$1,372.32
|
| Rate for Payer: Cofinity Commercial |
$1,277.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.00
|
| Rate for Payer: Healthscope Commercial |
$1,524.80
|
| Rate for Payer: Healthscope Commercial |
$1,763.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,000.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.40
|
| Rate for Payer: Nomi Health Commercial |
$1,143.60
|
| Rate for Payer: PACE SWMI |
$953.00
|
| Rate for Payer: PHP Medicare Advantage |
$953.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,570.40
|
| Rate for Payer: Priority Health Medicare |
$953.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$953.00
|
| Rate for Payer: UHC Medicare Advantage |
$953.00
|
|
|
PR VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 57110
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$1,601.95 |
| Rate for Payer: Aetna Commercial |
$1,160.33
|
| Rate for Payer: Aetna Medicare |
$900.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,246.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,160.33
|
| Rate for Payer: BCBS Complete |
$810.00
|
| Rate for Payer: BCBS MAPPO |
$865.92
|
| Rate for Payer: BCN Medicare Advantage |
$865.92
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cofinity Commercial |
$1,246.92
|
| Rate for Payer: Cofinity Commercial |
$1,160.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$865.92
|
| Rate for Payer: Healthscope Commercial |
$1,601.95
|
| Rate for Payer: Healthscope Commercial |
$1,385.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$909.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.25
|
| Rate for Payer: Nomi Health Commercial |
$1,039.10
|
| Rate for Payer: PACE SWMI |
$865.92
|
| Rate for Payer: PHP Medicare Advantage |
$865.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.25
|
| Rate for Payer: Priority Health Medicare |
$865.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$865.92
|
| Rate for Payer: UHC Medicare Advantage |
$865.92
|
|
|
PR VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
HCPCS 57106
|
| Min. Negotiated Rate |
$510.28 |
| Max. Negotiated Rate |
$1,295.45 |
| Rate for Payer: Aetna Commercial |
$683.78
|
| Rate for Payer: Aetna Medicare |
$530.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.78
|
| Rate for Payer: BCBS Complete |
$797.20
|
| Rate for Payer: BCBS MAPPO |
$510.28
|
| Rate for Payer: BCN Medicare Advantage |
$510.28
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cofinity Commercial |
$734.80
|
| Rate for Payer: Cofinity Commercial |
$683.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.28
|
| Rate for Payer: Healthscope Commercial |
$816.45
|
| Rate for Payer: Healthscope Commercial |
$944.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.45
|
| Rate for Payer: Nomi Health Commercial |
$612.34
|
| Rate for Payer: PACE SWMI |
$510.28
|
| Rate for Payer: PHP Medicare Advantage |
$510.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.45
|
| Rate for Payer: Priority Health Medicare |
$510.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.28
|
| Rate for Payer: UHC Medicare Advantage |
$510.28
|
|
|
PR VAGINOPLASTY INTERSEX STATE
|
Professional
|
Both
|
$2,533.00
|
|
|
Service Code
|
HCPCS 57335
|
| Min. Negotiated Rate |
$1,013.20 |
| Max. Negotiated Rate |
$2,086.80 |
| Rate for Payer: Aetna Commercial |
$1,511.52
|
| Rate for Payer: Aetna Medicare |
$1,173.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,511.52
|
| Rate for Payer: BCBS Complete |
$1,013.20
|
| Rate for Payer: BCBS MAPPO |
$1,128.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,128.00
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cofinity Commercial |
$1,624.32
|
| Rate for Payer: Cofinity Commercial |
$1,511.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,128.00
|
| Rate for Payer: Healthscope Commercial |
$2,086.80
|
| Rate for Payer: Healthscope Commercial |
$1,804.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,184.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,646.45
|
| Rate for Payer: Nomi Health Commercial |
$1,353.60
|
| Rate for Payer: PACE SWMI |
$1,128.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.45
|
| Rate for Payer: Priority Health Medicare |
$1,128.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,128.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,128.00
|
|
|
PR VAGNC PRTL RMVL VAG WALL W/RMVL PARAVAGINAL TISS
|
Professional
|
Both
|
$2,571.00
|
|
|
Service Code
|
HCPCS 57107
