|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 99239
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$1,216.15 |
| Rate for Payer: Aetna Commercial |
$150.20
|
| Rate for Payer: Aetna Medicare |
$112.09
|
| Rate for Payer: BCBS Complete |
$76.04
|
| Rate for Payer: BCBS MAPPO |
$112.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.15
|
| Rate for Payer: BCN Commercial |
$165.66
|
| Rate for Payer: BCN Medicare Advantage |
$112.09
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$150.20
|
| Rate for Payer: Cofinity Commercial |
$161.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.09
|
| Rate for Payer: Healthscope Commercial |
$123.30
|
| Rate for Payer: Healthscope Whirlpool |
$123.30
|
| Rate for Payer: Meridian Medicaid |
$76.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.69
|
| Rate for Payer: PACE SWMI |
$112.09
|
| Rate for Payer: PHP Medicare Advantage |
$112.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.20
|
| Rate for Payer: Priority Health Medicare |
$112.09
|
| Rate for Payer: Priority Health Narrow Network |
$145.20
|
| Rate for Payer: UHC Medicare Advantage |
$115.45
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 99238
|
| Min. Negotiated Rate |
$51.33 |
| Max. Negotiated Rate |
$255.17 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: Aetna Medicare |
$78.92
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: BCBS MAPPO |
$78.92
|
| Rate for Payer: BCBS Trust/PPO |
$255.17
|
| Rate for Payer: BCN Commercial |
$116.79
|
| Rate for Payer: BCN Medicare Advantage |
$78.92
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$113.64
|
| Rate for Payer: Cofinity Commercial |
$105.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.92
|
| Rate for Payer: Healthscope Commercial |
$86.81
|
| Rate for Payer: Healthscope Whirlpool |
$86.81
|
| Rate for Payer: Meridian Medicaid |
$53.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.87
|
| Rate for Payer: PACE SWMI |
$78.92
|
| Rate for Payer: PHP Medicare Advantage |
$78.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.37
|
| Rate for Payer: Priority Health Medicare |
$78.92
|
| Rate for Payer: Priority Health Narrow Network |
$102.37
|
| Rate for Payer: UHC Medicare Advantage |
$81.29
|
|
|
PR HO W/O JOINTS CF
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS L3919
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$234.03 |
| Rate for Payer: Aetna Commercial |
$148.45
|
| Rate for Payer: BCBS Complete |
$99.20
|
| Rate for Payer: BCN Commercial |
$234.03
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.60
|
|
|
PR HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY
|
Professional
|
Both
|
$1,159.00
|
|
|
Service Code
|
HCPCS 46258
|
| Min. Negotiated Rate |
$311.62 |
| Max. Negotiated Rate |
$1,432.75 |
| Rate for Payer: Aetna Commercial |
$636.89
|
| Rate for Payer: Aetna Medicare |
$475.29
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$475.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.75
|
| Rate for Payer: BCN Commercial |
$707.61
|
| Rate for Payer: BCN Medicare Advantage |
$475.29
|
| Rate for Payer: Cash Price |
$927.20
|
| Rate for Payer: Cash Price |
$927.20
|
| Rate for Payer: Cofinity Commercial |
$636.89
|
| Rate for Payer: Cofinity Commercial |
$684.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.29
|
| Rate for Payer: Healthscope Commercial |
$570.35
|
| Rate for Payer: Healthscope Whirlpool |
$570.35
|
| Rate for Payer: Meridian Medicaid |
$327.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$499.05
|
| Rate for Payer: PACE SWMI |
$475.29
|
| Rate for Payer: PHP Medicare Advantage |
$475.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$311.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$811.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$851.39
|
| Rate for Payer: Priority Health Medicare |
$475.29
|
| Rate for Payer: Priority Health Narrow Network |
$851.39
|
| Rate for Payer: UHC Medicare Advantage |
$489.55
|
|
|
PR HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY
|
Professional
|
Both
|
$1,740.00
|
|
|
Service Code
|
HCPCS 46262
|
| Min. Negotiated Rate |
$236.15 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$777.01
|
| Rate for Payer: Aetna Medicare |
$579.86
|
| Rate for Payer: BCBS Complete |
$396.53
|
| Rate for Payer: BCBS MAPPO |
$579.86
|
| Rate for Payer: BCBS Trust/PPO |
$236.15
|
| Rate for Payer: BCN Commercial |
$862.52
|
| Rate for Payer: BCN Medicare Advantage |
$579.86
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cofinity Commercial |
$835.00
|
| Rate for Payer: Cofinity Commercial |
$777.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$579.86
|
| Rate for Payer: Healthscope Commercial |
$695.83
|
| Rate for Payer: Healthscope Whirlpool |
