|
PR ENDOBRONCHIAL U/S ADD-ON
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 31620
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: Aetna Medicare |
$232.00
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.60
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
57505
|
| Min. Negotiated Rate |
$102.36 |
| Max. Negotiated Rate |
$202.80 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: Aetna Medicare |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.40
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Cofinity Commercial |
$147.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Healthscope Commercial |
$189.37
|
| Rate for Payer: Healthscope Commercial |
$163.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.80
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Medicare |
$102.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$2,390.47 |
| Rate for Payer: Aetna Commercial |
$265.20
|
| Rate for Payer: Aetna Medicare |
$883.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,061.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,061.53
|
| Rate for Payer: BCBS Complete |
$477.94
|
| Rate for Payer: BCBS MAPPO |
$849.22
|
| Rate for Payer: BCN Medicare Advantage |
$849.22
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$268.32
|
| Rate for Payer: Cofinity Commercial |
$218.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$849.22
|
| Rate for Payer: Healthscope Commercial |
$280.80
|
| Rate for Payer: Mclaren Medicaid |
$455.18
|
| Rate for Payer: Mclaren Medicare |
$849.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.68
|
| Rate for Payer: Meridian Medicaid |
$477.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$976.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: PACE Medicare |
$806.76
|
| Rate for Payer: PACE SWMI |
$849.22
|
| Rate for Payer: PHP Commercial |
$265.20
|
| Rate for Payer: PHP Medicare Advantage |
$849.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Medicare |
$849.22
|
| Rate for Payer: Priority Health SBD |
$196.56
|
| Rate for Payer: Railroad Medicare Medicare |
$849.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,390.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.22
|
| Rate for Payer: UHC Medicare Advantage |
$849.22
|
| Rate for Payer: UHCCP Medicaid |
$478.11
|
| Rate for Payer: VA VA |
$849.22
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna Commercial |
$265.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.80
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$268.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.60
|
| Rate for Payer: Healthscope Commercial |
$280.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: PHP Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health SBD |
$196.56
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57505
|
| Min. Negotiated Rate |
$102.36 |
| Max. Negotiated Rate |
$202.80 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: Aetna Medicare |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.16
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Cofinity Commercial |
$147.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Healthscope Commercial |
$189.37
|
| Rate for Payer: Healthscope Commercial |
$163.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.80
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Medicare |
$102.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
|
|
PR END OF LIFE COUNSELING
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS S0257
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 92979
|
| Min. Negotiated Rate |
$122.80 |
| Max. Negotiated Rate |
$199.55 |
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: BCBS Complete |
$122.80
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.55
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 92978
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Medicare |
$250.50
|
| Rate for Payer: BCBS Complete |
$200.40
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
|
|
PR ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$2,043.00
|
|
|
Service Code
|
HCPCS 58353
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$1,327.95 |
| Rate for Payer: Aetna Commercial |
$295.13
|
| Rate for Payer: Aetna Medicare |
$229.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.13
|
| Rate for Payer: BCBS Complete |
$817.20
|
| Rate for Payer: BCBS MAPPO |
$220.25
|
| Rate for Payer: BCN Medicare Advantage |
$220.25
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cofinity Commercial |
$295.13
|
| Rate for Payer: Cofinity Commercial |
$317.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.25
|
| Rate for Payer: Healthscope Commercial |
$407.46
|
| Rate for Payer: Healthscope Commercial |
$352.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,327.95
|
| Rate for Payer: Nomi Health Commercial |
$264.30
|
| Rate for Payer: PACE SWMI |
$220.25
|
| Rate for Payer: PHP Medicare Advantage |
$220.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,327.95
|
| Rate for Payer: Priority Health Medicare |
$220.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.25
|
| Rate for Payer: UHC Medicare Advantage |
$220.25
|
|
|
PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Commercial |
$52.22
|
| Rate for Payer: Aetna Medicare |
$40.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.22
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$38.97
|
| Rate for Payer: BCN Medicare Advantage |
$38.97
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Cofinity Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.97
|
| Rate for Payer: Healthscope Commercial |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$62.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.45
|
| Rate for Payer: Nomi Health Commercial |
$46.76
|
| Rate for Payer: PACE SWMI |
$38.97
|
| Rate for Payer: PHP Medicare Advantage |
$38.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$38.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.97
|
| Rate for Payer: UHC Medicare Advantage |
$38.97
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
58100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health SBD |
