|
PR HYDROXYPROGESTERONE CAPROATE
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1725
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
|
|
PR HYDROXYZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J3410
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: Aetna Commercial |
$22.68
|
| Rate for Payer: Aetna Medicare |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.38
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$16.93
|
| Rate for Payer: BCBS Trust/PPO |
$5.95
|
| Rate for Payer: BCN Commercial |
$7.98
|
| Rate for Payer: BCN Medicare Advantage |
$16.93
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$24.38
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.77
|
| Rate for Payer: Nomi Health Commercial |
$20.31
|
| Rate for Payer: PACE SWMI |
$16.93
|
| Rate for Payer: PHP Commercial |
$23.70
|
| Rate for Payer: PHP Medicare Advantage |
$16.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$16.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.93
|
| Rate for Payer: UHC Medicare Advantage |
$16.93
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
|
|
PR HYMENOTOMY SIMPLE INCISION
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 56442
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$2,246.86 |
| Rate for Payer: Aetna Commercial |
$61.36
|
| Rate for Payer: Aetna Medicare |
$47.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.94
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS MAPPO |
$45.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,246.86
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: BCN Medicare Advantage |
$45.79
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.08
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Nomi Health Commercial |
$54.95
|
| Rate for Payer: PACE SWMI |
$45.79
|
| Rate for Payer: PHP Commercial |
$64.11
|
| Rate for Payer: PHP Medicare Advantage |
$45.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.93
|
| Rate for Payer: Priority Health Medicare |
$45.79
|
| Rate for Payer: Priority Health Narrow Network |
$70.93
|
| Rate for Payer: Priority Health SBD |
$70.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.79
|
| Rate for Payer: UHC Medicare Advantage |
$45.79
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
| Rate for Payer: UMR Bronson Commercial |
$71.76
|
|
|
PR HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL
|
Professional
|
Both
|
$8,489.00
|
|
|
Service Code
|
HCPCS 61548
|
| Min. Negotiated Rate |
$712.15 |
| Max. Negotiated Rate |
$5,517.85 |
| Rate for Payer: Aetna Commercial |
$2,068.64
|
| Rate for Payer: Aetna Medicare |
$1,605.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,068.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,223.01
|
| Rate for Payer: BCBS Complete |
$1,068.83
|
| Rate for Payer: BCBS MAPPO |
$1,543.76
|
| Rate for Payer: BCBS Trust/PPO |
$712.15
|
| Rate for Payer: BCN Commercial |
$3,198.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,543.76
|
| Rate for Payer: Cash Price |
$6,791.20
|
| Rate for Payer: Cash Price |
$6,791.20
|
| Rate for Payer: Cofinity Commercial |
$2,068.64
|
| Rate for Payer: Cofinity Commercial |
$2,223.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,543.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,620.95
|
| Rate for Payer: Meridian Medicaid |
$1,068.83
|
| Rate for Payer: Nomi Health Commercial |
$1,852.51
|
| Rate for Payer: PACE SWMI |
$1,543.76
|
| Rate for Payer: PHP Commercial |
$2,161.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,543.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,517.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,708.79
|
| Rate for Payer: Priority Health Medicare |
$1,543.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,708.79
|
| Rate for Payer: Priority Health SBD |
$2,708.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,543.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,543.76
|
| Rate for Payer: UHCCP Medicaid |
$1,017.93
|
| Rate for Payer: UMR Bronson Commercial |
$3,904.94
|
|
|
PR HYSTERORRHAPHY RUPTURED UTERUS
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 59350
|
| Min. Negotiated Rate |
$177.64 |
| Max. Negotiated Rate |
$852.80 |
| Rate for Payer: Aetna Commercial |
$365.40
|
| Rate for Payer: Aetna Medicare |
$283.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.67
|
| Rate for Payer: BCBS Complete |
$186.52
|
| Rate for Payer: BCBS MAPPO |
$272.69
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: BCN Commercial |
$407.56
|
| Rate for Payer: BCN Medicare Advantage |
$272.69
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cofinity Commercial |
$392.67
|
| Rate for Payer: Cofinity Commercial |
$365.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.32
|
| Rate for Payer: Meridian Medicaid |
$186.52
|
| Rate for Payer: Nomi Health Commercial |
$327.23
|
| Rate for Payer: PACE SWMI |
$272.69
|
| Rate for Payer: PHP Commercial |
$381.77
|
| Rate for Payer: PHP Medicare Advantage |
