|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
58558
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$1,979.15 |
| Rate for Payer: Aetna Commercial |
$307.05
|
| Rate for Payer: Aetna Medicare |
$238.31
|
| Rate for Payer: BCBS Complete |
$154.77
|
| Rate for Payer: BCBS MAPPO |
$229.14
|
| Rate for Payer: BCBS Trust/PPO |
$650.87
|
| Rate for Payer: BCN Commercial |
$1,979.15
|
| Rate for Payer: BCN Medicare Advantage |
$229.14
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Cofinity Commercial |
$329.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.14
|
| Rate for Payer: Mclaren Medicaid |
$147.40
|
| Rate for Payer: Meridian Medicaid |
$154.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$240.60
|
| Rate for Payer: PACE SWMI |
$229.14
|
| Rate for Payer: PHP Medicare Advantage |
$229.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.19
|
| Rate for Payer: Priority Health Medicare |
$229.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.14
|
| Rate for Payer: UHC Medicare Advantage |
$236.01
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$2,153.41 |
| Rate for Payer: Aetna Commercial |
$1,142.40
|
| Rate for Payer: Aetna Medicare |
$349.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$420.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$420.00
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$336.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,044.96
|
| Rate for Payer: BCN Commercial |
$1,044.96
|
| Rate for Payer: BCN Medicare Advantage |
$336.00
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cofinity Commercial |
$1,155.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.00
|
| Rate for Payer: Healthscope Commercial |
$1,209.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.00
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$352.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$386.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,142.40
|
| Rate for Payer: PACE Senior Care Partners |
$319.20
|
| Rate for Payer: PACE SWMI |
$336.00
|
| Rate for Payer: PHP Commercial |
$1,142.40
|
| Rate for Payer: PHP Medicare Advantage |
$336.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,169.28
|
| Rate for Payer: Priority Health Medicare |
$336.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$819.71
|
| Rate for Payer: Railroad Medicare Medicare |
$336.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,182.72
|
| Rate for Payer: UHC Core |
$1,122.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.00
|
| Rate for Payer: UHC Medicare Advantage |
$346.08
|
| Rate for Payer: VA VA |
$336.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.00
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$189.29 |
| Max. Negotiated Rate |
$2,153.41 |
| Rate for Payer: Aetna Commercial |
$677.45
|
| Rate for Payer: Aetna Medicare |
$207.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.06
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$199.25
|
| Rate for Payer: BCBS Trust/PPO |
$619.67
|
| Rate for Payer: BCN Commercial |
$619.67
|
| Rate for Payer: BCN Medicare Advantage |
$199.25
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$685.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.25
|
| Rate for Payer: Healthscope Commercial |
$717.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.75
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$209.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$677.45
|
| Rate for Payer: PACE Senior Care Partners |
$189.29
|
| Rate for Payer: PACE SWMI |
$199.25
|
| Rate for Payer: PHP Commercial |
$677.45
|
| Rate for Payer: PHP Medicare Advantage |
$199.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$693.39
|
| Rate for Payer: Priority Health Medicare |
$199.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.09
|
| Rate for Payer: Railroad Medicare Medicare |
$199.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$701.36
|
| Rate for Payer: UHC Core |
$665.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.25
|
| Rate for Payer: UHC Medicare Advantage |
$205.23
|
| Rate for Payer: VA VA |
$199.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.75
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 58555
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$1,037.58 |
| Rate for Payer: Aetna Commercial |
$200.57
|
| Rate for Payer: Aetna Medicare |
$155.67
|
| Rate for Payer: BCBS Complete |
$101.31
|
| Rate for Payer: BCBS MAPPO |
$149.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$536.08
|
| Rate for Payer: BCN Medicare Advantage |
$149.68
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$215.54
|
| Rate for Payer: Cofinity Commercial |
$200.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.68
|
| Rate for Payer: Mclaren Medicaid |
$96.49
|
| Rate for Payer: Meridian Medicaid |
$101.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.16
|
| Rate for Payer: PACE SWMI |
$149.68
|
| Rate for Payer: PHP Medicare Advantage |
$149.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.51
|
| Rate for Payer: Priority Health Medicare |
$149.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.68
|
| Rate for Payer: UHC Medicare Advantage |
$154.17
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$1,037.58 |
| Rate for Payer: Aetna Commercial |
$200.57
|
| Rate for Payer: Aetna Medicare |
$155.67
|
| Rate for Payer: BCBS Complete |
$101.31
|
