|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$889.56 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Commercial |
$1,200.20
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,373.16
|
| Rate for Payer: BCN Commercial |
$2,373.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cofinity Advantage |
$988.40
|
| Rate for Payer: Cofinity Commercial |
$1,214.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$1,270.80
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.20
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.00
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$1,200.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$889.56
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
58558
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$1,059.00 |
| Rate for Payer: Aetna Commercial |
$272.89
|
| Rate for Payer: Aetna Medicare |
$211.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.26
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCBS MAPPO |
$203.65
|
| Rate for Payer: BCN Commercial |
$345.59
|
| Rate for Payer: BCN Medicare Advantage |
$203.65
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cofinity Commercial |
$293.26
|
| Rate for Payer: Cofinity Commercial |
$272.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.65
|
| Rate for Payer: Healthscope Commercial |
$376.75
|
| Rate for Payer: Healthscope Commercial |
$325.84
|
| Rate for Payer: Mclaren Medicaid |
$130.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.83
|
| Rate for Payer: Meridian Medicaid |
$136.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$224.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.45
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.00
|
| Rate for Payer: PACE SWMI |
$203.65
|
| Rate for Payer: PHP Medicare Advantage |
$203.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$350.01
|
| Rate for Payer: Priority Health Medicare |
$203.65
|
| Rate for Payer: Priority Health SBD |
$350.01
|
| Rate for Payer: Priority Health Tiered Network |
$350.01
|
| Rate for Payer: Railroad Medicare Medicare |
$203.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.90
|
| Rate for Payer: UHC Core |
$412.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$203.65
|
| Rate for Payer: UHC Exchange |
$412.90
|
| Rate for Payer: UHC Medicaid |
$130.36
|
| Rate for Payer: UHCCP Medicaid |
$130.36
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$889.56 |
| Max. Negotiated Rate |
$1,270.80 |
| Rate for Payer: Aetna Commercial |
$1,200.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.80
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cofinity Advantage |
$988.40
|
| Rate for Payer: Cofinity Commercial |
$1,214.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.60
|
| Rate for Payer: Healthscope Commercial |
$1,270.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.00
|
| Rate for Payer: PHP Commercial |
$1,200.20
|
| Rate for Payer: Priority Health SBD |
$889.56
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$837.00
|
|
|
Service Code
|
HCPCS 58555
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$627.75 |
| Rate for Payer: Aetna Commercial |
$179.08
|
| Rate for Payer: Aetna Medicare |
$138.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.44
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$133.64
|
| Rate for Payer: BCN Commercial |
$227.58
|
| Rate for Payer: BCN Medicare Advantage |
$133.64
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cofinity Commercial |
$192.44
|
| Rate for Payer: Cofinity Commercial |
$179.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.64
|
| Rate for Payer: Healthscope Commercial |
$247.23
|
| Rate for Payer: Healthscope Commercial |
$213.82
|
| Rate for Payer: Mclaren Medicaid |
$85.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.32
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.42
|
| Rate for Payer: Nomi Health Commercial |
$160.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$627.75
|
| Rate for Payer: PACE SWMI |
$133.64
|
| Rate for Payer: PHP Medicare Advantage |
$133.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$230.48
|
| Rate for Payer: Priority Health Medicare |
$133.64
|
| Rate for Payer: Priority Health SBD |
$230.48
|
| Rate for Payer: Priority Health Tiered Network |
$230.48
|
| Rate for Payer: Railroad Medicare Medicare |
$133.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.33
|
| Rate for Payer: UHC Core |
$270.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.64
|
| Rate for Payer: UHC Exchange |
$270.33
|
| Rate for Payer: UHC Medicaid |
$85.84
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,723.00
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$1,292.25 |
| Rate for Payer: Aetna Commercial |
$367.82
|
| Rate for Payer: Aetna Medicare |
$285.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.27
|
| Rate for Payer: BCBS Complete |
$184.06
|
| Rate for Payer: BCBS MAPPO |
$274.49
|
| Rate for Payer: BCN Commercial |
$465.61