$135.45
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$110.46
|
| Rate for Payer: VA VA |
$196.20
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Hospital Charge Code |
58100
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$81.57
|
| Rate for Payer: Aetna Medicare |
$63.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.65
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$60.87
|
| Rate for Payer: BCN Medicare Advantage |
$60.87
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.87
|
| Rate for Payer: Healthscope Commercial |
$97.39
|
| Rate for Payer: Healthscope Commercial |
$112.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.75
|
| Rate for Payer: Nomi Health Commercial |
$73.04
|
| Rate for Payer: PACE SWMI |
$60.87
|
| Rate for Payer: PHP Medicare Advantage |
$60.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$60.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.87
|
| Rate for Payer: UHC Medicare Advantage |
$60.87
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
58100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health SBD |
$135.45
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$81.57
|
| Rate for Payer: Aetna Medicare |
$63.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.57
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$60.87
|
| Rate for Payer: BCN Medicare Advantage |
$60.87
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$87.65
|
| Rate for Payer: Cofinity Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.87
|
| Rate for Payer: Healthscope Commercial |
$112.61
|
| Rate for Payer: Healthscope Commercial |
$97.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.75
|
| Rate for Payer: Nomi Health Commercial |
$73.04
|
| Rate for Payer: PACE SWMI |
$60.87
|
| Rate for Payer: PHP Medicare Advantage |
$60.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$60.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.87
|
| Rate for Payer: UHC Medicare Advantage |
$60.87
|
|
|
PR ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR
|
Professional
|
Both
|
$2,813.00
|
|
|
Service Code
|
HCPCS 58356
|
| Min. Negotiated Rate |
$338.99 |
| Max. Negotiated Rate |
$1,828.45 |
| Rate for Payer: Aetna Commercial |
$454.25
|
| Rate for Payer: Aetna Medicare |
$352.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.25
|
| Rate for Payer: BCBS Complete |
$1,125.20
|
| Rate for Payer: BCBS MAPPO |
$338.99
|
| Rate for Payer: BCN Medicare Advantage |
$338.99
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cofinity Commercial |
$488.15
|
| Rate for Payer: Cofinity Commercial |
$454.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.99
|
| Rate for Payer: Healthscope Commercial |
$627.13
|
| Rate for Payer: Healthscope Commercial |
$542.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,828.45
|
| Rate for Payer: Nomi Health Commercial |
$406.79
|
| Rate for Payer: PACE SWMI |
$338.99
|
| Rate for Payer: PHP Medicare Advantage |
$338.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,828.45
|
| Rate for Payer: Priority Health Medicare |
$338.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.99
|
| Rate for Payer: UHC Medicare Advantage |
$338.99
|
|
|
PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 43273
|
| Min. Negotiated Rate |
$112.17 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna Commercial |
$150.31
|
| Rate for Payer: Aetna Medicare |
$116.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.31
|
| Rate for Payer: BCBS Complete |
$187.20
|
| Rate for Payer: BCBS MAPPO |
$112.17
|
| Rate for Payer: BCN Medicare Advantage |
$112.17
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Commercial |
$161.52
|
| Rate for Payer: Cofinity Commercial |
$150.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.17
|
| Rate for Payer: Healthscope Commercial |
$179.47
|
| Rate for Payer: Healthscope Commercial |
$207.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.20
|
| Rate for Payer: Nomi Health Commercial |
$134.60
|
| Rate for Payer: PACE SWMI |
$112.17
|
| Rate for Payer: PHP Medicare Advantage |
$112.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.20
|
| Rate for Payer: Priority Health Medicare |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.17
|
| Rate for Payer: UHC Medicare Advantage |
$112.17
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 44360
|
| Min. Negotiated Rate |
$134.86 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Aetna Commercial |
$180.71
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.71
|
| Rate for Payer: BCBS Complete |
$374.00
|
| Rate for Payer: BCBS MAPPO |
$134.86
|
| Rate for Payer: BCN Medicare Advantage |
$134.86
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$194.20
|
| Rate for Payer: Cofinity Commercial |
$180.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$249.49
|
| Rate for Payer: Healthscope Commercial |
$215.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.75
|
| Rate for Payer: Nomi Health Commercial |
$161.83
|
| Rate for Payer: PACE SWMI |
$134.86
|
| Rate for Payer: PHP Medicare Advantage |
$134.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.75
|
| Rate for Payer: Priority Health Medicare |
$134.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.86
|
| Rate for Payer: UHC Medicare Advantage |
$134.86
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 44361
|
| Min. Negotiated Rate |
$149.27 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna Commercial |
$200.02
|
| Rate for Payer: Aetna Medicare |
$155.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.02
|
| Rate for Payer: BCBS Complete |
$395.20
|
| Rate for Payer: BCBS MAPPO |
$149.27
|
| Rate for Payer: BCN Medicare Advantage |
$149.27
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cofinity Commercial |
$214.95
|
| Rate for Payer: Cofinity Commercial |
$200.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.27
|
| Rate for Payer: Healthscope Commercial |
$238.83
|
| Rate for Payer: Healthscope Commercial |
$276.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.20
|
| Rate for Payer: Nomi Health Commercial |
$179.12
|
| Rate for Payer: PACE SWMI |
