|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$1,977.00
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$790.80 |
| Max. Negotiated Rate |
$1,310.23 |
| Rate for Payer: Aetna Commercial |
$1,219.24
|
| Rate for Payer: Aetna Medicare |
$909.88
|
| Rate for Payer: BCBS Complete |
$790.80
|
| Rate for Payer: BCBS MAPPO |
$909.88
|
| Rate for Payer: BCN Medicare Advantage |
$909.88
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Cofinity Commercial |
$1,310.23
|
| Rate for Payer: Cofinity Commercial |
$1,219.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$909.88
|
| Rate for Payer: Healthscope Commercial |
$1,091.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,091.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$955.37
|
| Rate for Payer: Nomi Health Commercial |
$1,091.86
|
| Rate for Payer: PACE SWMI |
$909.88
|
| Rate for Payer: PHP Medicare Advantage |
$909.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.05
|
| Rate for Payer: Priority Health Medicare |
$909.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$909.88
|
| Rate for Payer: UHC Medicare Advantage |
$909.88
|
| Rate for Payer: UHCCP DNSP |
$909.88
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$2,730.00
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$1,092.00 |
| Max. Negotiated Rate |
$1,923.03 |
| Rate for Payer: Aetna Commercial |
$1,789.49
|
| Rate for Payer: Aetna Medicare |
$1,335.44
|
| Rate for Payer: BCBS Complete |
$1,092.00
|
| Rate for Payer: BCBS MAPPO |
$1,335.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,335.44
|
| Rate for Payer: Cash Price |
$2,184.00
|
| Rate for Payer: Cash Price |
$2,184.00
|
| Rate for Payer: Cofinity Commercial |
$1,923.03
|
| Rate for Payer: Cofinity Commercial |
$1,789.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,335.44
|
| Rate for Payer: Healthscope Commercial |
$1,602.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,602.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,402.21
|
| Rate for Payer: Nomi Health Commercial |
$1,602.53
|
| Rate for Payer: PACE SWMI |
$1,335.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,335.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,774.50
|
| Rate for Payer: Priority Health Medicare |
$1,335.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,335.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,335.44
|
| Rate for Payer: UHCCP DNSP |
$1,335.44
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,258.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$503.20 |
| Max. Negotiated Rate |
$821.75 |
| Rate for Payer: Aetna Commercial |
$764.68
|
| Rate for Payer: Aetna Medicare |
$570.66
|
| Rate for Payer: BCBS Complete |
$503.20
|
| Rate for Payer: BCBS MAPPO |
$570.66
|
| Rate for Payer: BCN Medicare Advantage |
$570.66
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cofinity Commercial |
$821.75
|
| Rate for Payer: Cofinity Commercial |
$764.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.66
|
| Rate for Payer: Healthscope Commercial |
$684.79
|
| Rate for Payer: Healthscope Whirlpool |
$684.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.19
|
| Rate for Payer: Nomi Health Commercial |
$684.79
|
| Rate for Payer: PACE SWMI |
$570.66
|
| Rate for Payer: PHP Medicare Advantage |
$570.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.70
|
| Rate for Payer: Priority Health Medicare |
$570.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.66
|
| Rate for Payer: UHC Medicare Advantage |
$570.66
|
| Rate for Payer: UHCCP DNSP |
$570.66
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$243.33 |
| Rate for Payer: Aetna Commercial |
$226.43
|
| Rate for Payer: Aetna Medicare |
$168.98
|
| Rate for Payer: BCBS Complete |
$148.40
|
| Rate for Payer: BCBS MAPPO |
$168.98
|
| Rate for Payer: BCN Medicare Advantage |
$168.98
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$243.33
|
| Rate for Payer: Cofinity Commercial |
$226.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.98
|
| Rate for Payer: Healthscope Commercial |
$185.88
|
| Rate for Payer: Healthscope Whirlpool |
$185.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.43
|
| Rate for Payer: Nomi Health Commercial |
$202.78
|
| Rate for Payer: PACE SWMI |
$168.98
|
| Rate for Payer: PHP Medicare Advantage |
$168.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
| Rate for Payer: Priority Health Medicare |
$168.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.98
|
| Rate for Payer: UHCCP DNSP |
$168.98
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$112.45 |
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna Medicare |
$68.14
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS MAPPO |
$68.14
|
| Rate for Payer: BCN Medicare Advantage |
$68.14
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$98.12
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.14
|
| Rate for Payer: Healthscope Commercial |
$74.95
|
| Rate for Payer: Healthscope Whirlpool |
$74.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.55
|
| Rate for Payer: Nomi Health Commercial |
$81.77
