|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 58558
|
| Min. Negotiated Rate |
$222.53 |
| Max. Negotiated Rate |
$891.15 |
| Rate for Payer: Aetna Commercial |
$298.19
|
| Rate for Payer: Aetna Medicare |
$231.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.19
|
| Rate for Payer: BCBS Complete |
$548.40
|
| Rate for Payer: BCBS MAPPO |
$222.53
|
| Rate for Payer: BCN Medicare Advantage |
$222.53
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$298.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.53
|
| Rate for Payer: Healthscope Commercial |
$356.05
|
| Rate for Payer: Healthscope Commercial |
$411.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$891.15
|
| Rate for Payer: Nomi Health Commercial |
$267.04
|
| Rate for Payer: PACE SWMI |
$222.53
|
| Rate for Payer: PHP Medicare Advantage |
$222.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health Medicare |
$222.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.53
|
| Rate for Payer: UHC Medicare Advantage |
$222.53
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
58558
|
| Min. Negotiated Rate |
$222.53 |
| Max. Negotiated Rate |
$891.15 |
| Rate for Payer: Aetna Commercial |
$298.19
|
| Rate for Payer: Aetna Medicare |
$231.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.19
|
| Rate for Payer: BCBS Complete |
$548.40
|
| Rate for Payer: BCBS MAPPO |
$222.53
|
| Rate for Payer: BCN Medicare Advantage |
$222.53
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$298.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.53
|
| Rate for Payer: Healthscope Commercial |
$356.05
|
| Rate for Payer: Healthscope Commercial |
$411.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$891.15
|
| Rate for Payer: Nomi Health Commercial |
$267.04
|
| Rate for Payer: PACE SWMI |
$222.53
|
| Rate for Payer: PHP Medicare Advantage |
$222.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health Medicare |
$222.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.53
|
| Rate for Payer: UHC Medicare Advantage |
$222.53
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$863.73 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Commercial |
$1,165.35
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$959.70
|
| Rate for Payer: Cofinity Commercial |
$1,179.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$959.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$1,233.90
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,165.35
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$1,165.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$863.73
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$863.73 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Aetna Commercial |
$1,165.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.15
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$1,179.06
|
| Rate for Payer: Cofinity Commercial |
$959.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$959.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.80
|
| Rate for Payer: Healthscope Commercial |
$1,233.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,165.35
|
| Rate for Payer: PHP Commercial |
$1,165.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health SBD |
$863.73
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$528.45 |
| Rate for Payer: Aetna Commercial |
$196.02
|
| Rate for Payer: Aetna Medicare |
$152.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.02
|
| Rate for Payer: BCBS Complete |
$325.20
|
| Rate for Payer: BCBS MAPPO |
$146.28
|
| Rate for Payer: BCN Medicare Advantage |
$146.28
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Commercial |
$196.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.28
|
| Rate for Payer: Healthscope Commercial |
$270.62
|
| Rate for Payer: Healthscope Commercial |
$234.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.45
|
| Rate for Payer: Nomi Health Commercial |
$175.54
|
| Rate for Payer: PACE SWMI |
$146.28
|
| Rate for Payer: PHP Medicare Advantage |
$146.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health Medicare |
$146.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.28
|
| Rate for Payer: UHC Medicare Advantage |
$146.28
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 58555
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$528.45 |
| Rate for Payer: Aetna Commercial |
$196.02
|
| Rate for Payer: Aetna Medicare |
$152.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.02
|
| Rate for Payer: BCBS Complete |
$325.20
|
| Rate for Payer: BCBS MAPPO |
$146.28
|
| Rate for Payer: BCN Medicare Advantage |
$146.28
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Commercial |
$196.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.28
|
| Rate for Payer: Healthscope Commercial |
$270.62
|
| Rate for Payer: Healthscope Commercial |
$234.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.45
|
| Rate for Payer: Nomi Health Commercial |
$175.54
|
| Rate for Payer: PACE SWMI |
$146.28
|
| Rate for Payer: PHP Medicare Advantage |
$146.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health Medicare |
