|
PR HYDROMORPHONE INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J1170
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.40
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR HYDROXYPROGESTERONE CAPROATE
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1725
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| 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 |
$10.50 |
| Rate for Payer: Aetna Commercial |
$10.21
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.95
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
|
|
PR HYMENOTOMY SIMPLE INCISION
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 56442
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$2,246.86 |
| Rate for Payer: Aetna Commercial |
$55.11
|
| Rate for Payer: BCBS Complete |
$31.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,246.86
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Meridian Medicaid |
$31.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.23
|
| Rate for Payer: Priority Health Narrow Network |
$67.23
|
| Rate for Payer: Priority Health SBD |
$67.23
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL
|
Professional
|
Both
|
$8,323.00
|
|
|
Service Code
|
HCPCS 61548
|
| Min. Negotiated Rate |
$712.15 |
| Max. Negotiated Rate |
$5,826.10 |
| Rate for Payer: Aetna Commercial |
$2,027.19
|
| Rate for Payer: BCBS Complete |
$1,065.25
|
| Rate for Payer: BCBS Trust/PPO |
$712.15
|
| Rate for Payer: Cash Price |
$6,658.40
|
| Rate for Payer: Cash Price |
$6,658.40
|
| Rate for Payer: Meridian Medicaid |
$1,065.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,014.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,826.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,671.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,671.45
|
| Rate for Payer: Priority Health SBD |
$2,671.45
|
| Rate for Payer: UMR Bronson Commercial |
$3,828.58
|
|
|
PR HYSTERORRHAPHY RUPTURED UTERUS
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
HCPCS 59350
|
| Min. Negotiated Rate |
$178.07 |
| Max. Negotiated Rate |
$900.20 |
| Rate for Payer: Aetna Commercial |
$307.58
|
| Rate for Payer: BCBS Complete |
$186.97
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: Cash Price |
$1,028.80
|
| Rate for Payer: Cash Price |
$1,028.80
|
| Rate for Payer: Meridian Medicaid |
$186.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.79
|
| Rate for Payer: Priority Health Narrow Network |
$393.79
|
| Rate for Payer: Priority Health SBD |
$393.79
|
| Rate for Payer: UMR Bronson Commercial |
$591.56
|
|
|
PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
HCPCS 58565
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$2,310.00 |
| Rate for Payer: Aetna Commercial |
$542.07
|
| Rate for Payer: BCBS Complete |
$1,320.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,310.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$652.38
|
| Rate for Payer: Priority Health Narrow Network |
$652.38
|
| Rate for Payer: Priority Health SBD |
$652.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,518.00
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna American Axle |
$873.60
|
| Rate for Payer: Aetna Commercial |
$1,142.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.60
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cofinity Commercial |
$1,155.84
|
| Rate for Payer: Cofinity Commercial |
$940.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.20
|
| Rate for Payer: Healthscope Commercial |
$1,209.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$940.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,142.40
|
| Rate for Payer: PHP Commercial |
$1,142.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: Priority Health SBD |
$846.72
|
| Rate for Payer: UMR Bronson Commercial |
$591.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.00
|
|
|
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 |
$940.80 |
| Rate for Payer: Aetna Commercial |
$276.01
|
| Rate for Payer: BCBS Complete |
$154.77
|
| Rate for Payer: BCBS Trust/PPO |
$650.87
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Meridian Medicaid |
$154.77
|
| 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 Narrow Network |
$326.19
|
| Rate for Payer: Priority Health SBD |
$326.19
|
| Rate for Payer: UMR Bronson Commercial |
$618.24
|
|
|
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 |
$226.59 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna American Axle |
$873.60
|
| Rate for Payer: Aetna Commercial |
$1,142.40
|
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,078.05
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| 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: Cofinity Commercial |
$940.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$1,209.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$940.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.00
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,142.40
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$1,142.40
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Priority Health SBD |
$846.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$226.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: UMR Bronson Commercial |
$497.28
|
| Rate for Payer: VA VA |
$2,778.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.00
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
HCPCS 58558
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$276.01
|
| Rate for Payer: BCBS Complete |
$154.77
|
| Rate for Payer: BCBS Trust/PPO |
$650.87
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Meridian Medicaid |
$154.77
|
| 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 Narrow Network |
$326.19
|
| Rate for Payer: Priority Health SBD |
$326.19
|
| Rate for Payer: UMR Bronson Commercial |
$618.24
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$350.68 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Aetna American Axle |
$518.05
|
| Rate for Payer: Aetna Commercial |
$677.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.05
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$557.90
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$557.90
|
| 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 SBD |
$502.11
|
| Rate for Payer: UMR Bronson Commercial |
$350.68
|
| 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 |
$181.23
|
| Rate for Payer: BCBS Complete |
$101.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Meridian Medicaid |
$101.31
|
| 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 Narrow Network |
$213.51
|