|
| Rate for Payer: BCN Medicare Advantage |
$274.49
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Cofinity Commercial |
$395.27
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.49
|
| Rate for Payer: Healthscope Commercial |
$507.81
|
| Rate for Payer: Healthscope Commercial |
$439.18
|
| Rate for Payer: Mclaren Medicaid |
$175.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.21
|
| Rate for Payer: Meridian Medicaid |
$184.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$301.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.46
|
| Rate for Payer: Nomi Health Commercial |
$329.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,292.25
|
| Rate for Payer: PACE SWMI |
$274.49
|
| Rate for Payer: PHP Medicare Advantage |
$274.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$471.56
|
| Rate for Payer: Priority Health Medicare |
$274.49
|
| Rate for Payer: Priority Health SBD |
$471.56
|
| Rate for Payer: Priority Health Tiered Network |
$471.56
|
| Rate for Payer: Railroad Medicare Medicare |
$274.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.76
|
| Rate for Payer: UHC Core |
$561.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$274.49
|
| Rate for Payer: UHC Exchange |
$561.76
|
| Rate for Payer: UHC Medicaid |
$175.30
|
| Rate for Payer: UHCCP Medicaid |
$175.30
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,611.00
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Aetna Commercial |
$290.12
|
| Rate for Payer: Aetna Medicare |
$225.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.77
|
| Rate for Payer: BCBS Complete |
$145.37
|
| Rate for Payer: BCBS MAPPO |
$216.51
|
| Rate for Payer: BCN Commercial |
$366.51
|
| Rate for Payer: BCN Medicare Advantage |
$216.51
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cofinity Commercial |
$311.77
|
| Rate for Payer: Cofinity Commercial |
$290.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.51
|
| Rate for Payer: Healthscope Commercial |
$400.54
|
| Rate for Payer: Healthscope Commercial |
$346.42
|
| Rate for Payer: Mclaren Medicaid |
$138.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.34
|
| Rate for Payer: Meridian Medicaid |
$145.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$238.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.04
|
| Rate for Payer: Nomi Health Commercial |
$259.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.25
|
| Rate for Payer: PACE SWMI |
$216.51
|
| Rate for Payer: PHP Medicare Advantage |
$216.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$371.20
|
| Rate for Payer: Priority Health Medicare |
$216.51
|
| Rate for Payer: Priority Health SBD |
$371.20
|
| Rate for Payer: Priority Health Tiered Network |
$371.20
|
| Rate for Payer: Railroad Medicare Medicare |
$216.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.99
|
| Rate for Payer: UHC Core |
$439.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$216.51
|
| Rate for Payer: UHC Exchange |
$439.99
|
| Rate for Payer: UHC Medicaid |
$138.45
|
| Rate for Payer: UHCCP Medicaid |
$138.45
|
|
|
PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS
|
Professional
|
Both
|
$1,560.00
|
|
|
Service Code
|
HCPCS 58559
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$333.19
|
| Rate for Payer: Aetna Medicare |
$258.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.06
|
| Rate for Payer: BCBS Complete |
$166.84
|
| Rate for Payer: BCBS MAPPO |
$248.65
|
| Rate for Payer: BCN Commercial |
$422.79
|
| Rate for Payer: BCN Medicare Advantage |
$248.65
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cofinity Commercial |
$358.06
|
| Rate for Payer: Cofinity Commercial |
$333.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.65
|
| Rate for Payer: Healthscope Commercial |
$460.00
|
| Rate for Payer: Healthscope Commercial |
$397.84
|
| Rate for Payer: Mclaren Medicaid |
$158.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.08
|
| Rate for Payer: Meridian Medicaid |
$166.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.23
|
| Rate for Payer: Nomi Health Commercial |
$298.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,170.00
|
| Rate for Payer: PACE SWMI |
$248.65
|
| Rate for Payer: PHP Medicare Advantage |
$248.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.19
|
| Rate for Payer: Priority Health Medicare |
$248.65
|
| Rate for Payer: Priority Health SBD |
$428.19
|
| Rate for Payer: Priority Health Tiered Network |
$428.19
|
| Rate for Payer: Railroad Medicare Medicare |
$248.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.66
|
| Rate for Payer: UHC Core |
$510.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.65
|
| Rate for Payer: UHC Exchange |
$510.66
|
| Rate for Payer: UHC Medicaid |
$158.90
|
| Rate for Payer: UHCCP Medicaid |
$158.90
|
|
|
PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY
|
Professional
|
Both
|
$1,212.00
|
|
|
Service Code
|
HCPCS 58562
|
| Min. Negotiated Rate |
$124.39 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.84
