|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,258.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$503.20 |
| Max. Negotiated Rate |
$821.75 |
| Rate for Payer: Aetna Commercial |
$764.68
|
| Rate for Payer: Aetna Medicare |
$593.49
|
| Rate for Payer: BCBS Complete |
$503.20
|
| Rate for Payer: BCBS MAPPO |
$570.66
|
| Rate for Payer: BCN Medicare Advantage |
$570.66
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cofinity Commercial |
$821.75
|
| Rate for Payer: Cofinity Commercial |
$764.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.19
|
| Rate for Payer: Nomi Health Commercial |
$684.79
|
| Rate for Payer: PACE SWMI |
$570.66
|
| Rate for Payer: PHP Medicare Advantage |
$570.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.70
|
| Rate for Payer: Priority Health Medicare |
$576.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.66
|
| Rate for Payer: UHC Exchange |
$570.66
|
| Rate for Payer: UHC Medicare Advantage |
$570.66
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$243.33 |
| Rate for Payer: Aetna Commercial |
$226.43
|
| Rate for Payer: Aetna Medicare |
$175.74
|
| Rate for Payer: BCBS Complete |
$148.40
|
| Rate for Payer: BCBS MAPPO |
$168.98
|
| Rate for Payer: BCN Medicare Advantage |
$168.98
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$243.33
|
| Rate for Payer: Cofinity Commercial |
$226.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.43
|
| Rate for Payer: Nomi Health Commercial |
$202.78
|
| Rate for Payer: PACE SWMI |
$168.98
|
| Rate for Payer: PHP Medicare Advantage |
$168.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
| Rate for Payer: Priority Health Medicare |
$170.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.98
|
| Rate for Payer: UHC Exchange |
$168.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.98
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$112.45 |
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna Medicare |
$70.87
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS MAPPO |
$68.14
|
| Rate for Payer: BCN Medicare Advantage |
$68.14
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$98.12
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.55
|
| Rate for Payer: Nomi Health Commercial |
$81.77
|
| Rate for Payer: PACE SWMI |
$68.14
|
| Rate for Payer: PHP Medicare Advantage |
$68.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health Medicare |
$68.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.14
|
| Rate for Payer: UHC Exchange |
$68.14
|
| Rate for Payer: UHC Medicare Advantage |
$68.14
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Aetna Commercial |
$14.73
|
| Rate for Payer: Aetna Medicare |
$11.43
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS MAPPO |
$10.99
|
| Rate for Payer: BCN Medicare Advantage |
$10.99
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Commercial |
$14.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.54
|
| Rate for Payer: Nomi Health Commercial |
$13.19
|
| Rate for Payer: PACE SWMI |
$10.99
|
| Rate for Payer: PHP Medicare Advantage |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
| Rate for Payer: Priority Health Medicare |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.99
|
| Rate for Payer: UHC Exchange |
$10.99
|
| Rate for Payer: UHC Medicare Advantage |
$10.99
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$167.66 |
| Rate for Payer: Aetna Commercial |
$156.02
|
| Rate for Payer: Aetna Medicare |
$121.09
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$116.43
|
| Rate for Payer: BCN Medicare Advantage |
$116.43
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$167.66
|
| Rate for Payer: Cofinity Commercial |
$156.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.25
|
| Rate for Payer: Nomi Health Commercial |
$139.72
|
| Rate for Payer: PACE SWMI |
$116.43
|
| Rate for Payer: PHP Medicare Advantage |
$116.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health Medicare |
$117.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.43
|
| Rate for Payer: UHC Exchange |
$116.43
|
| Rate for Payer: UHC Medicare Advantage |
$116.43
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Aetna Commercial |
$54.08
|
| Rate for Payer: Aetna Medicare |
$41.97
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$40.36
|
| Rate for Payer: BCN Medicare Advantage |
$40.36
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Cofinity Commercial |
$54.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.38
|
| Rate for Payer: Nomi Health Commercial |
$48.43
|
| Rate for Payer: PACE SWMI |
$40.36
|
| Rate for Payer: PHP Medicare Advantage |