$272.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.37
|
| Rate for Payer: Priority Health Medicare |
$272.69
|
| Rate for Payer: Priority Health Narrow Network |
$389.37
|
| Rate for Payer: Priority Health SBD |
$389.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.69
|
| Rate for Payer: UHC Medicare Advantage |
$272.69
|
| Rate for Payer: UHCCP Medicaid |
$177.64
|
| Rate for Payer: UMR Bronson Commercial |
$603.52
|
|
|
PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS
|
Professional
|
Both
|
$3,366.00
|
|
|
Service Code
|
HCPCS 58565
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$2,480.04 |
| Rate for Payer: Aetna Commercial |
$584.60
|
| Rate for Payer: Aetna Medicare |
$453.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.23
|
| Rate for Payer: BCBS Complete |
$1,346.40
|
| Rate for Payer: BCBS MAPPO |
$436.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2,480.04
|
| Rate for Payer: BCN Medicare Advantage |
$436.27
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cofinity Commercial |
$628.23
|
| Rate for Payer: Cofinity Commercial |
$584.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.08
|
| Rate for Payer: Nomi Health Commercial |
$523.52
|
| Rate for Payer: PACE SWMI |
$436.27
|
| Rate for Payer: PHP Commercial |
$610.78
|
| Rate for Payer: PHP Medicare Advantage |
$436.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.53
|
| Rate for Payer: Priority Health Medicare |
$436.27
|
| Rate for Payer: Priority Health Narrow Network |
$686.53
|
| Rate for Payer: Priority Health SBD |
$686.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.27
|
| Rate for Payer: UHC Medicare Advantage |
$436.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,548.36
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 58558
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$1,979.15 |
| Rate for Payer: Aetna Commercial |
$298.19
|
| Rate for Payer: Aetna Medicare |
$231.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.44
|
| Rate for Payer: BCBS Complete |
$155.21
|
| Rate for Payer: BCBS MAPPO |
$222.53
|
| Rate for Payer: BCBS Trust/PPO |
$650.87
|
| Rate for Payer: BCN Commercial |
$1,979.15
|
| 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 |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.66
|
| Rate for Payer: Meridian Medicaid |
$155.21
|
| Rate for Payer: Nomi Health Commercial |
$267.04
|
| Rate for Payer: PACE SWMI |
$222.53
|
| Rate for Payer: PHP Commercial |
$311.54
|
| Rate for Payer: PHP Medicare Advantage |
$222.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.27
|
| Rate for Payer: Priority Health Medicare |
$222.53
|
| Rate for Payer: Priority Health Narrow Network |
$343.27
|
| Rate for Payer: Priority Health SBD |
$343.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.53
|
| Rate for Payer: UHC Medicare Advantage |
$222.53
|
| Rate for Payer: UHCCP Medicaid |
$147.82
|
| Rate for Payer: UMR Bronson Commercial |
$630.66
|
|
|
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 |
$147.82 |
| Max. Negotiated Rate |
$1,979.15 |
| Rate for Payer: Aetna Commercial |
$298.19
|
| Rate for Payer: Aetna Medicare |
$231.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.44
|
| Rate for Payer: BCBS Complete |
$155.21
|
| Rate for Payer: BCBS MAPPO |
$222.53
|
| Rate for Payer: BCBS Trust/PPO |
$650.87
|
| Rate for Payer: BCN Commercial |
$1,979.15
|
| 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 |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.66
|
| Rate for Payer: Meridian Medicaid |
$155.21
|
| Rate for Payer: Nomi Health Commercial |
$267.04
|
| Rate for Payer: PACE SWMI |
$222.53
|
| Rate for Payer: PHP Commercial |
$311.54
|
| Rate for Payer: PHP Medicare Advantage |
$222.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.27
|
| Rate for Payer: Priority Health Medicare |
$222.53
|
| Rate for Payer: Priority Health Narrow Network |
$343.27
|
| Rate for Payer: Priority Health SBD |
$343.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.53
|
| Rate for Payer: UHC Medicare Advantage |
$222.53
|
| Rate for Payer: UHCCP Medicaid |
$147.82
|
| Rate for Payer: UMR Bronson Commercial |
$630.66
|
|
|
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 |
$603.24 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Aetna American Axle |
$891.15
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$959.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,028.25
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$603.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,028.25
|
|
|
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 |
$224.67 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna American Axle |
$891.15
|
| Rate for Payer: Aetna Commercial |
$1,165.35
|
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,228.30
|
| Rate for Payer: BCN Commercial |
$3,228.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$1,096.80
|
| 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 |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$1,233.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$959.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,028.25