|
| Rate for Payer: BCBS Complete |
$130.61
|
| Rate for Payer: BCBS MAPPO |
$194.33
|
| Rate for Payer: BCN Commercial |
$330.16
|
| Rate for Payer: BCN Medicare Advantage |
$194.33
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cofinity Commercial |
$279.84
|
| Rate for Payer: Cofinity Commercial |
$260.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.33
|
| Rate for Payer: Healthscope Commercial |
$359.51
|
| Rate for Payer: Healthscope Commercial |
$310.93
|
| Rate for Payer: Mclaren Medicaid |
$124.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.05
|
| Rate for Payer: Meridian Medicaid |
$130.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$213.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.10
|
| Rate for Payer: Nomi Health Commercial |
$233.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$909.00
|
| Rate for Payer: PACE SWMI |
$194.33
|
| Rate for Payer: PHP Medicare Advantage |
$194.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$334.39
|
| Rate for Payer: Priority Health Medicare |
$194.33
|
| Rate for Payer: Priority Health SBD |
$334.39
|
| Rate for Payer: Priority Health Tiered Network |
$334.39
|
| Rate for Payer: Railroad Medicare Medicare |
$194.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.37
|
| Rate for Payer: UHC Core |
$396.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$194.33
|
| Rate for Payer: UHC Exchange |
$396.37
|
| Rate for Payer: UHC Medicaid |
$124.39
|
| Rate for Payer: UHCCP Medicaid |
$124.39
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 58561
|
| Min. Negotiated Rate |
$200.22 |
| Max. Negotiated Rate |
$726.75 |
| Rate for Payer: Aetna Commercial |
$420.30
|
| Rate for Payer: Aetna Medicare |
$326.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.67
|
| Rate for Payer: BCBS Complete |
$210.23
|
| Rate for Payer: BCBS MAPPO |
$313.66
|
| Rate for Payer: BCN Commercial |
$532.84
|
| Rate for Payer: BCN Medicare Advantage |
$313.66
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$451.67
|
| Rate for Payer: Cofinity Commercial |
$420.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.66
|
| Rate for Payer: Healthscope Commercial |
$580.27
|
| Rate for Payer: Healthscope Commercial |
$501.86
|
| Rate for Payer: Mclaren Medicaid |
$200.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.34
|
| Rate for Payer: Meridian Medicaid |
$210.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$345.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.69
|
| Rate for Payer: Nomi Health Commercial |
$376.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$726.75
|
| Rate for Payer: PACE SWMI |
$313.66
|
| Rate for Payer: PHP Medicare Advantage |
$313.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$539.65
|
| Rate for Payer: Priority Health Medicare |
$313.66
|
| Rate for Payer: Priority Health SBD |
$539.65
|
| Rate for Payer: Priority Health Tiered Network |
$539.65
|
| Rate for Payer: Railroad Medicare Medicare |
$313.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.88
|
| Rate for Payer: UHC Core |
$642.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$313.66
|
| Rate for Payer: UHC Exchange |
$642.88
|
| Rate for Payer: UHC Medicaid |
$200.22
|
| Rate for Payer: UHCCP Medicaid |
$200.22
|
|
|
PR HYSTEROTOMY ABDOMINAL
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
HCPCS 59100
|
| Min. Negotiated Rate |
$491.39 |
| Max. Negotiated Rate |
$1,545.75 |
| Rate for Payer: Aetna Commercial |
$1,033.90
|
| Rate for Payer: Aetna Medicare |
$802.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,111.06
|
| Rate for Payer: BCBS Complete |
$515.96
|
| Rate for Payer: BCBS MAPPO |
$771.57
|
| Rate for Payer: BCN Commercial |
$1,288.78
|
| Rate for Payer: BCN Medicare Advantage |
$771.57
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cofinity Commercial |
$1,111.06
|
| Rate for Payer: Cofinity Commercial |
$1,033.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$771.57
|
| Rate for Payer: Healthscope Commercial |
$1,427.40
|
| Rate for Payer: Healthscope Commercial |
$1,234.51
|
| Rate for Payer: Mclaren Medicaid |
$491.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$810.15
|
| Rate for Payer: Meridian Medicaid |
$515.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$848.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,545.75
|
| Rate for Payer: Nomi Health Commercial |
$925.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.00
|
| Rate for Payer: PACE SWMI |
$771.57
|
| Rate for Payer: PHP Medicare Advantage |
$771.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,216.61
|
| Rate for Payer: Priority Health Medicare |
$771.57
|
| Rate for Payer: Priority Health SBD |
$1,216.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,216.61
|
| Rate for Payer: Railroad Medicare Medicare |
$771.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,507.80
|
| Rate for Payer: UHC Core |
$1,507.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$771.57
|
