|
PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 99234
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$188.83 |
| Rate for Payer: Aetna Commercial |
$117.41
|
| Rate for Payer: Aetna Medicare |
$87.62
|
| Rate for Payer: BCBS Complete |
$59.04
|
| Rate for Payer: BCBS MAPPO |
$87.62
|
| Rate for Payer: BCN Commercial |
$144.41
|
| Rate for Payer: BCN Medicare Advantage |
$87.62
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Commercial |
$126.17
|
| Rate for Payer: Cofinity Commercial |
$117.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$96.38
|
| Rate for Payer: Healthscope Whirlpool |
$96.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.00
|
| Rate for Payer: Meridian Medicaid |
$59.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.38
|
| Rate for Payer: Nomi Health Commercial |
$105.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.00
|
| Rate for Payer: PACE SWMI |
$87.62
|
| Rate for Payer: PHP Medicare Advantage |
$87.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$129.90
|
| Rate for Payer: Priority Health Medicare |
$87.62
|
| Rate for Payer: Priority Health Narrow Network |
$129.90
|
| Rate for Payer: Railroad Medicare Medicare |
$87.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$87.62
|
| Rate for Payer: UHC Exchange |
$188.83
|
| Rate for Payer: UHC Medicaid |
$56.23
|
| Rate for Payer: UHCCP DNSP |
$87.62
|
| Rate for Payer: UHCCP Medicaid |
$56.23
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 99239
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Commercial |
$140.27
|
| Rate for Payer: Aetna Medicare |
$104.68
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$104.68
|
| Rate for Payer: BCN Commercial |
$170.31
|
| Rate for Payer: BCN Medicare Advantage |
$104.68
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cofinity Commercial |
$150.74
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.68
|
| Rate for Payer: Healthscope Commercial |
$115.15
|
| Rate for Payer: Healthscope Whirlpool |
$115.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.91
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.15
|
| Rate for Payer: Nomi Health Commercial |
$125.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: PACE SWMI |
$104.68
|
| Rate for Payer: PHP Medicare Advantage |
$104.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$153.21
|
| Rate for Payer: Priority Health Medicare |
$104.68
|
| Rate for Payer: Priority Health Narrow Network |
$153.21
|
| Rate for Payer: Railroad Medicare Medicare |
$104.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.68
|
| Rate for Payer: UHC Exchange |
$150.41
|
| Rate for Payer: UHC Medicaid |
$67.95
|
| Rate for Payer: UHCCP DNSP |
$104.68
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 99238
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$120.51 |
| Rate for Payer: Aetna Commercial |
$98.53
|
| Rate for Payer: Aetna Medicare |
$73.53
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS MAPPO |
$73.53
|
| Rate for Payer: BCN Commercial |
$120.51
|
| Rate for Payer: BCN Medicare Advantage |
$73.53
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$98.53
|
| Rate for Payer: Cofinity Commercial |
$105.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.53
|
| Rate for Payer: Healthscope Commercial |
$80.88
|
| Rate for Payer: Healthscope Whirlpool |
$80.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.21
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.88
|
| Rate for Payer: Nomi Health Commercial |
$88.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.50
|
| Rate for Payer: PACE SWMI |
$73.53
|
| Rate for Payer: PHP Medicare Advantage |
$73.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.40
|
| Rate for Payer: Priority Health Medicare |
$73.53
|
| Rate for Payer: Priority Health Narrow Network |
$108.40
|
| Rate for Payer: Railroad Medicare Medicare |
$73.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.53
|
| Rate for Payer: UHC Exchange |
$102.55
|
| Rate for Payer: UHC Medicaid |
$47.71
|
| Rate for Payer: UHCCP DNSP |
$73.53
|
| Rate for Payer: UHCCP Medicaid |
$47.71
|
|
|
PR HO W/O JOINTS CF
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS L3919
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$436.18 |
| Rate for Payer: Aetna Commercial |
$405.89
|
| Rate for Payer: Aetna Medicare |
$302.90
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: BCBS MAPPO |
$302.90
|
| Rate for Payer: BCN Commercial |
$290.00
|
| Rate for Payer: BCN Medicare Advantage |
$302.90
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$436.18
|
| Rate for Payer: Cofinity Commercial |
$405.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.90
|
| Rate for Payer: Healthscope Commercial |
$363.48
|
| Rate for Payer: Healthscope Whirlpool |
$363.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.19
|
| Rate for Payer: Nomi Health Commercial |
$363.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.75
|
| Rate for Payer: PACE SWMI |
$302.90
|
| Rate for Payer: PHP Medicare Advantage |
$302.90
|
| Rate for Payer: Priority Health Medicare |
$302.90
|
| Rate for Payer: Railroad Medicare Medicare |
$302.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$302.90
|
| Rate for Payer: UHC Exchange |