$146.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.28
|
| Rate for Payer: UHC Medicare Advantage |
$146.28
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$512.19 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Commercial |
$691.05
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$699.18
|
| Rate for Payer: Cofinity Commercial |
$569.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$569.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$731.70
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.05
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$691.05
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$512.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$512.19 |
| Max. Negotiated Rate |
$731.70 |
| Rate for Payer: Aetna Commercial |
$691.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.45
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$569.10
|
| Rate for Payer: Cofinity Commercial |
$699.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$569.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.40
|
| Rate for Payer: Healthscope Commercial |
$731.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.05
|
| Rate for Payer: PHP Commercial |
$691.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health SBD |
$512.19
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,673.00
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$1,087.45 |
| Rate for Payer: Aetna Commercial |
$402.40
|
| Rate for Payer: Aetna Medicare |
$312.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.40
|
| Rate for Payer: BCBS Complete |
$669.20
|
| Rate for Payer: BCBS MAPPO |
$300.30
|
| Rate for Payer: BCN Medicare Advantage |
$300.30
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cofinity Commercial |
$432.43
|
| Rate for Payer: Cofinity Commercial |
$402.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.30
|
| Rate for Payer: Healthscope Commercial |
$480.48
|
| Rate for Payer: Healthscope Commercial |
$555.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.45
|
| Rate for Payer: Nomi Health Commercial |
$360.36
|
| Rate for Payer: PACE SWMI |
$300.30
|
| Rate for Payer: PHP Medicare Advantage |
$300.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.45
|
| Rate for Payer: Priority Health Medicare |
$300.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.30
|
| Rate for Payer: UHC Medicare Advantage |
$300.30
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$985.32 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.60
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.80
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,094.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health SBD |
$985.32
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,016.60 |
| Rate for Payer: Aetna Commercial |
$316.27
|
| Rate for Payer: Aetna Medicare |
$245.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.27
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$236.02
|
| Rate for Payer: BCN Medicare Advantage |
$236.02
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$339.87
|
| Rate for Payer: Cofinity Commercial |
$316.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.02
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: Healthscope Commercial |
$377.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,016.60
|
| Rate for Payer: Nomi Health Commercial |
$283.22
|
| Rate for Payer: PACE SWMI |
$236.02
|
| Rate for Payer: PHP Medicare Advantage |
$236.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$236.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.02
|
| Rate for Payer: UHC Medicare Advantage |
$236.02
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,016.60 |
| Rate for Payer: Aetna Commercial |
$316.27
|
| Rate for Payer: Aetna Medicare |
$245.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.27
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$236.02
|
| Rate for Payer: BCN Medicare Advantage |
$236.02
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$339.87
|
| Rate for Payer: Cofinity Commercial |
$316.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.02
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: Healthscope Commercial |
$377.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,016.60
|
| Rate for Payer: Nomi Health Commercial |
$283.22
|
| Rate for Payer: PACE SWMI |
$236.02
|
| Rate for Payer: PHP Medicare Advantage |
$236.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$236.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.02
|
| Rate for Payer: UHC Medicare Advantage |
$236.02
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$985.32 |
| Max. Negotiated Rate |
$13,552.11 |
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna Medicare |
$5,007.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.80
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,094.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Priority Health SBD |
$985.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,552.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,710.52
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 58559
|
| Min. Negotiated Rate |