|
| Min. Negotiated Rate |
$1,028.40 |
| Max. Negotiated Rate |
$2,588.22 |
| Rate for Payer: Aetna Commercial |
$1,874.71
|
| Rate for Payer: Aetna Medicare |
$1,455.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,014.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,874.71
|
| Rate for Payer: BCBS Complete |
$1,028.40
|
| Rate for Payer: BCBS MAPPO |
$1,399.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,399.04
|
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Cofinity Commercial |
$2,014.62
|
| Rate for Payer: Cofinity Commercial |
$1,874.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,399.04
|
| Rate for Payer: Healthscope Commercial |
$2,238.46
|
| Rate for Payer: Healthscope Commercial |
$2,588.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,468.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,671.15
|
| Rate for Payer: Nomi Health Commercial |
$1,678.85
|
| Rate for Payer: PACE SWMI |
$1,399.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,399.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,671.15
|
| Rate for Payer: Priority Health Medicare |
$1,399.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,399.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,399.04
|
|
|
PR VAGOTOMY PFRMD W/PRTL DSTL GSTRCT
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 43635
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: Aetna Commercial |
$146.53
|
| Rate for Payer: Aetna Medicare |
$113.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.53
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$109.35
|
| Rate for Payer: BCN Medicare Advantage |
$109.35
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$157.46
|
| Rate for Payer: Cofinity Commercial |
$146.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.35
|
| Rate for Payer: Healthscope Commercial |
$202.30
|
| Rate for Payer: Healthscope Commercial |
$174.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Nomi Health Commercial |
$131.22
|
| Rate for Payer: PACE SWMI |
$109.35
|
| Rate for Payer: PHP Medicare Advantage |
$109.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$109.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.35
|
| Rate for Payer: UHC Medicare Advantage |
$109.35
|
|
|
PR VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP
|
Professional
|
Both
|
$4,859.00
|
|
|
Service Code
|
HCPCS 33460
|
| Min. Negotiated Rate |
$1,943.60 |
| Max. Negotiated Rate |
$4,238.18 |
| Rate for Payer: Aetna Commercial |
$3,069.82
|
| Rate for Payer: Aetna Medicare |
$2,382.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,298.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,069.82
|
| Rate for Payer: BCBS Complete |
$1,943.60
|
| Rate for Payer: BCBS MAPPO |
$2,290.91
|
| Rate for Payer: BCN Medicare Advantage |
$2,290.91
|
| Rate for Payer: Cash Price |
$3,887.20
|
| Rate for Payer: Cash Price |
$3,887.20
|
| Rate for Payer: Cofinity Commercial |
$3,298.91
|
| Rate for Payer: Cofinity Commercial |
$3,069.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,290.91
|
| Rate for Payer: Healthscope Commercial |
$3,665.46
|
| Rate for Payer: Healthscope Commercial |
$4,238.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,405.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,158.35
|
| Rate for Payer: Nomi Health Commercial |
$2,749.09
|
| Rate for Payer: PACE SWMI |
$2,290.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,290.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,158.35
|
| Rate for Payer: Priority Health Medicare |
$2,290.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,290.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,290.91
|
|
|
PR VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS
|
Professional
|
Both
|
$8,923.00
|
|
|
Service Code
|
HCPCS 33422
|
| Min. Negotiated Rate |
$1,590.96 |
| Max. Negotiated Rate |
$5,799.95 |
| Rate for Payer: Aetna Commercial |
$2,131.89
|
| Rate for Payer: Aetna Medicare |
$1,654.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,131.89
|
| Rate for Payer: BCBS Complete |
$3,569.20
|
| Rate for Payer: BCBS MAPPO |
$1,590.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,590.96
|
| Rate for Payer: Cash Price |
$7,138.40
|
| Rate for Payer: Cash Price |
$7,138.40
|
| Rate for Payer: Cofinity Commercial |
$2,290.98
|
| Rate for Payer: Cofinity Commercial |
$2,131.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,590.96
|
| Rate for Payer: Healthscope Commercial |