|
| Rate for Payer: PACE SWMI |
$68.14
|
| Rate for Payer: PHP Medicare Advantage |
$68.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health Medicare |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.14
|
| Rate for Payer: UHC Medicare Advantage |
$68.14
|
| Rate for Payer: UHCCP DNSP |
$68.14
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Aetna Commercial |
$14.73
|
| Rate for Payer: Aetna Medicare |
$10.99
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS MAPPO |
$10.99
|
| Rate for Payer: BCN Medicare Advantage |
$10.99
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Commercial |
$14.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.99
|
| Rate for Payer: Healthscope Commercial |
$12.09
|
| Rate for Payer: Healthscope Whirlpool |
$12.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.54
|
| Rate for Payer: Nomi Health Commercial |
$13.19
|
| Rate for Payer: PACE SWMI |
$10.99
|
| Rate for Payer: PHP Medicare Advantage |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
| Rate for Payer: Priority Health Medicare |
$10.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.99
|
| Rate for Payer: UHC Medicare Advantage |
$10.99
|
| Rate for Payer: UHCCP DNSP |
$10.99
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$167.66 |
| Rate for Payer: Aetna Commercial |
$156.02
|
| Rate for Payer: Aetna Medicare |
$116.43
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$116.43
|
| Rate for Payer: BCN Medicare Advantage |
$116.43
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$167.66
|
| Rate for Payer: Cofinity Commercial |
$156.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.43
|
| Rate for Payer: Healthscope Commercial |
$128.07
|
| Rate for Payer: Healthscope Whirlpool |
$128.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.25
|
| Rate for Payer: Nomi Health Commercial |
$139.72
|
| Rate for Payer: PACE SWMI |
$116.43
|
| Rate for Payer: PHP Medicare Advantage |
$116.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health Medicare |
$116.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.43
|
| Rate for Payer: UHC Medicare Advantage |
$116.43
|
| Rate for Payer: UHCCP DNSP |
$116.43
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Aetna Commercial |
$54.08
|
| Rate for Payer: Aetna Medicare |
$40.36
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$40.36
|
| Rate for Payer: BCN Medicare Advantage |
$40.36
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Cofinity Commercial |
$54.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.36
|
| Rate for Payer: Healthscope Commercial |
$44.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.38
|
| Rate for Payer: Nomi Health Commercial |
$48.43
|
| Rate for Payer: PACE SWMI |
$40.36
|
| Rate for Payer: PHP Medicare Advantage |
$40.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health Medicare |
$40.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.36
|
| Rate for Payer: UHC Medicare Advantage |
$40.36
|
| Rate for Payer: UHCCP DNSP |
$40.36
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$59.33 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Aetna Commercial |
$79.50
|
| Rate for Payer: Aetna Medicare |
$59.33
|
| Rate for Payer: BCBS Complete |
$157.20
|
| Rate for Payer: BCBS MAPPO |
$59.33
|
| Rate for Payer: BCN Medicare Advantage |
$59.33
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cofinity Commercial |
$85.44
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.33
|
| Rate for Payer: Healthscope Commercial |
$71.20
|
| Rate for Payer: Healthscope Whirlpool |
$71.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.30
|
| Rate for Payer: Nomi Health Commercial |
$71.20
|
| Rate for Payer: PACE SWMI |
$59.33
|
| Rate for Payer: PHP Medicare Advantage |
$59.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.45
|
| Rate for Payer: Priority Health Medicare |
$59.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$59.33
|
| Rate for Payer: UHCCP DNSP |
$59.33
|
|
|
PR ENDOBRONCHIAL U/S ADD-ON
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 31620
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: Aetna Medicare |
$232.00
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.60
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$1,316.29 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Medicare |
$849.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,061.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,061.53
|
| Rate for Payer: ASR ASR |
$302.64
|
| Rate for Payer: ASR Commercial |
$302.64
|
| Rate for Payer: BCBS Complete |
$477.94
|
| Rate for Payer: BCBS MAPPO |
$849.22
|
| Rate for Payer: BCBS Trust/PPO |
$255.50
|
| Rate for Payer: BCN Commercial |
$241.89
|
| Rate for Payer: BCN Medicare Advantage |
$849.22
|
| 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 |
$849.22
|
| Rate for Payer: Healthscope Commercial |
$312.00
|
| Rate for Payer: Healthscope Whirlpool |
$302.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$849.22
|
| Rate for Payer: Mclaren Commercial |
$280.80
|
| Rate for Payer: Mclaren Medicaid |