| Rate for Payer: UHC Exchange |
$1,507.80
|
| Rate for Payer: UHC Medicaid |
$491.39
|
| Rate for Payer: UHCCP Medicaid |
$491.39
|
|
|
PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 90750
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$215.51 |
| Rate for Payer: Aetna Commercial |
$187.08
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.08
|
| Rate for Payer: BCBS Trust/PPO |
$215.51
|
| Rate for Payer: BCN Commercial |
$212.06
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.51
|
| Rate for Payer: UHC Core |
$215.51
|
| Rate for Payer: UHC Exchange |
$215.51
|
|
|
PR I131 IODIDE CAP, RX
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS A9517
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$103.26 |
| Rate for Payer: Aetna Commercial |
$40.43
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.43
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCN Commercial |
$23.13
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.84
|
| Rate for Payer: UHC Core |
$42.84
|
| Rate for Payer: UHC Exchange |
$42.84
|
|
|
PR ICAR CATH ABLATION DISCRETE MECHANISM ARRHYTHMIA
|
Professional
|
Both
|
$1,537.00
|
|
|
Service Code
|
HCPCS 93655
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$1,152.75 |
| Rate for Payer: Aetna Commercial |
$352.29
|
| Rate for Payer: Aetna Medicare |
$273.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.58
|
| Rate for Payer: BCBS Complete |
$174.67
|
| Rate for Payer: BCBS MAPPO |
$262.90
|
| Rate for Payer: BCN Commercial |
$447.18
|
| Rate for Payer: BCN Medicare Advantage |
$262.90
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cofinity Commercial |
$378.58
|
| Rate for Payer: Cofinity Commercial |
$352.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.90
|
| Rate for Payer: Healthscope Commercial |
$486.37
|
| Rate for Payer: Healthscope Commercial |
$420.64
|
| Rate for Payer: Mclaren Medicaid |
$166.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.05
|
| Rate for Payer: Meridian Medicaid |
$174.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$289.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.58
|
| Rate for Payer: Nomi Health Commercial |
$315.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,152.75
|
| Rate for Payer: PACE SWMI |
$262.90
|
| Rate for Payer: PHP Medicare Advantage |
$262.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$425.03
|
| Rate for Payer: Priority Health Medicare |
$262.90
|
| Rate for Payer: Priority Health SBD |
$425.03
|
| Rate for Payer: Priority Health Tiered Network |
$425.03
|
| Rate for Payer: Railroad Medicare Medicare |
$262.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.80
|
| Rate for Payer: UHC Core |
$760.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$262.90
|
| Rate for Payer: UHC Exchange |
$760.80
|
| Rate for Payer: UHC Medicaid |
$166.35
|
| Rate for Payer: UHCCP Medicaid |
$166.35
|
|
|
PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION
|
Professional
|
Both
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93650
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$1,421.25 |
| Rate for Payer: Aetna Commercial |
$669.62
|
| Rate for Payer: Aetna Medicare |
$519.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$669.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.60
|
| Rate for Payer: BCBS Complete |
$332.79
|
| Rate for Payer: BCBS MAPPO |
$499.72
|
| Rate for Payer: BCN Commercial |
$849.05
|
| Rate for Payer: BCN Medicare Advantage |
$499.72
|
| Rate for Payer: Cash Price |
$1,516.00
|
| Rate for Payer: Cash Price |
$1,516.00
|
| Rate for Payer: Cofinity Commercial |
$719.60
|
| Rate for Payer: Cofinity Commercial |
$669.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.72
|
| Rate for Payer: Healthscope Commercial |
$924.48
|
| Rate for Payer: Healthscope Commercial |
$799.55
|
| Rate for Payer: Mclaren Medicaid |
$316.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$524.71
|
| Rate for Payer: Meridian Medicaid |
$332.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$549.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$861.93
|
| Rate for Payer: Nomi Health Commercial |
$599.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,421.25
|
| Rate for Payer: PACE SWMI |
$499.72
|
| Rate for Payer: PHP Medicare Advantage |
$499.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$806.99
|
| Rate for Payer: Priority Health Medicare |
$499.72
|
| Rate for Payer: Priority Health SBD |
$806.99
|
| Rate for Payer: Priority Health Tiered Network |
$806.99
|
| Rate for Payer: Railroad Medicare Medicare |
$499.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.50
|
| Rate for Payer: UHC Core |
$974.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$499.72
|
| Rate for Payer: UHC Exchange |
$974.50
|
| Rate for Payer: UHC Medicaid |
$316.94
|
| Rate for Payer: UHCCP Medicaid |
$316.94
|
|
|
PR I&D ABSCESS PERITONSILLAR
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 42700