$2,943.28
|
| Rate for Payer: Healthscope Commercial |
$2,545.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,670.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,799.95
|
| Rate for Payer: Nomi Health Commercial |
$1,909.15
|
| Rate for Payer: PACE SWMI |
$1,590.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,590.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,799.95
|
| Rate for Payer: Priority Health Medicare |
$1,590.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,590.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,590.96
|
|
|
PR VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS
|
Professional
|
Both
|
$8,513.00
|
|
|
Service Code
|
HCPCS 33425
|
| Min. Negotiated Rate |
$2,612.40 |
| Max. Negotiated Rate |
$5,533.45 |
| Rate for Payer: Aetna Commercial |
$3,500.62
|
| Rate for Payer: Aetna Medicare |
$2,716.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,761.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,500.62
|
| Rate for Payer: BCBS Complete |
$3,405.20
|
| Rate for Payer: BCBS MAPPO |
$2,612.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,612.40
|
| Rate for Payer: Cash Price |
$6,810.40
|
| Rate for Payer: Cash Price |
$6,810.40
|
| Rate for Payer: Cofinity Commercial |
$3,761.86
|
| Rate for Payer: Cofinity Commercial |
$3,500.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,612.40
|
| Rate for Payer: Healthscope Commercial |
$4,179.84
|
| Rate for Payer: Healthscope Commercial |
$4,832.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,743.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,533.45
|
| Rate for Payer: Nomi Health Commercial |
$3,134.88
|
| Rate for Payer: PACE SWMI |
$2,612.40
|
| Rate for Payer: PHP Medicare Advantage |
$2,612.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,533.45
|
| Rate for Payer: Priority Health Medicare |
$2,612.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,612.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,612.40
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION
|
Professional
|
Both
|
$7,544.00
|
|
|
Service Code
|
HCPCS 33463
|
| Min. Negotiated Rate |
$2,943.26 |
| Max. Negotiated Rate |
$5,445.03 |
| Rate for Payer: Aetna Commercial |
$3,943.97
|
| Rate for Payer: Aetna Medicare |
$3,060.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,238.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,943.97
|
| Rate for Payer: BCBS Complete |
$3,017.60
|
| Rate for Payer: BCBS MAPPO |
$2,943.26
|
| Rate for Payer: BCN Medicare Advantage |
$2,943.26
|
| Rate for Payer: Cash Price |
$6,035.20
|
| Rate for Payer: Cash Price |
$6,035.20
|
| Rate for Payer: Cofinity Commercial |
$4,238.29
|
| Rate for Payer: Cofinity Commercial |
$3,943.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,943.26
|
| Rate for Payer: Healthscope Commercial |
$5,445.03
|
| Rate for Payer: Healthscope Commercial |
$4,709.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,090.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,903.60
|
| Rate for Payer: Nomi Health Commercial |
$3,531.91
|
| Rate for Payer: PACE SWMI |
$2,943.26
|
| Rate for Payer: PHP Medicare Advantage |
$2,943.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,903.60
|
| Rate for Payer: Priority Health Medicare |
$2,943.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,943.26
|
| Rate for Payer: UHC Medicare Advantage |
$2,943.26
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION
|
Professional
|
Both
|
$5,116.00
|
|
|
Service Code
|
HCPCS 33464
|
| Min. Negotiated Rate |
$2,046.40 |
| Max. Negotiated Rate |
$4,315.64 |
| Rate for Payer: Aetna Commercial |
$3,125.93
|
| Rate for Payer: Aetna Medicare |
$2,426.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,359.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,125.93
|
| Rate for Payer: BCBS Complete |
$2,046.40
|
| Rate for Payer: BCBS MAPPO |
$2,332.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,332.78
|
| Rate for Payer: Cash Price |
$4,092.80
|
| Rate for Payer: Cash Price |
$4,092.80
|
| Rate for Payer: Cofinity Commercial |
$3,359.20
|
| Rate for Payer: Cofinity Commercial |
$3,125.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,332.78
|
| Rate for Payer: Healthscope Commercial |
$3,732.45
|
| Rate for Payer: Healthscope Commercial |
$4,315.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,449.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,325.40
|
| Rate for Payer: Nomi Health Commercial |