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,165.35
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$1,165.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Priority Health SBD |
$863.73
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.14
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$224.67
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: UMR Bronson Commercial |
$507.27
|
| Rate for Payer: VA VA |
$3,115.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,028.25
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$1,037.58 |
| Rate for Payer: Aetna Commercial |
$196.02
|
| Rate for Payer: Aetna Medicare |
$152.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.64
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$146.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$536.08
|
| 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 |
$196.02
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.59
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Nomi Health Commercial |
$175.54
|
| Rate for Payer: PACE SWMI |
$146.28
|
| Rate for Payer: PHP Commercial |
$204.79
|
| Rate for Payer: PHP Medicare Advantage |
$146.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.71
|
| Rate for Payer: Priority Health Medicare |
$146.28
|
| Rate for Payer: Priority Health Narrow Network |
$224.71
|
| Rate for Payer: Priority Health SBD |
$224.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.28
|
| Rate for Payer: UHC Medicare Advantage |
$146.28
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
| Rate for Payer: UMR Bronson Commercial |
$373.98
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$146.63 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna American Axle |
$528.45
|
| Rate for Payer: Aetna Commercial |
$691.05
|
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,685.09
|
| Rate for Payer: BCN Commercial |
$1,685.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$650.40
|
| 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 |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$731.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$569.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$609.75
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.05
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$691.05
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Priority Health SBD |
$512.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.29
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$146.63
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: UMR Bronson Commercial |
$300.81
|
| Rate for Payer: VA VA |
$3,115.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$609.75
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 58555
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$1,037.58 |
| Rate for Payer: Aetna Commercial |
$196.02
|
| Rate for Payer: Aetna Medicare |
$152.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.64
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$146.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$536.08
|
| 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 |
$196.02
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.59
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Nomi Health Commercial |
$175.54
|
| Rate for Payer: PACE SWMI |
$146.28
|
| Rate for Payer: PHP Commercial |
$204.79
|
| Rate for Payer: PHP Medicare Advantage |
$146.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.71
|
| Rate for Payer: Priority Health Medicare |
$146.28
|
| Rate for Payer: Priority Health Narrow Network |
$224.71
|
| Rate for Payer: Priority Health SBD |
$224.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.28
|
| Rate for Payer: UHC Medicare Advantage |
$146.28
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
| Rate for Payer: UMR Bronson Commercial |
$373.98
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$357.72 |
| Max. Negotiated Rate |
$731.70 |
| Rate for Payer: Aetna American Axle |
$528.45
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$569.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$609.75
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$357.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$609.75
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,673.00
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$29.58 |
| 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) |
$402.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.43
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$300.30
|
| Rate for Payer: BCBS Trust/PPO |
$29.58
|
| Rate for Payer: BCN Commercial |
$454.47
|
| 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 |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$432.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.32
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Nomi Health Commercial |
$360.36
|