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$251.81 |
| Rate for Payer: Aetna Commercial |
$165.77
|
| Rate for Payer: Aetna Medicare |
$128.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.14
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$123.71
|
| Rate for Payer: BCN Commercial |
$206.66
|
| Rate for Payer: BCN Medicare Advantage |
$123.71
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$178.14
|
| Rate for Payer: Cofinity Commercial |
$165.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.71
|
| Rate for Payer: Healthscope Commercial |
$228.86
|
| Rate for Payer: Healthscope Commercial |
$197.94
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.90
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.86
|
| Rate for Payer: Nomi Health Commercial |
$148.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.75
|
| Rate for Payer: PACE SWMI |
$123.71
|
| Rate for Payer: PHP Medicare Advantage |
$123.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$251.81
|
| Rate for Payer: Priority Health Medicare |
$123.71
|
| Rate for Payer: Priority Health SBD |
$251.81
|
| Rate for Payer: Priority Health Tiered Network |
$251.81
|
| Rate for Payer: Railroad Medicare Medicare |
$123.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.03
|
| Rate for Payer: UHC Core |
$232.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$123.71
|
| Rate for Payer: UHC Exchange |
$232.03
|
| Rate for Payer: UHC Medicaid |
$81.79
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL APPR
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 42720
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$706.88 |
| Rate for Payer: Aetna Commercial |
$441.38
|
| Rate for Payer: Aetna Medicare |
$342.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.32
|
| Rate for Payer: BCBS Complete |
$223.65
|
| Rate for Payer: BCBS MAPPO |
$329.39
|
| Rate for Payer: BCN Commercial |
$580.15
|
| Rate for Payer: BCN Medicare Advantage |
$329.39
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cofinity Commercial |
$474.32
|
| Rate for Payer: Cofinity Commercial |
$441.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.39
|
| Rate for Payer: Healthscope Commercial |
$609.37
|
| Rate for Payer: Healthscope Commercial |
$527.02
|
| Rate for Payer: Mclaren Medicaid |
$213.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.86
|
| Rate for Payer: Meridian Medicaid |
$223.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.16
|
| Rate for Payer: Nomi Health Commercial |
$395.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$639.00
|
| Rate for Payer: PACE SWMI |
$329.39
|
| Rate for Payer: PHP Medicare Advantage |
$329.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$706.88
|
| Rate for Payer: Priority Health Medicare |
$329.39
|
| Rate for Payer: Priority Health SBD |
$706.88
|
| Rate for Payer: Priority Health Tiered Network |
$706.88
|
| Rate for Payer: Railroad Medicare Medicare |
$329.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.83
|
| Rate for Payer: UHC Core |
$678.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.39
|
| Rate for Payer: UHC Exchange |
$678.83
|
| Rate for Payer: UHC Medicaid |
$213.00
|
| Rate for Payer: UHCCP Medicaid |
$213.00
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR
|
Professional
|
Both
|
$1,522.00
|
|
|
Service Code
|
HCPCS 42725
|
| Min. Negotiated Rate |
$451.56 |
| Max. Negotiated Rate |
$1,468.36 |
| Rate for Payer: Aetna Commercial |
$931.98
|
| Rate for Payer: Aetna Medicare |
$723.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.98
|
| Rate for Payer: BCBS Complete |
$474.14
|
| Rate for Payer: BCBS MAPPO |
$695.51
|
| Rate for Payer: BCN Commercial |
$1,205.11
|
| Rate for Payer: BCN Medicare Advantage |
$695.51
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Cofinity Commercial |
$931.98
|
| Rate for Payer: Cofinity Commercial |
$1,001.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.51
|
| Rate for Payer: Healthscope Commercial |
$1,286.69
|
| Rate for Payer: Healthscope Commercial |
$1,112.82
|
| Rate for Payer: Mclaren Medicaid |
$451.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.29
|
| Rate for Payer: Meridian Medicaid |
$474.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$765.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,411.24
|
| Rate for Payer: Nomi Health Commercial |
$834.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,141.50
|
| Rate for Payer: PACE SWMI |
$695.51
|
| Rate for Payer: PHP Medicare Advantage |
$695.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$451.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,468.36
|
| Rate for Payer: Priority Health Medicare |
$695.51
|
| Rate for Payer: Priority Health SBD |
$1,468.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,468.36
|
| Rate for Payer: Railroad Medicare Medicare |
$695.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,400.09
|
| Rate for Payer: UHC Core |
$1,400.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$695.51
|
