|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$3,642.10 |
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna Medicare |
$196.50
|
| Rate for Payer: BCBS Complete |
$24.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,642.10
|
| Rate for Payer: BCN Commercial |
$93.34
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Meridian Medicaid |
$24.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.05
|
| Rate for Payer: Priority Health Narrow Network |
$58.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.15
|
| Rate for Payer: UHC Exchange |
$228.15
|
| Rate for Payer: UHCCP Medicaid |
$23.22
|
|
|
PR ENDOBRONCHIAL U/S ADD-ON
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 31620
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: Aetna Medicare |
$232.00
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.60
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$1,322.35 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Medicare |
$853.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,066.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,066.41
|
| Rate for Payer: ASR ASR |
$302.64
|
| Rate for Payer: ASR Commercial |
$302.64
|
| Rate for Payer: BCBS Complete |
$480.14
|
| Rate for Payer: BCBS MAPPO |
$853.13
|
| Rate for Payer: BCBS Trust/PPO |
$255.50
|
| Rate for Payer: BCCCP Commercial |
$145.60
|
| Rate for Payer: BCN Commercial |
$241.89
|
| Rate for Payer: BCN Medicare Advantage |
$853.13
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$293.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$853.13
|
| Rate for Payer: Healthscope Commercial |
$312.00
|
| Rate for Payer: Healthscope Whirlpool |
$302.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$853.13
|
| Rate for Payer: Mclaren Commercial |
$280.80
|
| Rate for Payer: Mclaren Medicaid |
$457.28
|
| Rate for Payer: Mclaren Medicare |
$853.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.79
|
| Rate for Payer: Meridian Medicaid |
$480.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$981.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Nomi Health Commercial |
$255.84
|
| Rate for Payer: PACE Medicare |
$810.47
|
| Rate for Payer: PACE SWMI |
$853.13
|
| Rate for Payer: PHP Commercial |
$938.44
|
| Rate for Payer: PHP Medicaid |
$457.28
|
| Rate for Payer: PHP Medicare Advantage |
$853.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.37
|
| Rate for Payer: Priority Health Medicare |
$853.13
|
| Rate for Payer: Priority Health Narrow Network |
$218.71
|
| Rate for Payer: Railroad Medicare Medicare |
$853.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$853.13
|
| Rate for Payer: UHC Exchange |
$1,322.35
|
| Rate for Payer: UHC Medicare Advantage |
$853.13
|
| Rate for Payer: UHCCP DNSP |
$853.13
|
| Rate for Payer: UHCCP Medicaid |
$457.28
|
| Rate for Payer: VA VA |
$853.13
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
57505
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$232.98 |
| Rate for Payer: Aetna Commercial |
$124.37
|
| Rate for Payer: Aetna Medicare |
$156.00
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS Trust/PPO |
$232.98
|
| Rate for Payer: BCN Commercial |
$184.16
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.68
|
| Rate for Payer: Priority Health Narrow Network |
$164.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.22
|
| Rate for Payer: UHC Exchange |
$102.22
|
| Rate for Payer: UHCCP Medicaid |
$70.29
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: ASR ASR |
$302.64
|
| Rate for Payer: ASR Commercial |
$302.64
|
| Rate for Payer: BCBS Trust/PPO |
$254.25
|
| Rate for Payer: BCN Commercial |
$241.89
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$293.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.60
|
| Rate for Payer: Healthscope Commercial |
$312.00
|
| Rate for Payer: Healthscope Whirlpool |
$302.64
|
| Rate for Payer: Mclaren Commercial |
$280.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Nomi Health Commercial |
$255.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.56
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57505
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$232.98 |
| Rate for Payer: Aetna Commercial |
$124.37
|
| Rate for Payer: Aetna Medicare |
$156.00
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS Trust/PPO |
$232.98
|
| Rate for Payer: BCN Commercial |
$184.16
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.68
|
| Rate for Payer: Priority Health Narrow Network |
$164.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.22
|
| Rate for Payer: UHC Exchange |
$102.22
|
| Rate for Payer: UHCCP Medicaid |
$70.29
|
|
|
PR END OF LIFE COUNSELING
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS S0257
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$206.57 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: BCN Commercial |
$28.73
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.64
|
| Rate for Payer: Priority Health Narrow Network |
$47.64
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 92979
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS Trust/PPO |
$230.34
|
| Rate for Payer: BCN Commercial |
$233.10
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.11
|
| Rate for Payer: Priority Health Narrow Network |
$103.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.61
|
| Rate for Payer: UHC Exchange |
$214.61
|
| Rate for Payer: UHCCP Medicaid |
$47.07
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 92978
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$386.06 |
| Rate for Payer: Aetna Commercial |
$348.91
|
| Rate for Payer: Aetna Medicare |
$250.50