$98.77
|
| Rate for Payer: UHCCP DNSP |
$302.90
|
|
|
PR HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 46258
|
| Min. Negotiated Rate |
$306.72 |
| Max. Negotiated Rate |
$912.75 |
| Rate for Payer: Aetna Commercial |
$628.92
|
| Rate for Payer: Aetna Medicare |
$469.34
|
| Rate for Payer: BCBS Complete |
$322.06
|
| Rate for Payer: BCBS MAPPO |
$469.34
|
| Rate for Payer: BCN Commercial |
$734.02
|
| Rate for Payer: BCN Medicare Advantage |
$469.34
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cofinity Commercial |
$675.85
|
| Rate for Payer: Cofinity Commercial |
$628.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$469.34
|
| Rate for Payer: Healthscope Commercial |
$563.21
|
| Rate for Payer: Healthscope Whirlpool |
$563.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$492.81
|
| Rate for Payer: Meridian Medicaid |
$322.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$516.27
|
| Rate for Payer: Nomi Health Commercial |
$563.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$912.75
|
| Rate for Payer: PACE SWMI |
$469.34
|
| Rate for Payer: PHP Medicare Advantage |
$469.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$306.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$894.37
|
| Rate for Payer: Priority Health Medicare |
$469.34
|
| Rate for Payer: Priority Health Narrow Network |
$894.37
|
| Rate for Payer: Railroad Medicare Medicare |
$469.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$469.34
|
| Rate for Payer: UHC Exchange |
$830.76
|
| Rate for Payer: UHC Medicaid |
$306.72
|
| Rate for Payer: UHCCP DNSP |
$469.34
|
| Rate for Payer: UHCCP Medicaid |
$306.72
|
|
|
PR HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY
|
Professional
|
Both
|
$1,828.00
|
|
|
Service Code
|
HCPCS 46262
|
| Min. Negotiated Rate |
$374.88 |
| Max. Negotiated Rate |
$1,371.00 |
| Rate for Payer: Aetna Commercial |
$769.13
|
| Rate for Payer: Aetna Medicare |
$573.98
|
| Rate for Payer: BCBS Complete |
$393.62
|
| Rate for Payer: BCBS MAPPO |
$573.98
|
| Rate for Payer: BCN Commercial |
$892.38
|
| Rate for Payer: BCN Medicare Advantage |
$573.98
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cofinity Commercial |
$826.53
|
| Rate for Payer: Cofinity Commercial |
$769.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.98
|
| Rate for Payer: Healthscope Commercial |
$688.78
|
| Rate for Payer: Healthscope Whirlpool |
$688.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$602.68
|
| Rate for Payer: Meridian Medicaid |
$393.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$631.38
|
| Rate for Payer: Nomi Health Commercial |
$688.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.00
|
| Rate for Payer: PACE SWMI |
$573.98
|
| Rate for Payer: PHP Medicare Advantage |
$573.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,087.31
|
| Rate for Payer: Priority Health Medicare |
$573.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,087.31
|
| Rate for Payer: Railroad Medicare Medicare |
$573.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$972.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$573.98
|
| Rate for Payer: UHC Exchange |
$972.90
|
| Rate for Payer: UHC Medicaid |
$374.88
|
| Rate for Payer: UHCCP DNSP |
$573.98
|
| Rate for Payer: UHCCP Medicaid |
$374.88
|
|
|
PR HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU
|
Professional
|
Both
|
$1,784.00
|
|
|
Service Code
|
HCPCS 46261
|
| Min. Negotiated Rate |
$328.66 |
| Max. Negotiated Rate |
$1,338.00 |
| Rate for Payer: Aetna Commercial |
$673.91
|
| Rate for Payer: Aetna Medicare |
$502.92
|
| Rate for Payer: BCBS Complete |
$345.09
|
| Rate for Payer: BCBS MAPPO |
$502.92
|
| Rate for Payer: BCN Commercial |
$806.73
|
| Rate for Payer: BCN Medicare Advantage |
$502.92
|
| Rate for Payer: Cash Price |
$1,427.20
|
| Rate for Payer: Cash Price |
$1,427.20
|
| Rate for Payer: Cofinity Commercial |
$724.20
|
| Rate for Payer: Cofinity Commercial |
$673.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.92
|
| Rate for Payer: Healthscope Commercial |
$603.50
|
| Rate for Payer: Healthscope Whirlpool |
$603.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$528.07
|
| Rate for Payer: Meridian Medicaid |
$345.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$553.21
|
| Rate for Payer: Nomi Health Commercial |
$603.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,338.00
|
| Rate for Payer: PACE SWMI |
$502.92
|
| Rate for Payer: PHP Medicare Advantage |
$502.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$982.94
|
| Rate for Payer: Priority Health Medicare |
$502.92
|
| Rate for Payer: Priority Health Narrow Network |
$982.94
|
| Rate for Payer: Railroad Medicare Medicare |
$502.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$919.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$502.92
|
| Rate for Payer: UHC Exchange |
$919.45
|
| Rate for Payer: UHC Medicaid |
$328.66
|
| Rate for Payer: UHCCP DNSP |
$502.92
|
| Rate for Payer: UHCCP Medicaid |
$328.66
|
|
|
PR HRV SKIN FOR SKIN CELL SSP AGRFT 1ST 25 SQ CM/<
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 15011
|
| Min. Negotiated Rate |
$66.70 |
| Max. Negotiated Rate |
$2,744.01 |
| Rate for Payer: BCBS Complete |
$70.03
|