| Rate for Payer: UHC Exchange |
$1,400.09
|
| Rate for Payer: UHC Medicaid |
$451.56
|
| Rate for Payer: UHCCP Medicaid |
$451.56
|
|
|
PR I&D BELOW FASCIA FOOT 1 BURSAL SPACE
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
HCPCS 28002
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Aetna Commercial |
$168.69
|
| Rate for Payer: Aetna Medicare |
$130.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.28
|
| Rate for Payer: BCBS Complete |
$85.21
|
| Rate for Payer: BCBS MAPPO |
$125.89
|
| Rate for Payer: BCN Commercial |
$209.65
|
| Rate for Payer: BCN Medicare Advantage |
$125.89
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cofinity Commercial |
$181.28
|
| Rate for Payer: Cofinity Commercial |
$168.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.89
|
| Rate for Payer: Healthscope Commercial |
$232.90
|
| Rate for Payer: Healthscope Commercial |
$201.42
|
| Rate for Payer: Mclaren Medicaid |
$81.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.18
|
| Rate for Payer: Meridian Medicaid |
$85.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.27
|
| Rate for Payer: Nomi Health Commercial |
$151.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.50
|
| Rate for Payer: PACE SWMI |
$125.89
|
| Rate for Payer: PHP Medicare Advantage |
$125.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$224.11
|
| Rate for Payer: Priority Health Medicare |
$125.89
|
| Rate for Payer: Priority Health SBD |
$224.11
|
| Rate for Payer: Priority Health Tiered Network |
$224.11
|
| Rate for Payer: Railroad Medicare Medicare |
$125.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.65
|
| Rate for Payer: UHC Core |
$560.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.89
|
| Rate for Payer: UHC Exchange |
$560.65
|
| Rate for Payer: UHC Medicaid |
$81.15
|
| Rate for Payer: UHCCP Medicaid |
$81.15
|
|
|
PR I&D BELOW FASCIA FOOT MULTIPLE AREAS
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 28003
|
| Min. Negotiated Rate |
$147.18 |
| Max. Negotiated Rate |
$980.65 |
| Rate for Payer: Aetna Commercial |
$307.64
|
| Rate for Payer: Aetna Medicare |
$238.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.60
|
| Rate for Payer: BCBS Complete |
$154.54
|
| Rate for Payer: BCBS MAPPO |
$229.58
|
| Rate for Payer: BCN Commercial |
$383.94
|
| Rate for Payer: BCN Medicare Advantage |
$229.58
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Commercial |
$330.60
|
| Rate for Payer: Cofinity Commercial |
$307.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.58
|
| Rate for Payer: Healthscope Commercial |
$424.72
|
| Rate for Payer: Healthscope Commercial |
$367.33
|
| Rate for Payer: Mclaren Medicaid |
$147.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.06
|
| Rate for Payer: Meridian Medicaid |
$154.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.70
|
| Rate for Payer: Nomi Health Commercial |
$275.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$960.00
|
| Rate for Payer: PACE SWMI |
$229.58
|
| Rate for Payer: PHP Medicare Advantage |
$229.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$410.42
|
| Rate for Payer: Priority Health Medicare |
$229.58
|
| Rate for Payer: Priority Health SBD |
$410.42
|
| Rate for Payer: Priority Health Tiered Network |
$410.42
|
| Rate for Payer: Railroad Medicare Medicare |
$229.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.65
|
| Rate for Payer: UHC Core |
$980.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$229.58
|
| Rate for Payer: UHC Exchange |
$980.65
|
| Rate for Payer: UHC Medicaid |
$147.18
|
| Rate for Payer: UHCCP Medicaid |
$147.18
|
|
|
PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Professional
|
Both
|
$1,715.00
|
|
|
Service Code
|
HCPCS 27301
|
| Min. Negotiated Rate |
$309.28 |
| Max. Negotiated Rate |
$1,286.25 |
| Rate for Payer: Aetna Commercial |
$632.99
|
| Rate for Payer: Aetna Medicare |
$491.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$680.23
|
| Rate for Payer: BCBS Complete |
$324.74
|
| Rate for Payer: BCBS MAPPO |
$472.38
|
| Rate for Payer: BCN Commercial |
$777.85
|
| Rate for Payer: BCN Medicare Advantage |
$472.38
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cofinity Commercial |
$680.23
|
| Rate for Payer: Cofinity Commercial |
$632.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.38
|
| Rate for Payer: Healthscope Commercial |
$873.90
|
| Rate for Payer: Healthscope Commercial |
$755.81
|
| Rate for Payer: Mclaren Medicaid |
$309.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$496.00
|
| Rate for Payer: Meridian Medicaid |
$324.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$519.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$900.99
|
| Rate for Payer: Nomi Health Commercial |
$566.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,286.25
|
| Rate for Payer: PACE SWMI |
$472.38
|
| Rate for Payer: PHP Medicare Advantage |
$472.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$831.49
|
| Rate for Payer: Priority Health Medicare |