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS Trust/PPO |
$154.26
|
| Rate for Payer: BCN Commercial |
$386.06
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.95
|
| Rate for Payer: Priority Health Narrow Network |
$129.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$350.16
|
| Rate for Payer: UHC Exchange |
$350.16
|
| Rate for Payer: UHCCP Medicaid |
$59.00
|
|
|
PR ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$2,043.00
|
|
|
Service Code
|
HCPCS 58353
|
| Min. Negotiated Rate |
$148.04 |
| Max. Negotiated Rate |
$1,387.35 |
| Rate for Payer: Aetna Commercial |
$274.07
|
| Rate for Payer: Aetna Medicare |
$1,021.50
|
| Rate for Payer: BCBS Complete |
$155.44
|
| Rate for Payer: BCBS Trust/PPO |
$572.15
|
| Rate for Payer: BCN Commercial |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Meridian Medicaid |
$155.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,327.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.74
|
| Rate for Payer: Priority Health Narrow Network |
$345.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.23
|
| Rate for Payer: UHC Exchange |
$251.23
|
| Rate for Payer: UHCCP Medicaid |
$148.04
|
|
|
PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$1,845.88 |
| Rate for Payer: Aetna Commercial |
$49.01
|
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.88
|
| Rate for Payer: BCN Commercial |
$72.82
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Meridian Medicaid |
$27.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.53
|
| Rate for Payer: Priority Health Narrow Network |
$59.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.79
|
| Rate for Payer: UHC Exchange |
$47.79
|
| Rate for Payer: UHCCP Medicaid |
$25.77
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
58100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: ASR ASR |
$208.55
|
| Rate for Payer: ASR Commercial |
$208.55
|
| Rate for Payer: BCBS Trust/PPO |
$175.20
|
| Rate for Payer: BCN Commercial |
$166.69
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$215.00
|
| Rate for Payer: Healthscope Whirlpool |
$208.55
|
| Rate for Payer: Mclaren Commercial |
$193.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$176.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.20
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Hospital Charge Code |
58100
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$1,579.09 |
| Rate for Payer: Aetna Commercial |
$76.79
|
| Rate for Payer: Aetna Medicare |
$107.50
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.09
|
| Rate for Payer: BCN Commercial |
$120.16
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.75
|
| Rate for Payer: Priority Health Narrow Network |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.52
|
| Rate for Payer: UHC Exchange |
$100.52
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
58100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.15 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Medicare |
$197.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: ASR ASR |
$208.55
|
| Rate for Payer: ASR Commercial |
$208.55
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$176.06
|
| Rate for Payer: BCCCP Commercial |
$97.15
|
| Rate for Payer: BCN Commercial |
$166.69
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$215.00
|
| Rate for Payer: Healthscope Whirlpool |
$208.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.10
|
| Rate for Payer: Mclaren Commercial |
$193.50
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$176.30
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$216.81
|
| Rate for Payer: PHP Medicaid |
$105.65
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.38
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$150.72
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$305.50
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP DNSP |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$1,579.09 |
| Rate for Payer: Aetna Commercial |
$76.79
|
| Rate for Payer: Aetna Medicare |
$107.50
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.09
|
| Rate for Payer: BCN Commercial |
$120.16
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.75
|
| Rate for Payer: Priority Health Narrow Network |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.52
|
| Rate for Payer: UHC Exchange |
$100.52
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
PR ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR
|
Professional
|
Both
|
$2,813.00
|
|
|
Service Code
|
HCPCS 58356
|
| Min. Negotiated Rate |
$225.14 |
| Max. Negotiated Rate |
$2,491.27 |
| Rate for Payer: Aetna Commercial |
$426.17
|
| Rate for Payer: Aetna Medicare |
$1,406.50
|
| Rate for Payer: BCBS Complete |
$236.40
|
| Rate for Payer: BCBS Trust/PPO |
$503.47
|
| Rate for Payer: BCN Commercial |
$2,491.27
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Meridian Medicaid |
$236.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,828.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.30
|
| Rate for Payer: Priority Health Narrow Network |
$527.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.50
|
| Rate for Payer: UHC Exchange |
$401.50
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
|
|
PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 43273
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$786.11 |
| Rate for Payer: Aetna Commercial |
$159.96
|
| Rate for Payer: Aetna Medicare |
$234.00
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS Trust/PPO |
$786.11
|
| Rate for Payer: BCN Commercial |
$169.57
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.81
|
| Rate for Payer: Priority Health Narrow Network |