$695.83
|
| Rate for Payer: Meridian Medicaid |
$396.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$608.85
|
| Rate for Payer: PACE SWMI |
$579.86
|
| Rate for Payer: PHP Medicare Advantage |
$579.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,037.77
|
| Rate for Payer: Priority Health Medicare |
$579.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,037.77
|
| Rate for Payer: UHC Medicare Advantage |
$597.26
|
|
|
PR HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 46261
|
| Min. Negotiated Rate |
$131.02 |
| Max. Negotiated Rate |
$1,188.60 |
| Rate for Payer: Aetna Commercial |
$699.02
|
| Rate for Payer: Aetna Medicare |
$521.66
|
| Rate for Payer: BCBS Complete |
$360.30
|
| Rate for Payer: BCBS MAPPO |
$521.66
|
| Rate for Payer: BCBS Trust/PPO |
$131.02
|
| Rate for Payer: BCN Commercial |
$776.51
|
| Rate for Payer: BCN Medicare Advantage |
$521.66
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cofinity Commercial |
$699.02
|
| Rate for Payer: Cofinity Commercial |
$751.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$521.66
|
| Rate for Payer: Healthscope Commercial |
$625.99
|
| Rate for Payer: Healthscope Whirlpool |
$625.99
|
| Rate for Payer: Meridian Medicaid |
$360.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$547.74
|
| Rate for Payer: PACE SWMI |
$521.66
|
| Rate for Payer: PHP Medicare Advantage |
$521.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,188.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$934.29
|
| Rate for Payer: Priority Health Medicare |
$521.66
|
| Rate for Payer: Priority Health Narrow Network |
$934.29
|
| Rate for Payer: UHC Medicare Advantage |
$537.31
|
|
|
PR HYALGAN SUPARTZ VISCO-3 DOSE
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS J7321
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna Commercial |
$98.46
|
| Rate for Payer: Aetna Medicare |
$73.48
|
| Rate for Payer: BCBS Complete |
$118.80
|
| Rate for Payer: BCBS MAPPO |
$73.48
|
| Rate for Payer: BCBS Trust/PPO |
$64.00
|
| Rate for Payer: BCN Commercial |
$76.58
|
| Rate for Payer: BCN Medicare Advantage |
$73.48
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cofinity Commercial |
$98.46
|
| Rate for Payer: Cofinity Commercial |
$105.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.48
|
| Rate for Payer: Healthscope Commercial |
$88.18
|
| Rate for Payer: Healthscope Whirlpool |
$88.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.15
|
| Rate for Payer: PACE SWMI |
$73.48
|
| Rate for Payer: PHP Medicare Advantage |
$73.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.90
|
| Rate for Payer: Priority Health Medicare |
$73.48
|
| Rate for Payer: UHC Medicare Advantage |
$75.68
|
|
|
PR HYDROCORTISONE SODIUM SUCC I
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1720
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Aetna Commercial |
$23.47
|
| Rate for Payer: Aetna Medicare |
$17.51
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$17.51
|
| Rate for Payer: BCBS Trust/PPO |
$16.18
|
| Rate for Payer: BCN Commercial |
$16.11
|
| Rate for Payer: BCN Medicare Advantage |
$17.51
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.51
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Healthscope Whirlpool |
$21.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.39
|
| Rate for Payer: PACE SWMI |
$17.51
|
| Rate for Payer: PHP Medicare Advantage |
$17.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$17.51
|
| Rate for Payer: UHC Medicare Advantage |
$18.04
|
|
|
PR HYDROMORPHONE INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J1170
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Aetna Commercial |
$5.82
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$4.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.40
|
| Rate for Payer: BCN Commercial |
$0.24
|
| Rate for Payer: BCN Medicare Advantage |
$4.35
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$6.26
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.35
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Healthscope Whirlpool |
$5.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.56
|
| Rate for Payer: PACE SWMI |
$4.35
|
| Rate for Payer: PHP Medicare Advantage |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$4.48
|
|
|
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
|
|
|
PR HYDROXYZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J3410
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$19.62 |
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna Medicare |
$13.62
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$13.62
|
| Rate for Payer: BCBS Trust/PPO |
$5.95
|
| Rate for Payer: BCN Commercial |
$7.98
|
| Rate for Payer: BCN Medicare Advantage |