$2,799.34
|
| Rate for Payer: PACE SWMI |
$2,332.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,332.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,325.40
|
| Rate for Payer: Priority Health Medicare |
$2,332.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,332.78
|
| Rate for Payer: UHC Medicare Advantage |
$2,332.78
|
|
|
PR VANTAS IMPLANT
|
Professional
|
Both
|
$3,401.00
|
|
|
Service Code
|
HCPCS J9225
|
| Min. Negotiated Rate |
$1,360.40 |
| Max. Negotiated Rate |
$2,210.65 |
| Rate for Payer: Aetna Medicare |
$1,700.50
|
| Rate for Payer: BCBS Complete |
$1,360.40
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,210.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,210.65
|
|
|
PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 90716
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
|
|
PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 37500
|
| Min. Negotiated Rate |
$534.00 |
| Max. Negotiated Rate |
$1,122.77 |
| Rate for Payer: Aetna Commercial |
$813.25
|
| Rate for Payer: Aetna Medicare |
$631.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.25
|
| Rate for Payer: BCBS Complete |
$534.00
|
| Rate for Payer: BCBS MAPPO |
$606.90
|
| Rate for Payer: BCN Medicare Advantage |
$606.90
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cofinity Commercial |
$813.25
|
| Rate for Payer: Cofinity Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.90
|
| Rate for Payer: Healthscope Commercial |
$971.04
|
| Rate for Payer: Healthscope Commercial |
$1,122.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.75
|
| Rate for Payer: Nomi Health Commercial |
$728.28
|
| Rate for Payer: PACE SWMI |
$606.90
|
| Rate for Payer: PHP Medicare Advantage |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.75
|
| Rate for Payer: Priority Health Medicare |
$606.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$606.90
|
| Rate for Payer: UHC Medicare Advantage |
$606.90
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 37242
|
| Min. Negotiated Rate |
$450.23 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$603.31
|
| Rate for Payer: Aetna Medicare |
$468.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.31
|
| Rate for Payer: BCBS Complete |
$606.00
|
| Rate for Payer: BCBS MAPPO |
$450.23
|
| Rate for Payer: BCN Medicare Advantage |
$450.23
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cofinity Commercial |
$648.33
|
| Rate for Payer: Cofinity Commercial |
$603.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.23
|
| Rate for Payer: Healthscope Commercial |
$832.93
|
| Rate for Payer: Healthscope Commercial |
$720.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$984.75
|
| Rate for Payer: Nomi Health Commercial |
$540.28
|
| Rate for Payer: PACE SWMI |
$450.23
|
| Rate for Payer: PHP Medicare Advantage |
$450.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.75
|
| Rate for Payer: Priority Health Medicare |
$450.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.23
|
| Rate for Payer: UHC Medicare Advantage |
$450.23
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Professional
|
Both
|
$9,702.00
|
|
|
Service Code
|
HCPCS 37244
|
| Min. Negotiated Rate |
$620.47 |
| Max. Negotiated Rate |
$6,306.30 |
| Rate for Payer: Aetna Commercial |
$831.43
|
| Rate for Payer: Aetna Medicare |
$645.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$893.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.43
|
| Rate for Payer: BCBS Complete |
$3,880.80
|
| Rate for Payer: BCBS MAPPO |
$620.47
|
| Rate for Payer: BCN Medicare Advantage |
$620.47
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Cofinity Commercial |
$893.48
|
| Rate for Payer: Cofinity Commercial |
$831.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$620.47
|
| Rate for Payer: Healthscope Commercial |
$1,147.87
|
| Rate for Payer: Healthscope Commercial |
$992.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$651.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,306.30
|
| Rate for Payer: Nomi Health Commercial |
$744.56
|
| Rate for Payer: PACE SWMI |
$620.47
|
| Rate for Payer: PHP Medicare Advantage |
$620.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,306.30
|
| Rate for Payer: Priority Health Medicare |
$620.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$620.47
|
| Rate for Payer: UHC Medicare Advantage |
$620.47
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 37241