| Rate for Payer: BCBS MAPPO |
$149.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$536.08
|
| Rate for Payer: BCN Medicare Advantage |
$149.68
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$215.54
|
| Rate for Payer: Cofinity Commercial |
$200.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.68
|
| Rate for Payer: Mclaren Medicaid |
$96.49
|
| Rate for Payer: Meridian Medicaid |
$101.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.16
|
| Rate for Payer: PACE SWMI |
$149.68
|
| Rate for Payer: PHP Medicare Advantage |
$149.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.51
|
| Rate for Payer: Priority Health Medicare |
$149.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.68
|
| Rate for Payer: UHC Medicare Advantage |
$154.17
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$486.09 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Aetna Commercial |
$677.45
|
| Rate for Payer: BCBS Trust/PPO |
$615.92
|
| Rate for Payer: BCN Commercial |
$615.92
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$685.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.60
|
| Rate for Payer: Healthscope Commercial |
$717.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$677.45
|
| Rate for Payer: PHP Commercial |
$677.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$693.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$701.36
|
| Rate for Payer: UHC Core |
$665.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.75
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$1,148.00 |
| Rate for Payer: Aetna Commercial |
$415.00
|
| Rate for Payer: Aetna Medicare |
$322.09
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$309.70
|
| Rate for Payer: BCBS Trust/PPO |
$29.58
|
| Rate for Payer: BCN Commercial |
$454.47
|
| Rate for Payer: BCN Medicare Advantage |
$309.70
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cofinity Commercial |
$445.97
|
| Rate for Payer: Cofinity Commercial |
$415.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.70
|
| Rate for Payer: Mclaren Medicaid |
$199.16
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$325.18
|
| Rate for Payer: PACE SWMI |
$309.70
|
| Rate for Payer: PHP Medicare Advantage |
$309.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,148.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$440.28
|
| Rate for Payer: Priority Health Medicare |
$309.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$440.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.70
|
| Rate for Payer: UHC Medicare Advantage |
$318.99
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$934.98 |
| Max. Negotiated Rate |
$1,379.70 |
| Rate for Payer: Aetna Commercial |
$1,303.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.70
|
| Rate for Payer: BCN Commercial |
$1,184.70
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,318.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,226.40
|
| Rate for Payer: Healthscope Commercial |
$1,379.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,149.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.05
|
| Rate for Payer: PHP Commercial |
$1,303.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,333.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$934.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,349.04
|
| Rate for Payer: UHC Core |
$1,280.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,149.75
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$364.09 |
| Max. Negotiated Rate |
$3,425.99 |
| Rate for Payer: Aetna Commercial |
$1,303.05
|
| Rate for Payer: Aetna Medicare |
$398.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$479.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$479.06
|
| Rate for Payer: BCBS Complete |
$3,425.99
|
| Rate for Payer: BCBS MAPPO |
$383.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.91
|
| Rate for Payer: BCN Commercial |
$1,191.91
|
| Rate for Payer: BCN Medicare Advantage |
$383.25
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,318.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,226.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.25
|
| Rate for Payer: Healthscope Commercial |
$1,379.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,149.75
|
| Rate for Payer: Mclaren Medicaid |
$3,262.85
|
| Rate for Payer: Meridian Medicaid |
$3,425.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$402.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$440.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.05
|
| Rate for Payer: PACE Senior Care Partners |
$364.09
|
| Rate for Payer: PACE SWMI |
$383.25
|
| Rate for Payer: PHP Commercial |
$1,303.05
|
| Rate for Payer: PHP Medicare Advantage |
$383.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,262.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,333.71
|
| Rate for Payer: Priority Health Medicare |
$383.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$934.98
|
| Rate for Payer: Railroad Medicare Medicare |
$383.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,349.04
|
| Rate for Payer: UHC Core |
$1,280.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$383.25
|
| Rate for Payer: UHC Medicare Advantage |
$394.75
|
| Rate for Payer: VA VA |
$383.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,149.75
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$3,149.52 |
| Rate for Payer: Aetna Commercial |
$326.84
|