| Rate for Payer: PACE SWMI |
$300.30
|
| Rate for Payer: PHP Commercial |
$420.42
|
| Rate for Payer: PHP Medicare Advantage |
$300.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$463.81
|
| Rate for Payer: Priority Health Medicare |
$300.30
|
| Rate for Payer: Priority Health Narrow Network |
$463.81
|
| Rate for Payer: Priority Health SBD |
$463.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.30
|
| Rate for Payer: UHC Medicare Advantage |
$300.30
|
| Rate for Payer: UHCCP Medicaid |
$199.16
|
| Rate for Payer: UMR Bronson Commercial |
$769.58
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$238.71 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna American Axle |
$1,016.60
|
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,559.58
|
| Rate for Payer: BCN Commercial |
$3,559.58
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Cash Price |
$1,251.20
|
| 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 |
$4,836.63
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,094.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,173.00
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Priority Health SBD |
$985.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.58
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$238.71
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: UMR Bronson Commercial |
$578.68
|
| Rate for Payer: VA VA |
$4,836.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,173.00
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$688.16 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Aetna American Axle |
$1,016.60
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,094.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,173.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$688.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,173.00
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$3,149.52 |
| Rate for Payer: Aetna Commercial |
$316.27
|
| Rate for Payer: Aetna Medicare |
$245.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.87
|
| Rate for Payer: BCBS Complete |
$164.61
|
| Rate for Payer: BCBS MAPPO |
$236.02
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$3,149.52
|
| 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 |
$316.27
|
| Rate for Payer: Cofinity Commercial |
$339.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.82
|
| Rate for Payer: Meridian Medicaid |
$164.61
|
| Rate for Payer: Nomi Health Commercial |
$283.22
|
| Rate for Payer: PACE SWMI |
$236.02
|
| Rate for Payer: PHP Commercial |
$330.43
|
| Rate for Payer: PHP Medicare Advantage |
$236.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.59
|
| Rate for Payer: Priority Health Medicare |
$236.02
|
| Rate for Payer: Priority Health Narrow Network |
$364.59
|
| Rate for Payer: Priority Health SBD |
$364.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.02
|
| Rate for Payer: UHC Medicare Advantage |
$236.02
|
| Rate for Payer: UHCCP Medicaid |
$156.77
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$3,149.52 |
| Rate for Payer: Aetna Commercial |
$316.27
|
| Rate for Payer: Aetna Medicare |
$245.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.87
|
| Rate for Payer: BCBS Complete |
$164.61
|
| Rate for Payer: BCBS MAPPO |
$236.02
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$3,149.52
|
| 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 |
$316.27
|
| Rate for Payer: Cofinity Commercial |
$339.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.82
|
| Rate for Payer: Meridian Medicaid |
$164.61
|
| Rate for Payer: Nomi Health Commercial |
$283.22
|
| Rate for Payer: PACE SWMI |
$236.02
|
| Rate for Payer: PHP Commercial |
$330.43
|
| Rate for Payer: PHP Medicare Advantage |
$236.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.59
|
| Rate for Payer: Priority Health Medicare |
$236.02
|
| Rate for Payer: Priority Health Narrow Network |
$364.59
|
| Rate for Payer: Priority Health SBD |
$364.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.02
|
| Rate for Payer: UHC Medicare Advantage |
$236.02
|
| Rate for Payer: UHCCP Medicaid |
$156.77
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 58559
|
| Min. Negotiated Rate |
$180.84 |
| 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) |
$365.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.43
|
| Rate for Payer: BCBS Complete |
$189.88
|
| Rate for Payer: BCBS MAPPO |
$272.52
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$412.93
|
| 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 |
$365.18
|
| Rate for Payer: Cofinity Commercial |
$392.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.15
|
| Rate for Payer: Meridian Medicaid |
$189.88
|
| Rate for Payer: Nomi Health Commercial |
$327.02
|
| Rate for Payer: PACE SWMI |
$272.52
|
| Rate for Payer: PHP Commercial |
$381.53
|
| Rate for Payer: PHP Medicare Advantage |
$272.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.14
|
| Rate for Payer: Priority Health Medicare |
$272.52
|