$455.18
|
| Rate for Payer: Mclaren Medicare |
$849.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.68
|
| Rate for Payer: Meridian Medicaid |
$477.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$976.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Nomi Health Commercial |
$255.84
|
| Rate for Payer: PACE Medicare |
$806.76
|
| Rate for Payer: PACE SWMI |
$849.22
|
| Rate for Payer: PHP Commercial |
$934.14
|
| Rate for Payer: PHP Medicaid |
$455.18
|
| Rate for Payer: PHP Medicare Advantage |
$849.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.18
|
| 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 |
$849.22
|
| Rate for Payer: Priority Health Narrow Network |
$218.71
|
| Rate for Payer: Railroad Medicare Medicare |
$849.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.22
|
| Rate for Payer: UHC Exchange |
$1,316.29
|
| Rate for Payer: UHC Medicare Advantage |
$849.22
|
| Rate for Payer: UHCCP DNSP |
$849.22
|
| Rate for Payer: UHCCP Medicaid |
$455.18
|
| Rate for Payer: VA VA |
$849.22
|
|
|
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 |
$102.36 |
| Max. Negotiated Rate |
$202.80 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: Aetna Medicare |
$102.36
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$147.40
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Healthscope Commercial |
$122.83
|
| Rate for Payer: Healthscope Whirlpool |
$122.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Medicare |
$102.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
| Rate for Payer: UHCCP DNSP |
$102.36
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
57505
|
| Min. Negotiated Rate |
$102.36 |
| Max. Negotiated Rate |
$202.80 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: Aetna Medicare |
$102.36
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$147.40
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Healthscope Commercial |
$122.83
|
| Rate for Payer: Healthscope Whirlpool |
$122.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Medicare |
$102.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
| Rate for Payer: UHCCP DNSP |
$102.36
|
|
|
PR END OF LIFE COUNSELING
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS S0257
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 92979
|
| Min. Negotiated Rate |
$122.80 |
| Max. Negotiated Rate |
$199.55 |
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: BCBS Complete |
$122.80
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.55
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 92978
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Medicare |
$250.50
|
| Rate for Payer: BCBS Complete |
$200.40
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
|
|
PR ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$2,043.00
|
|
|
Service Code
|
HCPCS 58353
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$1,327.95 |
| Rate for Payer: Aetna Commercial |
$295.13
|
| Rate for Payer: Aetna Medicare |
$220.25
|
| Rate for Payer: BCBS Complete |
$817.20
|
| Rate for Payer: BCBS MAPPO |
$220.25
|
| Rate for Payer: BCN Medicare Advantage |
$220.25
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cofinity Commercial |
$317.16
|
| Rate for Payer: Cofinity Commercial |
$295.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.25
|
| Rate for Payer: Healthscope Commercial |
$264.30
|
| Rate for Payer: Healthscope Whirlpool |
$264.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.26
|
| Rate for Payer: Nomi Health Commercial |
$264.30
|
| Rate for Payer: PACE SWMI |
$220.25
|
| Rate for Payer: PHP Medicare Advantage |
$220.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,327.95
|
| Rate for Payer: Priority Health Medicare |
$220.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.25
|
| Rate for Payer: UHC Medicare Advantage |
$220.25
|
| Rate for Payer: UHCCP DNSP |
$220.25
|
|
|
PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Commercial |
$52.22
|
| Rate for Payer: Aetna Medicare |
$38.97
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$38.97
|
| Rate for Payer: BCN Medicare Advantage |
$38.97
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Cofinity Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.97
|
| Rate for Payer: Healthscope Commercial |
$46.76
|
| Rate for Payer: Healthscope Whirlpool |
$46.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.92
|
| Rate for Payer: Nomi Health Commercial |
$46.76
|
| Rate for Payer: PACE SWMI |
$38.97
|
| Rate for Payer: PHP Medicare Advantage |
$38.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$38.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.97
|
| Rate for Payer: UHC Medicare Advantage |
$38.97
|
| Rate for Payer: UHCCP DNSP |
$38.97
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$81.57
|
| Rate for Payer: Aetna Medicare |
$60.87
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$60.87
|
| Rate for Payer: BCN Medicare Advantage |
$60.87
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$87.65
|
| Rate for Payer: Cofinity Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.87