$272.52 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$365.18
|
| Rate for Payer: Aetna Medicare |
$283.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.18
|
| Rate for Payer: BCBS Complete |
$606.00
|
| Rate for Payer: BCBS MAPPO |
$272.52
|
| Rate for Payer: BCN Medicare Advantage |
$272.52
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cofinity Commercial |
$392.43
|
| Rate for Payer: Cofinity Commercial |
$365.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.52
|
| Rate for Payer: Healthscope Commercial |
$436.03
|
| Rate for Payer: Healthscope Commercial |
$504.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$984.75
|
| Rate for Payer: Nomi Health Commercial |
$327.02
|
| Rate for Payer: PACE SWMI |
$272.52
|
| Rate for Payer: PHP Medicare Advantage |
$272.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.75
|
| Rate for Payer: Priority Health Medicare |
$272.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.52
|
| Rate for Payer: UHC Medicare Advantage |
$272.52
|
|
|
PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS 58562
|
| Min. Negotiated Rate |
$212.48 |
| Max. Negotiated Rate |
$765.05 |
| Rate for Payer: Aetna Commercial |
$284.72
|
| Rate for Payer: Aetna Medicare |
$220.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.72
|
| Rate for Payer: BCBS Complete |
$470.80
|
| Rate for Payer: BCBS MAPPO |
$212.48
|
| Rate for Payer: BCN Medicare Advantage |
$212.48
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$284.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.48
|
| Rate for Payer: Healthscope Commercial |
$393.09
|
| Rate for Payer: Healthscope Commercial |
$339.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.05
|
| Rate for Payer: Nomi Health Commercial |
$254.98
|
| Rate for Payer: PACE SWMI |
$212.48
|
| Rate for Payer: PHP Medicare Advantage |
$212.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.05
|
| Rate for Payer: Priority Health Medicare |
$212.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.48
|
| Rate for Payer: UHC Medicare Advantage |
$212.48
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 58561
|
| Min. Negotiated Rate |
$343.71 |
| Max. Negotiated Rate |
$635.86 |
| Rate for Payer: Aetna Commercial |
$460.57
|
| Rate for Payer: Aetna Medicare |
$357.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.57
|
| Rate for Payer: BCBS Complete |
$376.40
|
| Rate for Payer: BCBS MAPPO |
$343.71
|
| Rate for Payer: BCN Medicare Advantage |
$343.71
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$494.94
|
| Rate for Payer: Cofinity Commercial |
$460.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.71
|
| Rate for Payer: Healthscope Commercial |
$549.94
|
| Rate for Payer: Healthscope Commercial |
$635.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.65
|
| Rate for Payer: Nomi Health Commercial |
$412.45
|
| Rate for Payer: PACE SWMI |
$343.71
|
| Rate for Payer: PHP Medicare Advantage |
$343.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health Medicare |
$343.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.71
|
| Rate for Payer: UHC Medicare Advantage |
$343.71
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$592.83 |
| Max. Negotiated Rate |
$13,552.11 |
| Rate for Payer: Aetna Commercial |
$799.85
|
| Rate for Payer: Aetna Medicare |
$5,007.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$809.26
|
| Rate for Payer: Cofinity Commercial |
$658.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Healthscope Commercial |
$846.90
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.85
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Commercial |
$799.85
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Priority Health SBD |
$592.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,552.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,710.52
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$592.83 |
| Max. Negotiated Rate |
$846.90 |
| Rate for Payer: Aetna Commercial |
$799.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.65
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$658.70
|
| Rate for Payer: Cofinity Commercial |
$809.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.80
|
| Rate for Payer: Healthscope Commercial |
$846.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.85
|
| Rate for Payer: PHP Commercial |
$799.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health SBD |
$592.83
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$343.71 |
| Max. Negotiated Rate |
$635.86 |
| Rate for Payer: Aetna Commercial |
$460.57
|
| Rate for Payer: Aetna Medicare |
$357.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.94
|
| Rate for Payer: BCBS Complete |
$376.40
|
| Rate for Payer: BCBS MAPPO |
$343.71
|
| Rate for Payer: BCN Medicare Advantage |
$343.71
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$494.94
|
| Rate for Payer: Cofinity Commercial |
$460.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.71
|
| Rate for Payer: Healthscope Commercial |
$549.94
|
| Rate for Payer: Healthscope Commercial |
$635.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.65