| Rate for Payer: Priority Health SBD |
$213.51
|
| Rate for Payer: UMR Bronson Commercial |
$366.62
|
|
|
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 |
$181.23
|
| Rate for Payer: BCBS Complete |
$101.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Meridian Medicaid |
$101.31
|
| 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 Narrow Network |
$213.51
|
| Rate for Payer: Priority Health SBD |
$213.51
|
| Rate for Payer: UMR Bronson Commercial |
$366.62
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna American Axle |
$518.05
|
| Rate for Payer: Aetna Commercial |
$677.45
|
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,606.67
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$557.90
|
| 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 |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$717.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$557.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.75
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$677.45
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$677.45
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Priority Health SBD |
$502.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$148.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: UMR Bronson Commercial |
$294.89
|
| Rate for Payer: VA VA |
$2,778.95
|
| 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 |
$375.75
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS Trust/PPO |
$29.58
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| 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 Narrow Network |
$440.28
|
| Rate for Payer: Priority Health SBD |
$440.28
|
| Rate for Payer: UMR Bronson Commercial |
$754.40
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$240.67 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna American Axle |
$996.45
|
| Rate for Payer: Aetna Commercial |
$1,303.05
|
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,393.91
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| 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: Cofinity Commercial |
$1,073.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,226.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Healthscope Commercial |
$1,379.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,073.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,149.75
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.05
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Commercial |
$1,303.05
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Priority Health SBD |
$965.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$240.67
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: UMR Bronson Commercial |
$567.21
|
| Rate for Payer: VA VA |
$4,421.20
|
| 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 |
$1,073.10 |
| Rate for Payer: Aetna Commercial |
$294.85
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| 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 Narrow Network |
$347.02
|
| Rate for Payer: Priority Health SBD |
$347.02
|
| Rate for Payer: UMR Bronson Commercial |
$705.18
|
|
|
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 |
$1,073.10 |
| Rate for Payer: Aetna Commercial |
$294.85
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| 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 Narrow Network |
$347.02
|
| Rate for Payer: Priority Health SBD |
$347.02
|
| Rate for Payer: UMR Bronson Commercial |
$705.18
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$674.52 |
| Max. Negotiated Rate |
$1,379.70 |
| Rate for Payer: Aetna American Axle |
$996.45
|
| Rate for Payer: Aetna Commercial |
$1,303.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.45
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,073.10
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,073.10
|
| 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 SBD |
$965.79
|
| Rate for Payer: UMR Bronson Commercial |
$674.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,149.75
|
|
|
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 |
$340.58
|
| Rate for Payer: BCBS Complete |
$189.88
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Meridian Medicaid |
$189.88
|
| 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 Narrow Network |
$400.05
|
| Rate for Payer: Priority Health SBD |
$400.05
|
| Rate for Payer: UMR Bronson Commercial |
$683.10
|
|
|
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 |
$265.43
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| 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 Narrow Network |
$312.47
|
| Rate for Payer: Priority Health SBD |
$312.47
|
| Rate for Payer: UMR Bronson Commercial |
$530.84
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$406.12 |
| Max. Negotiated Rate |
$830.70 |
| Rate for Payer: Aetna American Axle |
$599.95
|
| Rate for Payer: Aetna Commercial |
$784.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.95
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$646.10
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$646.10
|
| 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 SBD |
$581.49
|
| Rate for Payer: UMR Bronson Commercial |
$406.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$692.25
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$341.51 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna American Axle |
$599.95
|
| Rate for Payer: Aetna Commercial |
$784.55
|
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,098.13
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$793.78
|
| Rate for Payer: Cofinity Commercial |
$646.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Healthscope Commercial |
$830.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$646.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$692.25
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$784.55
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Commercial |
$784.55
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Priority Health SBD |
$581.49
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$350.36
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: UMR Bronson Commercial |
$341.51
|
| Rate for Payer: VA VA |
$4,421.20
|
| 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 |
$428.81
|
| Rate for Payer: BCBS Complete |
$239.31
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| 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 Narrow Network |
$504.20
|
| Rate for Payer: Priority Health SBD |
$504.20
|
| Rate for Payer: UMR Bronson Commercial |
$424.58
|
|