$40.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health Medicare |
$40.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.36
|
| Rate for Payer: UHC Exchange |
$40.36
|
| Rate for Payer: UHC Medicare Advantage |
$40.36
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$59.33 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Aetna Commercial |
$79.50
|
| Rate for Payer: Aetna Medicare |
$61.70
|
| Rate for Payer: BCBS Complete |
$157.20
|
| Rate for Payer: BCBS MAPPO |
$59.33
|
| Rate for Payer: BCN Medicare Advantage |
$59.33
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cofinity Commercial |
$85.44
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.30
|
| Rate for Payer: Nomi Health Commercial |
$71.20
|
| Rate for Payer: PACE SWMI |
$59.33
|
| Rate for Payer: PHP Medicare Advantage |
$59.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.45
|
| Rate for Payer: Priority Health Medicare |
$59.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.33
|
| Rate for Payer: UHC Exchange |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$59.33
|
|
|
PR ENDOBRONCHIAL U/S ADD-ON
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 31620
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: Aetna Medicare |
$232.00
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.60
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna Commercial |
$265.20
|
| Rate for Payer: BCBS Trust/PPO |
$254.69
|
| Rate for Payer: BCN Commercial |
$241.11
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$268.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.60
|
| Rate for Payer: Healthscope Commercial |
$280.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Nomi Health Commercial |
$255.84
|
| Rate for Payer: PHP Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health HMO/PPO |
$271.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.56
|
| Rate for Payer: UHC Core |
$260.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.00
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
57505
|
| Min. Negotiated Rate |
$102.36 |
| Max. Negotiated Rate |
$202.80 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: Aetna Medicare |
$106.45
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$147.40
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Medicare |
$103.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Exchange |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$661.07 |
| Rate for Payer: Aetna Commercial |
$265.20
|
| Rate for Payer: Aetna Medicare |
$81.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.50
|
| Rate for Payer: BCBS Complete |
$661.07
|
| Rate for Payer: BCBS MAPPO |
$78.00
|
| Rate for Payer: BCBS Trust/PPO |
$256.50
|
| Rate for Payer: BCN Commercial |
$242.58
|
| Rate for Payer: BCN Medicare Advantage |
$78.00
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$268.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.00
|
| Rate for Payer: Healthscope Commercial |
$280.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.00
|
| Rate for Payer: Mclaren Medicaid |
$629.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.90
|
| Rate for Payer: Meridian Medicaid |
$661.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Nomi Health Commercial |
$255.84
|
| Rate for Payer: PACE Senior Care Partners |
$74.10
|
| Rate for Payer: PACE SWMI |
$78.00
|
| Rate for Payer: PHP Commercial |
$265.20
|
| Rate for Payer: PHP Medicare Advantage |
$78.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$629.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health HMO/PPO |
$271.44
|
| Rate for Payer: Priority Health Medicare |
$78.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.04
|
| Rate for Payer: Railroad Medicare Medicare |
$78.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.56
|
| Rate for Payer: UHC Core |
$260.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.00
|
| Rate for Payer: UHC Exchange |
$78.00
|
| Rate for Payer: UHC Medicare Advantage |
$78.00
|
| Rate for Payer: UHCCP Medicaid |
$629.55
|
| Rate for Payer: VA VA |
$78.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.00
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57505
|
| Min. Negotiated Rate |
$102.36 |
| Max. Negotiated Rate |
$202.80 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: Aetna Medicare |
$106.45
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$147.40
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Medicare |
$103.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Exchange |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
|
|
PR END OF LIFE COUNSELING
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS S0257