| Rate for Payer: Priority Health Narrow Network |
$421.14
|
| Rate for Payer: Priority Health SBD |
$421.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.52
|
| Rate for Payer: UHC Medicare Advantage |
$272.52
|
| Rate for Payer: UHCCP Medicaid |
$180.84
|
| Rate for Payer: UMR Bronson Commercial |
$696.90
|
|
|
PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS 58562
|
| Min. Negotiated Rate |
$13.74 |
| 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) |
$284.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.97
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS MAPPO |
$212.48
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCN Commercial |
$639.19
|
| 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 |
$284.72
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.10
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Nomi Health Commercial |
$254.98
|
| Rate for Payer: PACE SWMI |
$212.48
|
| Rate for Payer: PHP Commercial |
$297.47
|
| Rate for Payer: PHP Medicare Advantage |
$212.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.88
|
| Rate for Payer: Priority Health Medicare |
$212.48
|
| Rate for Payer: Priority Health Narrow Network |
$328.88
|
| Rate for Payer: Priority Health SBD |
$328.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.48
|
| Rate for Payer: UHC Medicare Advantage |
$212.48
|
| Rate for Payer: UHCCP Medicaid |
$141.22
|
| Rate for Payer: UMR Bronson Commercial |
$541.42
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$414.04 |
| Max. Negotiated Rate |
$846.90 |
| Rate for Payer: Aetna American Axle |
$611.65
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$658.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.75
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$414.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.75
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 58561
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$611.65 |
| 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 |
$239.31
|
| Rate for Payer: BCBS MAPPO |
$343.71
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$520.44
|
| 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 |
$460.57
|
| Rate for Payer: Cofinity Commercial |
$494.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.90
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| Rate for Payer: Nomi Health Commercial |
$412.45
|
| Rate for Payer: PACE SWMI |
$343.71
|
| Rate for Payer: PHP Commercial |
$481.19
|
| Rate for Payer: PHP Medicare Advantage |
$343.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.78
|
| Rate for Payer: Priority Health Medicare |
$343.71
|
| Rate for Payer: Priority Health Narrow Network |
$530.78
|
| Rate for Payer: Priority Health SBD |
$530.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.71
|
| Rate for Payer: UHC Medicare Advantage |
$343.71
|
| Rate for Payer: UHCCP Medicaid |
$227.91
|
| Rate for Payer: UMR Bronson Commercial |
$432.86
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$348.11 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna American Axle |
$611.65
|
| Rate for Payer: Aetna Commercial |
$799.85
|
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,298.17
|
| Rate for Payer: BCN Commercial |
$4,298.17
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Cash Price |
$752.80
|
| 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 |
$4,836.63
|
| Rate for Payer: Healthscope Commercial |
$846.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$658.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.75
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.85
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Commercial |
$799.85
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Priority Health SBD |
$592.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.92
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$348.11
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: UMR Bronson Commercial |
$348.17
|
| Rate for Payer: VA VA |
$4,836.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.75
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$611.65 |
| 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 |
$239.31
|
| Rate for Payer: BCBS MAPPO |
$343.71
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$520.44
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.90
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| Rate for Payer: Nomi Health Commercial |
$412.45
|
| Rate for Payer: PACE SWMI |
$343.71
|
| Rate for Payer: PHP Commercial |
$481.19
|
| Rate for Payer: PHP Medicare Advantage |
$343.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.78
|
| Rate for Payer: Priority Health Medicare |
$343.71
|
| Rate for Payer: Priority Health Narrow Network |
$530.78
|
| Rate for Payer: Priority Health SBD |
$530.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.71
|
| Rate for Payer: UHC Medicare Advantage |
$343.71
|
| Rate for Payer: UHCCP Medicaid |
$227.91
|
| Rate for Payer: UMR Bronson Commercial |
$432.86
|
|