|
| Rate for Payer: Healthscope Commercial |
$73.04
|
| Rate for Payer: Healthscope Whirlpool |
$73.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.91
|
| Rate for Payer: Nomi Health Commercial |
$73.04
|
| Rate for Payer: PACE SWMI |
$60.87
|
| Rate for Payer: PHP Medicare Advantage |
$60.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$60.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.87
|
| Rate for Payer: UHC Medicare Advantage |
$60.87
|
| Rate for Payer: UHCCP DNSP |
$60.87
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Hospital Charge Code |
58100
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$81.57
|
| Rate for Payer: Aetna Medicare |
$60.87
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$60.87
|
| Rate for Payer: BCN Medicare Advantage |
$60.87
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$87.65
|
| Rate for Payer: Cofinity Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.87
|
| Rate for Payer: Healthscope Commercial |
$73.04
|
| Rate for Payer: Healthscope Whirlpool |
$73.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.91
|
| Rate for Payer: Nomi Health Commercial |
$73.04
|
| Rate for Payer: PACE SWMI |
$60.87
|
| Rate for Payer: PHP Medicare Advantage |
$60.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$60.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.87
|
| Rate for Payer: UHC Medicare Advantage |
$60.87
|
| Rate for Payer: UHCCP DNSP |
$60.87
|
|
|
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
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
58100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$304.11 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Medicare |
$196.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: ASR ASR |
$208.55
|
| Rate for Payer: ASR Commercial |
$208.55
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCBS Trust/PPO |
$176.06
|
| Rate for Payer: BCN Commercial |
$166.69
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| 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 |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$215.00
|
| Rate for Payer: Healthscope Whirlpool |
$208.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$196.20
|
| Rate for Payer: Mclaren Commercial |
$193.50
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$176.30
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$215.82
|
| Rate for Payer: PHP Medicaid |
$105.16
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| 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 |
$196.20
|
| Rate for Payer: Priority Health Narrow Network |
$150.72
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$304.11
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP DNSP |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: VA VA |
$196.20
|
|
|
PR ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR
|
Professional
|
Both
|
$2,813.00
|
|
|
Service Code
|
HCPCS 58356
|
| Min. Negotiated Rate |
$338.99 |
| Max. Negotiated Rate |
$1,828.45 |
| Rate for Payer: Aetna Commercial |
$454.25
|
| Rate for Payer: Aetna Medicare |
$338.99
|
| Rate for Payer: BCBS Complete |
$1,125.20
|
| Rate for Payer: BCBS MAPPO |
$338.99
|
| Rate for Payer: BCN Medicare Advantage |
$338.99
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cofinity Commercial |
$488.15
|
| Rate for Payer: Cofinity Commercial |
$454.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.99
|
| Rate for Payer: Healthscope Commercial |
$406.79
|
| Rate for Payer: Healthscope Whirlpool |
$406.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.94
|
| Rate for Payer: Nomi Health Commercial |
$406.79
|
| Rate for Payer: PACE SWMI |
$338.99
|
| Rate for Payer: PHP Medicare Advantage |
$338.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,828.45
|
| Rate for Payer: Priority Health Medicare |
$338.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.99
|
| Rate for Payer: UHC Medicare Advantage |
$338.99
|
| Rate for Payer: UHCCP DNSP |
$338.99
|
|
|
PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 43273
|
| Min. Negotiated Rate |
$112.17 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna Commercial |
$150.31
|
| Rate for Payer: Aetna Medicare |
$112.17
|
| Rate for Payer: BCBS Complete |
$187.20
|
| Rate for Payer: BCBS MAPPO |
$112.17
|
| Rate for Payer: BCN Medicare Advantage |
$112.17
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Commercial |
$161.52
|
| Rate for Payer: Cofinity Commercial |
$150.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.17
|
| Rate for Payer: Healthscope Commercial |
$134.60
|
| Rate for Payer: Healthscope Whirlpool |
$134.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.78
|
| Rate for Payer: Nomi Health Commercial |
$134.60
|
| Rate for Payer: PACE SWMI |
$112.17
|
| Rate for Payer: PHP Medicare Advantage |
$112.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.20
|
| Rate for Payer: Priority Health Medicare |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.17
|
| Rate for Payer: UHC Medicare Advantage |
$112.17
|
| Rate for Payer: UHCCP DNSP |
$112.17
|
|