$13.62
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.62
|
| Rate for Payer: Healthscope Commercial |
$16.35
|
| Rate for Payer: Healthscope Whirlpool |
$16.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.30
|
| Rate for Payer: PACE SWMI |
$13.62
|
| Rate for Payer: PHP Medicare Advantage |
$13.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health Medicare |
$13.62
|
| Rate for Payer: UHC Medicare Advantage |
$14.03
|
|
|
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 |
$62.39
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: BCBS Complete |
$31.98
|
| Rate for Payer: BCBS MAPPO |
$46.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,246.86
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: BCN Medicare Advantage |
$46.56
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$62.39
|
| Rate for Payer: Cofinity Commercial |
$67.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.56
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Whirlpool |
$55.87
|
| Rate for Payer: Meridian Medicaid |
$31.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.89
|
| Rate for Payer: PACE SWMI |
$46.56
|
| Rate for Payer: PHP Medicare Advantage |
$46.56
|
| 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 Medicare |
$46.56
|
| Rate for Payer: Priority Health Narrow Network |
$67.23
|
| Rate for Payer: UHC Medicare Advantage |
$47.96
|
|
|
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 |
$2,105.35
|
| Rate for Payer: Aetna Medicare |
$1,571.16
|
| Rate for Payer: BCBS Complete |
$1,065.25
|
| Rate for Payer: BCBS MAPPO |
$1,571.16
|
| Rate for Payer: BCBS Trust/PPO |
$712.15
|
| Rate for Payer: BCN Commercial |
$3,198.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,571.16
|
| Rate for Payer: Cash Price |
$6,658.40
|
| Rate for Payer: Cash Price |
$6,658.40
|
| Rate for Payer: Cofinity Commercial |
$2,262.47
|
| Rate for Payer: Cofinity Commercial |
$2,105.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,571.16
|
| Rate for Payer: Healthscope Commercial |
$1,885.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,885.39
|
| Rate for Payer: Meridian Medicaid |
$1,065.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,649.72
|
| Rate for Payer: PACE SWMI |
$1,571.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,571.16
|
| 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 Medicare |
$1,571.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,671.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,618.29
|
|
|
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 |
$376.14
|
| Rate for Payer: Aetna Medicare |
$280.70
|
| Rate for Payer: BCBS Complete |
$186.97
|
| Rate for Payer: BCBS MAPPO |
$280.70
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: BCN Commercial |
$407.56
|
| Rate for Payer: BCN Medicare Advantage |
$280.70
|
| Rate for Payer: Cash Price |
$1,028.80
|
| Rate for Payer: Cash Price |
$1,028.80
|
| Rate for Payer: Cofinity Commercial |
$404.21
|
| Rate for Payer: Cofinity Commercial |
$376.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.70
|
| Rate for Payer: Healthscope Commercial |
$336.84
|
| Rate for Payer: Healthscope Whirlpool |
$336.84
|
| Rate for Payer: Meridian Medicaid |
$186.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$294.74
|
| Rate for Payer: PACE SWMI |
$280.70
|
| Rate for Payer: PHP Medicare Advantage |
$280.70
|
| 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 Medicare |
$280.70
|
| Rate for Payer: Priority Health Narrow Network |
$393.79
|
| Rate for Payer: UHC Medicare Advantage |
$289.12
|
|
|
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 |
$2,480.04 |
| Rate for Payer: Aetna Commercial |
$607.66
|
| Rate for Payer: Aetna Medicare |
$453.48
|
| Rate for Payer: BCBS Complete |
$1,320.00
|
| Rate for Payer: BCBS MAPPO |
$453.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2,480.04
|
| Rate for Payer: BCN Medicare Advantage |
$453.48
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cofinity Commercial |
$607.66
|
| Rate for Payer: Cofinity Commercial |
$653.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.48
|
| Rate for Payer: Healthscope Commercial |
$544.18
|
| Rate for Payer: Healthscope Whirlpool |
$544.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$476.15
|
| Rate for Payer: PACE SWMI |
$453.48
|
| Rate for Payer: PHP Medicare Advantage |
$453.48
|
| 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 Medicare |
$453.48
|
| Rate for Payer: Priority Health Narrow Network |
$652.38
|
| Rate for Payer: UHC Medicare Advantage |
$467.08
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
58558
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$1,979.15 |
| Rate for Payer: Aetna Commercial |
$307.05
|