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$746.70 |
| Rate for Payer: Aetna Commercial |
$540.85
|
| Rate for Payer: Aetna Medicare |
$419.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.85
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS MAPPO |
$403.62
|
| Rate for Payer: BCN Medicare Advantage |
$403.62
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$581.21
|
| Rate for Payer: Cofinity Commercial |
$540.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.62
|
| Rate for Payer: Healthscope Commercial |
$746.70
|
| Rate for Payer: Healthscope Commercial |
$645.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.15
|
| Rate for Payer: Nomi Health Commercial |
$484.34
|
| Rate for Payer: PACE SWMI |
$403.62
|
| Rate for Payer: PHP Medicare Advantage |
$403.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health Medicare |
$403.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.62
|
| Rate for Payer: UHC Medicare Advantage |
$403.62
|
|
|
PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 37243
|
| Min. Negotiated Rate |
$486.80 |
| Max. Negotiated Rate |
$976.02 |
| Rate for Payer: Aetna Commercial |
$706.96
|
| Rate for Payer: Aetna Medicare |
$548.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.96
|
| Rate for Payer: BCBS Complete |
$486.80
|
| Rate for Payer: BCBS MAPPO |
$527.58
|
| Rate for Payer: BCN Medicare Advantage |
$527.58
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cofinity Commercial |
$759.72
|
| Rate for Payer: Cofinity Commercial |
$706.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.58
|
| Rate for Payer: Healthscope Commercial |
$844.13
|
| Rate for Payer: Healthscope Commercial |
$976.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.05
|
| Rate for Payer: Nomi Health Commercial |
$633.10
|
| Rate for Payer: PACE SWMI |
$527.58
|
| Rate for Payer: PHP Medicare Advantage |
$527.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.05
|
| Rate for Payer: Priority Health Medicare |
$527.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.58
|
| Rate for Payer: UHC Medicare Advantage |
$527.58
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
55250
|
| Min. Negotiated Rate |
$219.07 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Medicare |
$227.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.55
|
| Rate for Payer: BCBS Complete |
$357.20
|
| Rate for Payer: BCBS MAPPO |
$219.07
|
| Rate for Payer: BCN Medicare Advantage |
$219.07
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$315.46
|
| Rate for Payer: Cofinity Commercial |
$293.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.07
|
| Rate for Payer: Healthscope Commercial |
$350.51
|
| Rate for Payer: Healthscope Commercial |
$405.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$580.45
|
| Rate for Payer: Nomi Health Commercial |
$262.88
|
| Rate for Payer: PACE SWMI |
$219.07
|
| Rate for Payer: PHP Medicare Advantage |
$219.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health Medicare |
$219.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.07
|
| Rate for Payer: UHC Medicare Advantage |
$219.07
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 55250
|
| Min. Negotiated Rate |
$219.07 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Medicare |
$227.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.55
|
| Rate for Payer: BCBS Complete |
$357.20
|
| Rate for Payer: BCBS MAPPO |
$219.07
|
| Rate for Payer: BCN Medicare Advantage |
$219.07
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$315.46
|
| Rate for Payer: Cofinity Commercial |
$293.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.07
|
| Rate for Payer: Healthscope Commercial |
$405.28
|
| Rate for Payer: Healthscope Commercial |
$350.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$580.45
|
| Rate for Payer: Nomi Health Commercial |
$262.88
|
| Rate for Payer: PACE SWMI |
$219.07
|
| Rate for Payer: PHP Medicare Advantage |
$219.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health Medicare |
$219.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.07
|
| Rate for Payer: UHC Medicare Advantage |
$219.07
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$562.59 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Commercial |
$759.05
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$767.98
|
| Rate for Payer: Cofinity Commercial |
$625.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$803.70