$149.27
|
| Rate for Payer: PHP Medicare Advantage |
$149.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.20
|
| Rate for Payer: Priority Health Medicare |
$149.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.27
|
| Rate for Payer: UHC Medicare Advantage |
$149.27
|
|
|
PR ENDOVASC ABDO REPAIR W/PROS
|
Professional
|
Both
|
$5,333.00
|
|
|
Service Code
|
HCPCS 34805
|
| Min. Negotiated Rate |
$2,133.20 |
| Max. Negotiated Rate |
$3,466.45 |
| Rate for Payer: Aetna Medicare |
$2,666.50
|
| Rate for Payer: BCBS Complete |
$2,133.20
|
| Rate for Payer: Cash Price |
$4,266.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,466.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,466.45
|
|
|
PR ENDOVASCULAR REPAIR ILIAC ARTERY W ILIO-ILIAC PROSTHESIS
|
Professional
|
Both
|
$1,766.00
|
|
|
Service Code
|
HCPCS 34900
|
| Min. Negotiated Rate |
$706.40 |
| Max. Negotiated Rate |
$1,147.90 |
| Rate for Payer: Aetna Medicare |
$883.00
|
| Rate for Payer: BCBS Complete |
$706.40
|
| Rate for Payer: Cash Price |
$1,412.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,147.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.90
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Facility
|
IP
|
$2,741.00
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
36478
|
| Min. Negotiated Rate |
$1,726.83 |
| Max. Negotiated Rate |
$2,466.90 |
| Rate for Payer: Aetna Commercial |
$2,329.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,781.65
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$1,918.70
|
| Rate for Payer: Cofinity Commercial |
$2,357.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,918.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,192.80
|
| Rate for Payer: Healthscope Commercial |
$2,466.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,329.85
|
| Rate for Payer: PHP Commercial |
$2,329.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health SBD |
$1,726.83
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Facility
|
OP
|
$2,741.00
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
36478
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$2,329.85
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,781.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$1,918.70
|
| Rate for Payer: Cofinity Commercial |
$2,357.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,918.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$2,466.90
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,329.85
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$2,329.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$1,726.83
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Professional
|
Both
|
$2,741.00
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
36478
|
| Min. Negotiated Rate |
$265.37 |
| Max. Negotiated Rate |
$1,781.65 |
| Rate for Payer: Aetna Commercial |
$355.60
|
| Rate for Payer: Aetna Medicare |
$275.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.60
|
| Rate for Payer: BCBS Complete |
$1,096.40
|
| Rate for Payer: BCBS MAPPO |
$265.37
|
| Rate for Payer: BCN Medicare Advantage |
$265.37
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$382.13
|
| Rate for Payer: Cofinity Commercial |
$355.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.37
|
| Rate for Payer: Healthscope Commercial |
$490.93
|
| Rate for Payer: Healthscope Commercial |
$424.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,781.65
|
| Rate for Payer: Nomi Health Commercial |
$318.44
|
| Rate for Payer: PACE SWMI |
$265.37
|
| Rate for Payer: PHP Medicare Advantage |
$265.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health Medicare |
$265.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.37
|
| Rate for Payer: UHC Medicare Advantage |
$265.37
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Professional
|
Both
|
$2,741.00
|
|
|
Service Code
|
HCPCS 36478
|
| Min. Negotiated Rate |
$265.37 |
| Max. Negotiated Rate |
$1,781.65 |
| Rate for Payer: Aetna Commercial |
$355.60
|
| Rate for Payer: Aetna Medicare |
$275.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.60
|
| Rate for Payer: BCBS Complete |
$1,096.40
|
| Rate for Payer: BCBS MAPPO |
$265.37
|
| Rate for Payer: BCN Medicare Advantage |
$265.37
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$355.60
|
| Rate for Payer: Cofinity Commercial |
$382.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.37
|
| Rate for Payer: Healthscope Commercial |
$490.93
|
| Rate for Payer: Healthscope Commercial |
$424.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,781.65
|
| Rate for Payer: Nomi Health Commercial |
$318.44
|
| Rate for Payer: PACE SWMI |
$265.37
|
| Rate for Payer: PHP Medicare Advantage |
$265.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health Medicare |
$265.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.37
|
| Rate for Payer: UHC Medicare Advantage |
$265.37
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Professional
|
Both
|
$3,149.00
|
|
|
Service Code
|
HCPCS 36475
|
| Min. Negotiated Rate |
$265.46 |
| Max. Negotiated Rate |
$2,046.85 |
| Rate for Payer: Aetna Commercial |
$355.72
|
| Rate for Payer: Aetna Medicare |
$276.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.72
|
| Rate for Payer: BCBS Complete |
$1,259.60
|
| Rate for Payer: BCBS MAPPO |
$265.46
|
| Rate for Payer: BCN Medicare Advantage |
$265.46
|
| Rate for Payer: Cash Price |
$2,519.20
|
| Rate for Payer: Cash Price |
$2,519.20
|
| Rate for Payer: Cofinity Commercial |
$382.26
|
| Rate for Payer: Cofinity Commercial |
$355.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.46
|
| Rate for Payer: Healthscope Commercial |
$491.10
|
| Rate for Payer: Healthscope Commercial |
$424.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,046.85
|
| Rate for Payer: Nomi Health Commercial |
$318.55
|
| Rate for Payer: PACE SWMI |
$265.46
|
| Rate for Payer: PHP Medicare Advantage |
$265.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,046.85
|
| Rate for Payer: Priority Health Medicare |
$265.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.46
|
| Rate for Payer: UHC Medicare Advantage |
$265.46
|
|