| Rate for Payer: Aetna Medicare |
$229.14
|
| Rate for Payer: BCBS Complete |
$154.77
|
| Rate for Payer: BCBS MAPPO |
$229.14
|
| Rate for Payer: BCBS Trust/PPO |
$650.87
|
| Rate for Payer: BCN Commercial |
$1,979.15
|
| Rate for Payer: BCN Medicare Advantage |
$229.14
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Cofinity Commercial |
$329.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.14
|
| Rate for Payer: Healthscope Commercial |
$274.97
|
| Rate for Payer: Healthscope Whirlpool |
$274.97
|
| Rate for Payer: Meridian Medicaid |
$154.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$240.60
|
| Rate for Payer: PACE SWMI |
$229.14
|
| Rate for Payer: PHP Medicare Advantage |
$229.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.19
|
| Rate for Payer: Priority Health Medicare |
$229.14
|
| Rate for Payer: Priority Health Narrow Network |
$326.19
|
| Rate for Payer: UHC Medicare Advantage |
$236.01
|
|
|
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 |
$1,979.15 |
| Rate for Payer: Aetna Commercial |
$307.05
|
| Rate for Payer: Aetna Medicare |
$229.14
|
| Rate for Payer: BCBS Complete |
$154.77
|
| Rate for Payer: BCBS MAPPO |
$229.14
|
| Rate for Payer: BCBS Trust/PPO |
$650.87
|
| Rate for Payer: BCN Commercial |
$1,979.15
|
| Rate for Payer: BCN Medicare Advantage |
$229.14
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cofinity Commercial |
$329.96
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.14
|
| Rate for Payer: Healthscope Commercial |
$274.97
|
| Rate for Payer: Healthscope Whirlpool |
$274.97
|
| Rate for Payer: Meridian Medicaid |
$154.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$240.60
|
| Rate for Payer: PACE SWMI |
$229.14
|
| Rate for Payer: PHP Medicare Advantage |
$229.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.19
|
| Rate for Payer: Priority Health Medicare |
$229.14
|
| Rate for Payer: Priority Health Narrow Network |
$326.19
|
| Rate for Payer: UHC Medicare Advantage |
$236.01
|
|
|
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 |
$940.80 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,209.60
|
| Rate for Payer: ASR ASR |
$1,303.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.00
|
| Rate for Payer: BCN Commercial |
$1,042.00
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cofinity Commercial |
$1,263.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.20
|
| Rate for Payer: Healthscope Commercial |
$1,344.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,303.68
|
| Rate for Payer: Mclaren Commercial |
$1,209.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,142.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,182.72
|
|
|
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 |
$940.80 |
| Max. Negotiated Rate |
$3,473.69 |
| Rate for Payer: Aetna Commercial |
$1,209.60
|
| Rate for Payer: Aetna Medicare |
$2,778.95
|
| 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: ASR ASR |
$1,303.68
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.00
|
| Rate for Payer: BCN Commercial |
$1,042.00
|
| 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 |
$1,263.36
|
| 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 |
$1,344.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,303.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,778.95
|
| Rate for Payer: Mclaren Commercial |
$1,209.60
|
| 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 |
$3,056.84
|
| Rate for Payer: PHP Medicaid |
$1,520.09
|
| 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 |
$1,223.04
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$954.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,182.72
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$1,037.58 |
| Rate for Payer: Aetna Commercial |
$200.57
|
| Rate for Payer: Aetna Medicare |
$149.68
|
| Rate for Payer: BCBS Complete |
$101.31
|
| Rate for Payer: BCBS MAPPO |
$149.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$536.08
|
| Rate for Payer: BCN Medicare Advantage |
$149.68
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$215.54
|
| Rate for Payer: Cofinity Commercial |
$200.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.68
|
| Rate for Payer: Healthscope Commercial |
$179.62
|
| Rate for Payer: Healthscope Whirlpool |
$179.62
|
| Rate for Payer: Meridian Medicaid |
$101.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.16
|
| Rate for Payer: PACE SWMI |
$149.68
|
| Rate for Payer: PHP Medicare Advantage |
$149.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.51
|
| Rate for Payer: Priority Health Medicare |
$149.68
|
| Rate for Payer: Priority Health Narrow Network |
$213.51
|
| Rate for Payer: UHC Medicare Advantage |
$154.17
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$557.90 |