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$759.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$562.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,124.80
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$562.59 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna Commercial |
$759.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.45
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$625.10
|
| Rate for Payer: Cofinity Commercial |
$767.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Healthscope Commercial |
$803.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: PHP Commercial |
$759.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health SBD |
$562.59
|
|
|
PR VASOVASOSTOMY VASOVASORRHAPHY
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 55400
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$884.80 |
| Rate for Payer: Aetna Commercial |
$640.88
|
| Rate for Payer: Aetna Medicare |
$497.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$688.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.88
|
| Rate for Payer: BCBS Complete |
$380.80
|
| Rate for Payer: BCBS MAPPO |
$478.27
|
| Rate for Payer: BCN Medicare Advantage |
$478.27
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$688.71
|
| Rate for Payer: Cofinity Commercial |
$640.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$478.27
|
| Rate for Payer: Healthscope Commercial |
$765.23
|
| Rate for Payer: Healthscope Commercial |
$884.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$502.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.80
|
| Rate for Payer: Nomi Health Commercial |
$573.92
|
| Rate for Payer: PACE SWMI |
$478.27
|
| Rate for Payer: PHP Medicare Advantage |
$478.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.80
|
| Rate for Payer: Priority Health Medicare |
$478.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$478.27
|
| Rate for Payer: UHC Medicare Advantage |
$478.27
|
|
|
PR VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG
|
Professional
|
Both
|
$2,770.00
|
|
|
Service Code
|
HCPCS 63103
|
| Min. Negotiated Rate |
$286.24 |
| Max. Negotiated Rate |
$1,800.50 |
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna Medicare |
$297.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.56
|
| Rate for Payer: BCBS Complete |
$1,108.00
|
| Rate for Payer: BCBS MAPPO |
$286.24
|
| Rate for Payer: BCN Medicare Advantage |
$286.24
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cofinity Commercial |
$412.19
|
| Rate for Payer: Cofinity Commercial |
$383.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.24
|
| Rate for Payer: Healthscope Commercial |
$529.54
|
| Rate for Payer: Healthscope Commercial |
$457.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,800.50
|
| Rate for Payer: Nomi Health Commercial |
$343.49
|
| Rate for Payer: PACE SWMI |
$286.24
|
| Rate for Payer: PHP Medicare Advantage |
$286.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,800.50
|
| Rate for Payer: Priority Health Medicare |
$286.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.24
|
| Rate for Payer: UHC Medicare Advantage |
$286.24
|
|
|
PR VCRPEC LES 1 SGM XDRL CERVICAL
|
Professional
|
Both
|
$4,705.00
|
|
|
Service Code
|
HCPCS 63300
|
| Min. Negotiated Rate |
$1,791.63 |
| Max. Negotiated Rate |
$3,314.52 |
| Rate for Payer: Aetna Commercial |
$2,400.78
|
| Rate for Payer: Aetna Medicare |
$1,863.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,579.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.78
|
| Rate for Payer: BCBS Complete |
$1,882.00
|
| Rate for Payer: BCBS MAPPO |
$1,791.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,791.63
|
| Rate for Payer: Cash Price |
$3,764.00
|
| Rate for Payer: Cash Price |
$3,764.00
|
| Rate for Payer: Cofinity Commercial |
$2,579.95
|
| Rate for Payer: Cofinity Commercial |
$2,400.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,791.63
|
| Rate for Payer: Healthscope Commercial |
$2,866.61
|
| Rate for Payer: Healthscope Commercial |
$3,314.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,058.25
|
| Rate for Payer: Nomi Health Commercial |
$2,149.96
|
| Rate for Payer: PACE SWMI |
$1,791.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,791.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,058.25
|
| Rate for Payer: Priority Health Medicare |
$1,791.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,791.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,791.63
|
|