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 92979
|
| Min. Negotiated Rate |
$122.80 |
| Max. Negotiated Rate |
$199.55 |
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: BCBS Complete |
$122.80
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.55
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 92978
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Medicare |
$250.50
|
| Rate for Payer: BCBS Complete |
$200.40
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
|
|
PR ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$2,043.00
|
|
|
Service Code
|
HCPCS 58353
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$1,327.95 |
| Rate for Payer: Aetna Commercial |
$295.13
|
| Rate for Payer: Aetna Medicare |
$229.06
|
| Rate for Payer: BCBS Complete |
$817.20
|
| Rate for Payer: BCBS MAPPO |
$220.25
|
| Rate for Payer: BCN Medicare Advantage |
$220.25
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cofinity Commercial |
$317.16
|
| Rate for Payer: Cofinity Commercial |
$295.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.26
|
| Rate for Payer: Nomi Health Commercial |
$264.30
|
| Rate for Payer: PACE SWMI |
$220.25
|
| Rate for Payer: PHP Medicare Advantage |
$220.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,327.95
|
| Rate for Payer: Priority Health Medicare |
$222.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.25
|
| Rate for Payer: UHC Exchange |
$220.25
|
| Rate for Payer: UHC Medicare Advantage |
$220.25
|
|
|
PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Commercial |
$52.22
|
| Rate for Payer: Aetna Medicare |
$40.53
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$38.97
|
| Rate for Payer: BCN Medicare Advantage |
$38.97
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.92
|
| Rate for Payer: Nomi Health Commercial |
$46.76
|
| Rate for Payer: PACE SWMI |
$38.97
|
| Rate for Payer: PHP Medicare Advantage |
$38.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$39.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.97
|
| Rate for Payer: UHC Exchange |
$38.97
|
| Rate for Payer: UHC Medicare Advantage |
$38.97
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Hospital Charge Code |
58100
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$81.57
|
| Rate for Payer: Aetna Medicare |
$63.30
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$60.87
|
| Rate for Payer: BCN Medicare Advantage |
$60.87
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$87.65
|
| Rate for Payer: Cofinity Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.91
|
| Rate for Payer: Nomi Health Commercial |
$73.04
|
| Rate for Payer: PACE SWMI |
$60.87
|
| Rate for Payer: PHP Medicare Advantage |
$60.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$61.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.87
|
| Rate for Payer: UHC Exchange |
$60.87
|
| Rate for Payer: UHC Medicare Advantage |
$60.87
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$81.57
|
| Rate for Payer: Aetna Medicare |
$63.30
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$60.87
|
| Rate for Payer: BCN Medicare Advantage |
$60.87
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$87.65
|
| Rate for Payer: Cofinity Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.91
|
| Rate for Payer: Nomi Health Commercial |
$73.04
|
| Rate for Payer: PACE SWMI |
$60.87
|
| Rate for Payer: PHP Medicare Advantage |
$60.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$61.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.87
|
| Rate for Payer: UHC Exchange |
$60.87
|
| Rate for Payer: UHC Medicare Advantage |
$60.87
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
58100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.06 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna Medicare |
$55.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.19
|
| Rate for Payer: BCBS Complete |
$152.73
|
| Rate for Payer: BCBS MAPPO |
$53.75
|
| Rate for Payer: BCBS Trust/PPO |
$176.75
|
| Rate for Payer: BCN Commercial |
$167.16
|
| Rate for Payer: BCN Medicare Advantage |
$53.75
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: Mclaren Medicaid |
$145.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.44
|
| Rate for Payer: Meridian Medicaid |
$152.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$176.30
|
| Rate for Payer: PACE Senior Care Partners |
$51.06
|
| Rate for Payer: PACE SWMI |
$53.75
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: PHP Medicare Advantage |
$53.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO |
$187.05
|
| Rate for Payer: Priority Health Medicare |