$208.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.66
|
| Rate for Payer: UHC Exchange |
$162.66
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 44360
|
| Min. Negotiated Rate |
$90.53 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Aetna Commercial |
$190.22
|
| Rate for Payer: Aetna Medicare |
$467.50
|
| Rate for Payer: BCBS Complete |
$95.06
|
| Rate for Payer: BCBS Trust/PPO |
$381.96
|
| Rate for Payer: BCN Commercial |
$205.73
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Meridian Medicaid |
$95.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.55
|
| Rate for Payer: Priority Health Narrow Network |
$253.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.65
|
| Rate for Payer: UHC Exchange |
$197.65
|
| Rate for Payer: UHCCP Medicaid |
$90.53
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 44361
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna Commercial |
$210.83
|
| Rate for Payer: Aetna Medicare |
$494.00
|
| Rate for Payer: BCBS Complete |
$105.12
|
| Rate for Payer: BCBS Trust/PPO |
$508.22
|
| Rate for Payer: BCN Commercial |
$226.75
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Meridian Medicaid |
$105.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$279.21
|
| Rate for Payer: Priority Health Narrow Network |
$279.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.31
|
| Rate for Payer: UHC Exchange |
$217.31
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
|
|
PR ENDOVASC ABDO REPAIR W/PROS
|
Professional
|
Both
|
$5,333.00
|
|
|
Service Code
|
HCPCS 34805
|
| Min. Negotiated Rate |
$2,133.20 |
| Max. Negotiated Rate |
$3,466.45 |
| Rate for Payer: Aetna Medicare |
$2,666.50
|
| Rate for Payer: BCBS Complete |
$2,133.20
|
| Rate for Payer: Cash Price |
$4,266.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,466.45
|
|
|
PR ENDOVASCULAR REPAIR ILIAC ARTERY W ILIO-ILIAC PROSTHESIS
|
Professional
|
Both
|
$1,766.00
|
|
|
Service Code
|
HCPCS 34900
|
| Min. Negotiated Rate |
$706.40 |
| Max. Negotiated Rate |
$1,147.90 |
| Rate for Payer: Aetna Medicare |
$883.00
|
| Rate for Payer: BCBS Complete |
$706.40
|
| Rate for Payer: Cash Price |
$1,412.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.90
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Facility
|
OP
|
$2,741.00
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
36478
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$2,466.90
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$2,658.77
|
| Rate for Payer: ASR Commercial |
$2,658.77
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,244.60
|
| Rate for Payer: BCN Commercial |
$2,125.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$2,576.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$2,741.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,658.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$2,466.90
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,329.85
|
| Rate for Payer: Nomi Health Commercial |
$2,247.62
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,401.66
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,921.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,412.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Professional
|
Both
|
$2,741.00
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
36478
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$1,781.65 |
| Rate for Payer: Aetna Commercial |
$372.23
|
| Rate for Payer: Aetna Medicare |
$1,370.50
|
| Rate for Payer: BCBS Complete |
$182.94
|
| Rate for Payer: BCBS Trust/PPO |
$288.45
|
| Rate for Payer: BCN Commercial |
$1,440.13
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Meridian Medicaid |
$182.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.43
|
| Rate for Payer: Priority Health Narrow Network |
$433.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.91
|
| Rate for Payer: UHC Exchange |
$461.91
|
| Rate for Payer: UHCCP Medicaid |
$174.23
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Professional
|
Both
|
$2,741.00
|
|
|
Service Code
|
HCPCS 36478
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$1,781.65 |
| Rate for Payer: Aetna Commercial |
$372.23
|
| Rate for Payer: Aetna Medicare |
$1,370.50
|
| Rate for Payer: BCBS Complete |
$182.94
|
| Rate for Payer: BCBS Trust/PPO |
$288.45
|
| Rate for Payer: BCN Commercial |
$1,440.13
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Meridian Medicaid |
$182.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.43
|
| Rate for Payer: Priority Health Narrow Network |
$433.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.91
|
| Rate for Payer: UHC Exchange |
$461.91
|
| Rate for Payer: UHCCP Medicaid |
$174.23
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Facility
|
IP
|
$2,741.00
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
36478
|
| Min. Negotiated Rate |
$1,781.65 |
| Max. Negotiated Rate |
$2,741.00 |
| Rate for Payer: Aetna Commercial |
$2,466.90
|
| Rate for Payer: ASR ASR |
$2,658.77
|
| Rate for Payer: ASR Commercial |
$2,658.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,233.64
|
| Rate for Payer: BCN Commercial |
$2,125.10
|
| Rate for Payer: Cash Price |
$2,192.80
|
| Rate for Payer: Cofinity Commercial |
$2,576.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,192.80
|
| Rate for Payer: Healthscope Commercial |
$2,741.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,658.77
|
| Rate for Payer: Mclaren Commercial |
$2,466.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,329.85
|
| Rate for Payer: Nomi Health Commercial |
$2,247.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,781.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,412.08
|
|