$472.38
|
| Rate for Payer: Priority Health SBD |
$831.49
|
| Rate for Payer: Priority Health Tiered Network |
$831.49
|
| Rate for Payer: Railroad Medicare Medicare |
$472.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.48
|
| Rate for Payer: UHC Core |
$879.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$472.38
|
| Rate for Payer: UHC Exchange |
$879.48
|
| Rate for Payer: UHC Medicaid |
$309.28
|
| Rate for Payer: UHCCP Medicaid |
$309.28
|
|
|
PR I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR
|
Professional
|
Both
|
$2,534.00
|
|
|
Service Code
|
HCPCS 22010
|
| Min. Negotiated Rate |
$606.41 |
| Max. Negotiated Rate |
$1,900.50 |
| Rate for Payer: Aetna Commercial |
$1,250.35
|
| Rate for Payer: Aetna Medicare |
$970.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,343.66
|
| Rate for Payer: BCBS Complete |
$636.73
|
| Rate for Payer: BCBS MAPPO |
$933.10
|
| Rate for Payer: BCN Commercial |
$1,486.47
|
| Rate for Payer: BCN Medicare Advantage |
$933.10
|
| Rate for Payer: Cash Price |
$2,027.20
|
| Rate for Payer: Cash Price |
$2,027.20
|
| Rate for Payer: Cofinity Commercial |
$1,343.66
|
| Rate for Payer: Cofinity Commercial |
$1,250.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.10
|
| Rate for Payer: Healthscope Commercial |
$1,726.23
|
| Rate for Payer: Healthscope Commercial |
$1,492.96
|
| Rate for Payer: Mclaren Medicaid |
$606.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$979.75
|
| Rate for Payer: Meridian Medicaid |
$636.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,026.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.03
|
| Rate for Payer: Nomi Health Commercial |
$1,119.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,900.50
|
| Rate for Payer: PACE SWMI |
$933.10
|
| Rate for Payer: PHP Medicare Advantage |
$933.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$606.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,588.99
|
| Rate for Payer: Priority Health Medicare |
$933.10
|
| Rate for Payer: Priority Health SBD |
$1,588.99
|
| Rate for Payer: Priority Health Tiered Network |
$1,588.99
|
| Rate for Payer: Railroad Medicare Medicare |
$933.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,679.67
|
| Rate for Payer: UHC Core |
$1,679.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$933.10
|
| Rate for Payer: UHC Exchange |
$1,679.67
|
| Rate for Payer: UHC Medicaid |
$606.41
|
| Rate for Payer: UHCCP Medicaid |
$606.41
|
|
|
PR I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC
|
Professional
|
Both
|
$1,777.00
|
|
|
Service Code
|
HCPCS 22015
|
| Min. Negotiated Rate |
$587.88 |
| Max. Negotiated Rate |
$1,696.03 |
| Rate for Payer: Aetna Commercial |
$1,210.80
|
| Rate for Payer: Aetna Medicare |
$939.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,210.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,301.16
|
| Rate for Payer: BCBS Complete |
$617.27
|
| Rate for Payer: BCBS MAPPO |
$903.58
|
| Rate for Payer: BCN Commercial |
$1,448.13
|
| Rate for Payer: BCN Medicare Advantage |
$903.58
|
| Rate for Payer: Cash Price |
$1,421.60
|
| Rate for Payer: Cash Price |
$1,421.60
|
| Rate for Payer: Cofinity Commercial |
$1,301.16
|
| Rate for Payer: Cofinity Commercial |
$1,210.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.58
|
| Rate for Payer: Healthscope Commercial |
$1,671.62
|
| Rate for Payer: Healthscope Commercial |
$1,445.73
|
| Rate for Payer: Mclaren Medicaid |
$587.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.76
|
| Rate for Payer: Meridian Medicaid |
$617.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$993.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,696.03
|
| Rate for Payer: Nomi Health Commercial |
$1,084.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,332.75
|
| Rate for Payer: PACE SWMI |
$903.58
|
| Rate for Payer: PHP Medicare Advantage |
$903.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$587.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,548.02
|
| Rate for Payer: Priority Health Medicare |
$903.58
|
| Rate for Payer: Priority Health SBD |
$1,548.02
|
| Rate for Payer: Priority Health Tiered Network |
$1,548.02
|
| Rate for Payer: Railroad Medicare Medicare |
$903.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,652.39
|
| Rate for Payer: UHC Core |
$1,652.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.58
|
| Rate for Payer: UHC Exchange |
$1,652.39
|
| Rate for Payer: UHC Medicaid |
$587.88
|
| Rate for Payer: UHCCP Medicaid |
$587.88
|
|
|
PR I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 21501
|
| Min. Negotiated Rate |
$208.95 |
| Max. Negotiated Rate |
$902.25 |
| Rate for Payer: Aetna Commercial |
$424.00
|
| Rate for Payer: Aetna Medicare |
$329.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.64
|
| Rate for Payer: BCBS Complete |
$219.40
|
| Rate for Payer: BCBS MAPPO |
$316.42
|
| Rate for Payer: BCN Commercial |
$515.90
|
| Rate for Payer: BCN Medicare Advantage |
$316.42