| Rate for Payer: Aetna Medicare |
$253.67
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCBS MAPPO |
$243.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$3,149.52
|
| Rate for Payer: BCN Medicare Advantage |
$243.91
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$326.84
|
| Rate for Payer: Cofinity Commercial |
$351.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.91
|
| Rate for Payer: Mclaren Medicaid |
$156.56
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$256.11
|
| Rate for Payer: PACE SWMI |
$243.91
|
| Rate for Payer: PHP Medicare Advantage |
$243.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.02
|
| Rate for Payer: Priority Health Medicare |
$243.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$347.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.91
|
| Rate for Payer: UHC Medicare Advantage |
$251.23
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$3,149.52 |
| Rate for Payer: Aetna Commercial |
$326.84
|
| Rate for Payer: Aetna Medicare |
$253.67
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCBS MAPPO |
$243.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$3,149.52
|
| Rate for Payer: BCN Medicare Advantage |
$243.91
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$351.23
|
| Rate for Payer: Cofinity Commercial |
$326.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.91
|
| Rate for Payer: Mclaren Medicaid |
$156.56
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$256.11
|
| Rate for Payer: PACE SWMI |
$243.91
|
| Rate for Payer: PHP Medicare Advantage |
$243.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.02
|
| Rate for Payer: Priority Health Medicare |
$243.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$347.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.91
|
| Rate for Payer: UHC Medicare Advantage |
$251.23
|
|
|
PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
HCPCS 58559
|
| Min. Negotiated Rate |
$180.84 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: Aetna Commercial |
$376.86
|
| Rate for Payer: Aetna Medicare |
$292.49
|
| Rate for Payer: BCBS Complete |
$189.88
|
| Rate for Payer: BCBS MAPPO |
$281.24
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$412.93
|
| Rate for Payer: BCN Medicare Advantage |
$281.24
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cofinity Commercial |
$376.86
|
| Rate for Payer: Cofinity Commercial |
$404.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.24
|
| Rate for Payer: Mclaren Medicaid |
$180.84
|
| Rate for Payer: Meridian Medicaid |
$189.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$295.30
|
| Rate for Payer: PACE SWMI |
$281.24
|
| Rate for Payer: PHP Medicare Advantage |
$281.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.05
|
| Rate for Payer: Priority Health Medicare |
$281.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$400.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.24
|
| Rate for Payer: UHC Medicare Advantage |
$289.68
|
|
|
PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY
|
Professional
|
Both
|
$1,154.00
|
|
|
Service Code
|
HCPCS 58562
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$807.80 |
| Rate for Payer: Aetna Commercial |
$294.13
|
| Rate for Payer: Aetna Medicare |
$228.28
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS MAPPO |
$219.50
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCN Commercial |
$639.19
|
| Rate for Payer: BCN Medicare Advantage |
$219.50
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cofinity Commercial |
$316.08
|
| Rate for Payer: Cofinity Commercial |
$294.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.50
|
| Rate for Payer: Mclaren Medicaid |
$141.22
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.48
|
| Rate for Payer: PACE SWMI |
$219.50
|
| Rate for Payer: PHP Medicare Advantage |
$219.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.47
|
| Rate for Payer: Priority Health Medicare |
$219.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.50
|
| Rate for Payer: UHC Medicare Advantage |
$226.08
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$219.21 |
| Max. Negotiated Rate |
$3,425.99 |
| Rate for Payer: Aetna Commercial |
$784.55
|
| Rate for Payer: Aetna Medicare |
$239.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.44
|
| Rate for Payer: BCBS Complete |
$3,425.99
|
| Rate for Payer: BCBS MAPPO |
$230.75
|
| Rate for Payer: BCBS Trust/PPO |
$717.63
|
| Rate for Payer: BCN Commercial |
$717.63
|
| Rate for Payer: BCN Medicare Advantage |
$230.75
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$793.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.75
|
| Rate for Payer: Healthscope Commercial |
$830.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$692.25
|
| Rate for Payer: Mclaren Medicaid |
$3,262.85
|
| Rate for Payer: Meridian Medicaid |
$3,425.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$784.55
|
| Rate for Payer: PACE Senior Care Partners |
$219.21
|
| Rate for Payer: PACE SWMI |
$230.75
|
| Rate for Payer: PHP Commercial |
$784.55
|
| Rate for Payer: PHP Medicare Advantage |
$230.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,262.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$803.01
|
| Rate for Payer: Priority Health Medicare |
$230.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.94
|
| Rate for Payer: Railroad Medicare Medicare |
$230.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.24