| Max. Negotiated Rate |
$797.00 |
| Rate for Payer: Aetna Commercial |
$717.30
|
| Rate for Payer: ASR ASR |
$773.09
|
| Rate for Payer: BCBS Trust/PPO |
$617.91
|
| Rate for Payer: BCN Commercial |
$617.91
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$749.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.60
|
| Rate for Payer: Healthscope Commercial |
$797.00
|
| Rate for Payer: Healthscope Whirlpool |
$773.09
|
| Rate for Payer: Mclaren Commercial |
$717.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$677.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$701.36
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 58555
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$1,037.58 |
| Rate for Payer: Aetna Commercial |
$200.57
|
| Rate for Payer: Aetna Medicare |
$149.68
|
| Rate for Payer: BCBS Complete |
$101.31
|
| Rate for Payer: BCBS MAPPO |
$149.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$536.08
|
| Rate for Payer: BCN Medicare Advantage |
$149.68
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$215.54
|
| Rate for Payer: Cofinity Commercial |
$200.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.68
|
| Rate for Payer: Healthscope Commercial |
$179.62
|
| Rate for Payer: Healthscope Whirlpool |
$179.62
|
| Rate for Payer: Meridian Medicaid |
$101.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.16
|
| Rate for Payer: PACE SWMI |
$149.68
|
| Rate for Payer: PHP Medicare Advantage |
$149.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.51
|
| Rate for Payer: Priority Health Medicare |
$149.68
|
| Rate for Payer: Priority Health Narrow Network |
$213.51
|
| Rate for Payer: UHC Medicare Advantage |
$154.17
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$557.90 |
| Max. Negotiated Rate |
$3,473.69 |
| Rate for Payer: Aetna Commercial |
$717.30
|
| Rate for Payer: Aetna Medicare |
$2,778.95
|
| 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: ASR ASR |
$773.09
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$617.91
|
| Rate for Payer: BCN Commercial |
$617.91
|
| 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 |
$749.18
|
| 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 |
$797.00
|
| Rate for Payer: Healthscope Whirlpool |
$773.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,778.95
|
| Rate for Payer: Mclaren Commercial |
$717.30
|
| 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 |
$3,056.84
|
| Rate for Payer: PHP Medicaid |
$1,520.09
|
| 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 |
$725.27
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$565.87
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$701.36
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$1,148.00 |
| Rate for Payer: Aetna Commercial |
$415.00
|
| Rate for Payer: Aetna Medicare |
$309.70
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$309.70
|
| Rate for Payer: BCBS Trust/PPO |
$29.58
|
| Rate for Payer: BCN Commercial |
$454.47
|
| Rate for Payer: BCN Medicare Advantage |
$309.70
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cofinity Commercial |
$415.00
|
| Rate for Payer: Cofinity Commercial |
$445.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.70
|
| Rate for Payer: Healthscope Commercial |
$371.64
|
| Rate for Payer: Healthscope Whirlpool |
$371.64
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$325.18
|
| Rate for Payer: PACE SWMI |
$309.70
|
| Rate for Payer: PHP Medicare Advantage |
$309.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,148.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$440.28
|
| Rate for Payer: Priority Health Medicare |
$309.70
|
| Rate for Payer: Priority Health Narrow Network |
$440.28
|
| Rate for Payer: UHC Medicare Advantage |
$318.99
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$1,073.10 |
| Max. Negotiated Rate |
$5,526.50 |
| Rate for Payer: Aetna Commercial |
$1,379.70
|
| Rate for Payer: Aetna Medicare |
$4,421.20
|
| 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: ASR ASR |
$1,487.01
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.53
|
| Rate for Payer: BCN Commercial |
$1,188.53
|
| 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 |
$1,441.02
|
| 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 |
$1,533.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,421.20
|
| Rate for Payer: Mclaren Commercial |
$1,379.70
|
| 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 |
$4,863.32
|
| Rate for Payer: PHP Medicaid |
$2,418.40
|
| 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 |
$1,395.03
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.43
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,349.04
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