|
| Rate for Payer: Nomi Health Commercial |
$412.45
|
| Rate for Payer: PACE SWMI |
$343.71
|
| Rate for Payer: PHP Medicare Advantage |
$343.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health Medicare |
$343.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.71
|
| Rate for Payer: UHC Medicare Advantage |
$343.71
|
|
|
PR HYSTEROTOMY ABDOMINAL
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 59100
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$1,545.88 |
| Rate for Payer: Aetna Commercial |
$1,119.72
|
| Rate for Payer: Aetna Medicare |
$869.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.72
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$835.61
|
| Rate for Payer: BCN Medicare Advantage |
$835.61
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,203.28
|
| Rate for Payer: Cofinity Commercial |
$1,119.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.61
|
| Rate for Payer: Healthscope Commercial |
$1,336.98
|
| Rate for Payer: Healthscope Commercial |
$1,545.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$994.50
|
| Rate for Payer: Nomi Health Commercial |
$1,002.73
|
| Rate for Payer: PACE SWMI |
$835.61
|
| Rate for Payer: PHP Medicare Advantage |
$835.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$835.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.61
|
| Rate for Payer: UHC Medicare Advantage |
$835.61
|
|
|
PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 90750
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
|
|
PR I131 IODIDE CAP, RX
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS A9517
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
|
|
PR ICAR CATH ABLATION DISCRETE MECHANISM ARRHYTHMIA
|
Professional
|
Both
|
$1,492.00
|
|
|
Service Code
|
HCPCS 93655
|
| Min. Negotiated Rate |
$291.05 |
| Max. Negotiated Rate |
$969.80 |
| Rate for Payer: Aetna Commercial |
$390.01
|
| Rate for Payer: Aetna Medicare |
$302.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.01
|
| Rate for Payer: BCBS Complete |
$596.80
|
| Rate for Payer: BCBS MAPPO |
$291.05
|
| Rate for Payer: BCN Medicare Advantage |
$291.05
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Cofinity Commercial |
$419.11
|
| Rate for Payer: Cofinity Commercial |
$390.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.05
|
| Rate for Payer: Healthscope Commercial |
$538.44
|
| Rate for Payer: Healthscope Commercial |
$465.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$969.80
|
| Rate for Payer: Nomi Health Commercial |
$349.26
|
| Rate for Payer: PACE SWMI |
$291.05
|
| Rate for Payer: PHP Medicare Advantage |
$291.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.80
|
| Rate for Payer: Priority Health Medicare |
$291.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.05
|
| Rate for Payer: UHC Medicare Advantage |
$291.05
|
|
|
PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION
|
Professional
|
Both
|
$1,840.00
|
|
|
Service Code
|
HCPCS 93650
|
| Min. Negotiated Rate |
$551.48 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$738.98
|
| Rate for Payer: Aetna Medicare |
$573.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.98
|
| Rate for Payer: BCBS Complete |
$736.00
|
| Rate for Payer: BCBS MAPPO |
$551.48
|
| Rate for Payer: BCN Medicare Advantage |
$551.48
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cofinity Commercial |
$794.13
|
| Rate for Payer: Cofinity Commercial |
$738.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.48
|
| Rate for Payer: Healthscope Commercial |
$1,020.24
|
| Rate for Payer: Healthscope Commercial |
$882.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$579.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,196.00
|
| Rate for Payer: Nomi Health Commercial |
$661.78
|
| Rate for Payer: PACE SWMI |
$551.48
|
| Rate for Payer: PHP Medicare Advantage |
$551.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,196.00
|
| Rate for Payer: Priority Health Medicare |
$551.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.48
|
| Rate for Payer: UHC Medicare Advantage |
$551.48
|
|
|
PR I&D ABSCESS PERITONSILLAR
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 42700
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$239.37 |
| Rate for Payer: Aetna Commercial |
$173.38
|
| Rate for Payer: Aetna Medicare |
$134.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.38
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$129.39
|
| Rate for Payer: BCN Medicare Advantage |
$129.39
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$186.32
|
| Rate for Payer: Cofinity Commercial |
$173.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.39
|
| Rate for Payer: Healthscope Commercial |
$239.37
|
| Rate for Payer: Healthscope Commercial |
$207.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.20
|
| Rate for Payer: Nomi Health Commercial |
$155.27
|
| Rate for Payer: PACE SWMI |
$129.39
|
| Rate for Payer: PHP Medicare Advantage |
$129.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$129.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.39
|
| Rate for Payer: UHC Medicare Advantage |
$129.39
|
|