|
| Rate for Payer: UHC Core |
$770.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.75
|
| Rate for Payer: UHC Medicare Advantage |
$237.67
|
| Rate for Payer: VA VA |
$230.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$692.25
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$646.10 |
| Rate for Payer: Aetna Commercial |
$475.47
|
| Rate for Payer: Aetna Medicare |
$369.02
|
| Rate for Payer: BCBS Complete |
$239.31
|
| Rate for Payer: BCBS MAPPO |
$354.83
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$520.44
|
| Rate for Payer: BCN Medicare Advantage |
$354.83
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$510.96
|
| Rate for Payer: Cofinity Commercial |
$475.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.83
|
| Rate for Payer: Mclaren Medicaid |
$227.91
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.57
|
| Rate for Payer: PACE SWMI |
$354.83
|
| Rate for Payer: PHP Medicare Advantage |
$354.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$504.20
|
| Rate for Payer: Priority Health Medicare |
$354.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$504.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.83
|
| Rate for Payer: UHC Medicare Advantage |
$365.47
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$562.94 |
| Max. Negotiated Rate |
$830.70 |
| Rate for Payer: Aetna Commercial |
$784.55
|
| Rate for Payer: BCBS Trust/PPO |
$713.29
|
| Rate for Payer: BCN Commercial |
$713.29
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$793.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.40
|
| Rate for Payer: Healthscope Commercial |
$830.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$692.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$784.55
|
| Rate for Payer: PHP Commercial |
$784.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$803.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.24
|
| Rate for Payer: UHC Core |
$770.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$692.25
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 58561
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$646.10 |
| Rate for Payer: Aetna Commercial |
$475.47
|
| Rate for Payer: Aetna Medicare |
$369.02
|
| Rate for Payer: BCBS Complete |
$239.31
|
| Rate for Payer: BCBS MAPPO |
$354.83
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$520.44
|
| Rate for Payer: BCN Medicare Advantage |
$354.83
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$510.96
|
| Rate for Payer: Cofinity Commercial |
$475.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.83
|
| Rate for Payer: Mclaren Medicaid |
$227.91
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.57
|
| Rate for Payer: PACE SWMI |
$354.83
|
| Rate for Payer: PHP Medicare Advantage |
$354.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$504.20
|
| Rate for Payer: Priority Health Medicare |
$354.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$504.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.83
|
| Rate for Payer: UHC Medicare Advantage |
$365.47
|
|
|
PR HYSTEROTOMY ABDOMINAL
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 59100
|
| Min. Negotiated Rate |
$130.49 |
| Max. Negotiated Rate |
$1,260.30 |
| Rate for Payer: Aetna Commercial |
$1,150.72
|
| Rate for Payer: Aetna Medicare |
$893.10
|
| Rate for Payer: BCBS Complete |
$580.38
|
| Rate for Payer: BCBS MAPPO |
$858.75
|
| Rate for Payer: BCBS Trust/PPO |
$130.49
|
| Rate for Payer: BCN Commercial |
$1,260.30
|
| Rate for Payer: BCN Medicare Advantage |
$858.75
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,150.72
|
| Rate for Payer: Cofinity Commercial |
$1,236.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.75
|
| Rate for Payer: Mclaren Medicaid |
$552.74
|
| Rate for Payer: Meridian Medicaid |
$580.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$901.69
|
| Rate for Payer: PACE SWMI |
$858.75
|
| Rate for Payer: PHP Medicare Advantage |
$858.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,217.73
|
| Rate for Payer: Priority Health Medicare |
$858.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,217.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.75
|
| Rate for Payer: UHC Medicare Advantage |
$884.51
|
|
|
PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 90750
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$187.08 |
| Rate for Payer: Aetna Commercial |
$187.08
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS Trust/PPO |
$175.26
|
| Rate for Payer: BCN Commercial |
$172.01
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
|
|
PR I131 IODIDE CAP, RX
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS A9517
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$2,124.29 |
| Rate for Payer: Aetna Commercial |
$40.43
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,124.29
|
| Rate for Payer: BCN Commercial |
$23.73
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
|
|
PR ICAR CATHETER ABLATION ARRHYTHMIA ADD ON
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 93655
|
| Min. Negotiated Rate |
$190.64 |
| Max. Negotiated Rate |
$2,991.76 |
| Rate for Payer: Aetna Commercial |
$406.09
|
| Rate for Payer: Aetna Medicare |
$315.17
|
| Rate for Payer: BCBS Complete |
$200.17
|
| Rate for Payer: BCBS MAPPO |
$303.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,991.76
|
| Rate for Payer: BCN Commercial |
$442.74
|