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$455.64
|
| Rate for Payer: Cofinity Commercial |
$424.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.42
|
| Rate for Payer: Healthscope Commercial |
$585.38
|
| Rate for Payer: Healthscope Commercial |
$506.27
|
| Rate for Payer: Mclaren Medicaid |
$208.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.24
|
| Rate for Payer: Meridian Medicaid |
$219.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$348.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$590.24
|
| Rate for Payer: Nomi Health Commercial |
$379.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$902.25
|
| Rate for Payer: PACE SWMI |
$316.42
|
| Rate for Payer: PHP Medicare Advantage |
$316.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$551.49
|
| Rate for Payer: Priority Health Medicare |
$316.42
|
| Rate for Payer: Priority Health SBD |
$551.49
|
| Rate for Payer: Priority Health Tiered Network |
$551.49
|
| Rate for Payer: Railroad Medicare Medicare |
$316.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.74
|
| Rate for Payer: UHC Core |
$563.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$316.42
|
| Rate for Payer: UHC Exchange |
$563.74
|
| Rate for Payer: UHC Medicaid |
$208.95
|
| Rate for Payer: UHCCP Medicaid |
$208.95
|
|
|
PR I&D DP ABSC/HMTMA SFT TIS NCK/THRX PRTL RIB OSTC
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 21502
|
| Min. Negotiated Rate |
$326.32 |
| Max. Negotiated Rate |
$928.55 |
| Rate for Payer: Aetna Commercial |
$672.57
|
| Rate for Payer: Aetna Medicare |
$522.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.76
|
| Rate for Payer: BCBS Complete |
$342.64
|
| Rate for Payer: BCBS MAPPO |
$501.92
|
| Rate for Payer: BCN Commercial |
$767.39
|
| Rate for Payer: BCN Medicare Advantage |
$501.92
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$722.76
|
| Rate for Payer: Cofinity Commercial |
$672.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$501.92
|
| Rate for Payer: Healthscope Commercial |
$928.55
|
| Rate for Payer: Healthscope Commercial |
$803.07
|
| Rate for Payer: Mclaren Medicaid |
$326.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$527.02
|
| Rate for Payer: Meridian Medicaid |
$342.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$552.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$903.83
|
| Rate for Payer: Nomi Health Commercial |
$602.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$739.50
|
| Rate for Payer: PACE SWMI |
$501.92
|
| Rate for Payer: PHP Medicare Advantage |
$501.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$820.32
|
| Rate for Payer: Priority Health Medicare |
$501.92
|
| Rate for Payer: Priority Health SBD |
$820.32
|
| Rate for Payer: Priority Health Tiered Network |
$820.32
|
| Rate for Payer: Railroad Medicare Medicare |
$501.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$888.74
|
| Rate for Payer: UHC Core |
$888.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$501.92
|
| Rate for Payer: UHC Exchange |
$888.74
|
| Rate for Payer: UHC Medicaid |
$326.32
|
| Rate for Payer: UHCCP Medicaid |
$326.32
|
|
|
PR I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC
|
Professional
|
Both
|
$1,686.00
|
|
|
Service Code
|
HCPCS 45020
|
| Min. Negotiated Rate |
$351.88 |
| Max. Negotiated Rate |
$1,264.50 |
| Rate for Payer: Aetna Commercial |
$723.33
|
| Rate for Payer: Aetna Medicare |
$561.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.31
|
| Rate for Payer: BCBS Complete |
$369.47
|
| Rate for Payer: BCBS MAPPO |
$539.80
|
| Rate for Payer: BCN Commercial |
$867.98
|
| Rate for Payer: BCN Medicare Advantage |
$539.80
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cofinity Commercial |
$777.31
|
| Rate for Payer: Cofinity Commercial |
$723.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.80
|
| Rate for Payer: Healthscope Commercial |
$998.63
|
| Rate for Payer: Healthscope Commercial |
$863.68
|
| Rate for Payer: Mclaren Medicaid |
$351.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$566.79
|
| Rate for Payer: Meridian Medicaid |
$369.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$593.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.73
|
| Rate for Payer: Nomi Health Commercial |
$647.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,264.50
|
| Rate for Payer: PACE SWMI |
$539.80
|
| Rate for Payer: PHP Medicare Advantage |
$539.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,057.58
|
| Rate for Payer: Priority Health Medicare |
$539.80
|
| Rate for Payer: Priority Health SBD |
$1,057.58
|
| Rate for Payer: Priority Health Tiered Network |
$1,057.58
|
| Rate for Payer: Railroad Medicare Medicare |
$539.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.53
|
| Rate for Payer: UHC Core |
$1,007.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$539.80
|
| Rate for Payer: UHC Exchange |
$1,007.53
|
| Rate for Payer: UHC Medicaid |
$351.88
|
| Rate for Payer: UHCCP Medicaid |
$351.88
|
|