$54.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.05
|
| Rate for Payer: Railroad Medicare Medicare |
$53.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.20
|
| Rate for Payer: UHC Core |
$179.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.75
|
| Rate for Payer: UHC Exchange |
$53.75
|
| Rate for Payer: UHC Medicare Advantage |
$53.75
|
| Rate for Payer: UHCCP Medicaid |
$145.45
|
| Rate for Payer: VA VA |
$53.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
58100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: BCBS Trust/PPO |
$175.50
|
| Rate for Payer: BCN Commercial |
$166.15
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$176.30
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO |
$187.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.20
|
| Rate for Payer: UHC Core |
$179.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR
|
Professional
|
Both
|
$2,813.00
|
|
|
Service Code
|
HCPCS 58356
|
| Min. Negotiated Rate |
$338.99 |
| Max. Negotiated Rate |
$1,828.45 |
| Rate for Payer: Aetna Commercial |
$454.25
|
| Rate for Payer: Aetna Medicare |
$352.55
|
| Rate for Payer: BCBS Complete |
$1,125.20
|
| Rate for Payer: BCBS MAPPO |
$338.99
|
| Rate for Payer: BCN Medicare Advantage |
$338.99
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cofinity Commercial |
$488.15
|
| Rate for Payer: Cofinity Commercial |
$454.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.94
|
| Rate for Payer: Nomi Health Commercial |
$406.79
|
| Rate for Payer: PACE SWMI |
$338.99
|
| Rate for Payer: PHP Medicare Advantage |
$338.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,828.45
|
| Rate for Payer: Priority Health Medicare |
$342.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.99
|
| Rate for Payer: UHC Exchange |
$338.99
|
| Rate for Payer: UHC Medicare Advantage |
$338.99
|
|
|
PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 43273
|
| Min. Negotiated Rate |
$112.17 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna Commercial |
$150.31
|
| Rate for Payer: Aetna Medicare |
$116.66
|
| Rate for Payer: BCBS Complete |
$187.20
|
| Rate for Payer: BCBS MAPPO |
$112.17
|
| Rate for Payer: BCN Medicare Advantage |
$112.17
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Commercial |
$161.52
|
| Rate for Payer: Cofinity Commercial |
$150.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.78
|
| Rate for Payer: Nomi Health Commercial |
$134.60
|
| Rate for Payer: PACE SWMI |
$112.17
|
| Rate for Payer: PHP Medicare Advantage |
$112.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.20
|
| Rate for Payer: Priority Health Medicare |
$113.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.17
|
| Rate for Payer: UHC Exchange |
$112.17
|
| Rate for Payer: UHC Medicare Advantage |
$112.17
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 44360
|
| Min. Negotiated Rate |
$134.86 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Aetna Commercial |
$180.71
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: BCBS Complete |
$374.00
|
| Rate for Payer: BCBS MAPPO |
$134.86
|
| Rate for Payer: BCN Medicare Advantage |
$134.86
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$194.20
|
| Rate for Payer: Cofinity Commercial |
$180.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.60
|
| Rate for Payer: Nomi Health Commercial |
$161.83
|
| Rate for Payer: PACE SWMI |
$134.86
|
| Rate for Payer: PHP Medicare Advantage |
$134.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.75
|
| Rate for Payer: Priority Health Medicare |
$136.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.86
|
| Rate for Payer: UHC Exchange |
$134.86
|
| Rate for Payer: UHC Medicare Advantage |
$134.86
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 44361
|
| Min. Negotiated Rate |
$149.27 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna Commercial |
$200.02
|
| Rate for Payer: Aetna Medicare |
$155.24
|
| Rate for Payer: BCBS Complete |
$395.20
|
| Rate for Payer: BCBS MAPPO |
$149.27
|
| Rate for Payer: BCN Medicare Advantage |
$149.27
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cofinity Commercial |
$214.95
|
| Rate for Payer: Cofinity Commercial |
$200.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.73
|
| Rate for Payer: Nomi Health Commercial |
$179.12
|
| Rate for Payer: PACE SWMI |
$149.27
|
| Rate for Payer: PHP Medicare Advantage |
$149.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.20
|
| Rate for Payer: Priority Health Medicare |
$150.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.27
|
| Rate for Payer: UHC Exchange |
$149.27
|
| Rate for Payer: UHC Medicare Advantage |
$149.27
|
|