| Rate for Payer: BCN Medicare Advantage |
$303.05
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cofinity Commercial |
$436.39
|
| Rate for Payer: Cofinity Commercial |
$406.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.05
|
| Rate for Payer: Mclaren Medicaid |
$190.64
|
| Rate for Payer: Meridian Medicaid |
$200.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$318.20
|
| Rate for Payer: PACE SWMI |
$303.05
|
| Rate for Payer: PHP Medicare Advantage |
$303.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.42
|
| Rate for Payer: Priority Health Medicare |
$303.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$428.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.05
|
| Rate for Payer: UHC Medicare Advantage |
$312.14
|
|
|
PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION
|
Professional
|
Both
|
$1,804.00
|
|
|
Service Code
|
HCPCS 93650
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$2,821.65 |
| Rate for Payer: Aetna Commercial |
$769.99
|
| Rate for Payer: Aetna Medicare |
$597.60
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCBS MAPPO |
$574.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,821.65
|
| Rate for Payer: BCN Commercial |
$840.53
|
| Rate for Payer: BCN Medicare Advantage |
$574.62
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cofinity Commercial |
$827.45
|
| Rate for Payer: Cofinity Commercial |
$769.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$574.62
|
| Rate for Payer: Mclaren Medicaid |
$362.10
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$603.35
|
| Rate for Payer: PACE SWMI |
$574.62
|
| Rate for Payer: PHP Medicare Advantage |
$574.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.33
|
| Rate for Payer: Priority Health Medicare |
$574.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$813.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$574.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$574.62
|
| Rate for Payer: UHC Medicare Advantage |
$591.86
|
|
|
PR I&D ABSCESS PERITONSILLAR
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 42700
|
| Min. Negotiated Rate |
$87.76 |
| Max. Negotiated Rate |
$492.38 |
| Rate for Payer: Aetna Commercial |
$177.82
|
| Rate for Payer: Aetna Medicare |
$138.01
|
| Rate for Payer: BCBS Complete |
$92.15
|
| Rate for Payer: BCBS MAPPO |
$132.70
|
| Rate for Payer: BCBS Trust/PPO |
$492.38
|
| Rate for Payer: BCN Commercial |
$284.90
|
| Rate for Payer: BCN Medicare Advantage |
$132.70
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$191.09
|
| Rate for Payer: Cofinity Commercial |
$177.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.70
|
| Rate for Payer: Mclaren Medicaid |
$87.76
|
| Rate for Payer: Meridian Medicaid |
$92.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$139.34
|
| Rate for Payer: PACE SWMI |
$132.70
|
| Rate for Payer: PHP Medicare Advantage |
$132.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.48
|
| Rate for Payer: Priority Health Medicare |
$132.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.70
|
| Rate for Payer: UHC Medicare Advantage |
$136.68
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 42720
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$678.52 |
| Rate for Payer: Aetna Commercial |
$509.32
|
| Rate for Payer: Aetna Medicare |
$395.29
|
| Rate for Payer: BCBS Complete |
$259.43
|
| Rate for Payer: BCBS MAPPO |
$380.09
|
| Rate for Payer: BCBS Trust/PPO |
$613.88
|
| Rate for Payer: BCN Commercial |
$657.27
|
| Rate for Payer: BCN Medicare Advantage |
$380.09
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$547.33
|
| Rate for Payer: Cofinity Commercial |
$509.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.09
|
| Rate for Payer: Mclaren Medicaid |
$247.08
|
| Rate for Payer: Meridian Medicaid |
$259.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$399.09
|
| Rate for Payer: PACE SWMI |
$380.09
|
| Rate for Payer: PHP Medicare Advantage |
$380.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$678.52
|
| Rate for Payer: Priority Health Medicare |
$380.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.09
|
| Rate for Payer: UHC Medicare Advantage |
$391.49
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 42725
|
| Min. Negotiated Rate |
$512.90 |
| Max. Negotiated Rate |
$1,402.91 |
| Rate for Payer: Aetna Commercial |
$1,050.59
|
| Rate for Payer: Aetna Medicare |
$815.38
|
| Rate for Payer: BCBS Complete |
$538.54
|
| Rate for Payer: BCBS MAPPO |
$784.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,312.83
|
| Rate for Payer: BCN Commercial |
$1,165.98
|
| Rate for Payer: BCN Medicare Advantage |
$784.02
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Commercial |
$1,128.99
|
| Rate for Payer: Cofinity Commercial |
$1,050.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$784.02
|
| Rate for Payer: Mclaren Medicaid |
$512.90
|
| Rate for Payer: Meridian Medicaid |
$538.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$823.22
|
| Rate for Payer: PACE SWMI |
$784.02
|
| Rate for Payer: PHP Medicare Advantage |
$784.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,402.91
|
| Rate for Payer: Priority Health Medicare |
$784.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,402.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$784.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$784.02
|
| Rate for Payer: UHC Medicare Advantage |
$807.54
|
|