| Rate for Payer: BCN Commercial |
$1,710.33
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Meridian Medicaid |
$70.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,744.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,744.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.53
|
| Rate for Payer: UHC Exchange |
$133.53
|
| Rate for Payer: UHC Medicaid |
$66.70
|
| Rate for Payer: UHCCP Medicaid |
$66.70
|
|
|
PR HRV SKIN FOR SKIN CELL SSP AGRFT EA ADDL 25 SQCM
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 15012
|
| Min. Negotiated Rate |
$62.85 |
| Max. Negotiated Rate |
$1,836.75 |
| Rate for Payer: BCBS Complete |
$70.03
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Meridian Medicaid |
$70.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.85
|
| Rate for Payer: UHC Exchange |
$62.85
|
| Rate for Payer: UHC Medicaid |
$66.70
|
| Rate for Payer: UHCCP Medicaid |
$66.70
|
|
|
PR HYALGAN SUPARTZ VISCO-3 DOSE
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS J7321
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna Commercial |
$99.74
|
| Rate for Payer: Aetna Medicare |
$74.43
|
| Rate for Payer: BCBS MAPPO |
$74.43
|
| Rate for Payer: BCBS Trust/PPO |
$64.00
|
| Rate for Payer: BCN Commercial |
$76.58
|
| Rate for Payer: BCN Medicare Advantage |
$74.43
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$107.18
|
| Rate for Payer: Cofinity Commercial |
$99.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.43
|
| Rate for Payer: Healthscope Commercial |
$89.32
|
| Rate for Payer: Healthscope Whirlpool |
$89.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.87
|
| Rate for Payer: Nomi Health Commercial |
$89.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.00
|
| Rate for Payer: PACE SWMI |
$74.43
|
| Rate for Payer: PHP Medicare Advantage |
$74.43
|
| Rate for Payer: Priority Health Medicare |
$74.43
|
| Rate for Payer: Railroad Medicare Medicare |
$74.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.43
|
| Rate for Payer: UHC Exchange |
$72.97
|
| Rate for Payer: UHCCP DNSP |
$74.43
|
|
|
PR HYDROCORTISONE SODIUM SUCC I
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1720
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$31.88 |
| Rate for Payer: Aetna Commercial |
$29.67
|
| Rate for Payer: Aetna Medicare |
$22.14
|
| Rate for Payer: BCBS MAPPO |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$18.00
|
| Rate for Payer: BCN Commercial |
$17.66
|
| Rate for Payer: BCN Medicare Advantage |
$22.14
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$29.67
|
| Rate for Payer: Cofinity Commercial |
$31.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.14
|
| Rate for Payer: Healthscope Commercial |
$26.57
|
| Rate for Payer: Healthscope Whirlpool |
$26.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.35
|
| Rate for Payer: Nomi Health Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: PACE SWMI |
$22.14
|
| Rate for Payer: PHP Medicare Advantage |
$22.14
|
| Rate for Payer: Priority Health Medicare |
$22.14
|
| Rate for Payer: Railroad Medicare Medicare |
$22.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.14
|
| Rate for Payer: UHC Exchange |
$22.06
|
| Rate for Payer: UHCCP DNSP |
$22.14
|
|
|
PR HYDROMORPHONE INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J1170
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
|
|
PR HYDROXYPROGESTERONE CAPROATE
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1725
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
|
|
PR HYDROXYZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J3410
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$21.84 |
| Rate for Payer: Aetna Commercial |
$20.33
|
| Rate for Payer: Aetna Medicare |
$15.17
|
| Rate for Payer: BCBS MAPPO |
$15.17
|
| Rate for Payer: BCBS Trust/PPO |
$8.65
|
| Rate for Payer: BCN Commercial |
$10.67
|
| Rate for Payer: BCN Medicare Advantage |
$15.17
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.17
|
| Rate for Payer: Healthscope Commercial |
$18.20
|
| Rate for Payer: Healthscope Whirlpool |
$18.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.69
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PACE SWMI |
$15.17
|
| Rate for Payer: PHP Medicare Advantage |
$15.17
|
| Rate for Payer: Priority Health Medicare |
$15.17
|
| Rate for Payer: Railroad Medicare Medicare |
$15.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.17
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UHCCP DNSP |
$15.17
|
|
|
PR HYMENOTOMY SIMPLE INCISION
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 56442
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Aetna Commercial |
$57.26
|
| Rate for Payer: Aetna Medicare |
$42.73
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS MAPPO |
$42.73
|
| Rate for Payer: BCN Commercial |
$72.21
|
| Rate for Payer: BCN Medicare Advantage |
$42.73
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$57.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.73
|
| Rate for Payer: Healthscope Commercial |
$51.28
|
| Rate for Payer: Healthscope Whirlpool |
$51.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.87
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.00
|
| Rate for Payer: Nomi Health Commercial |
$51.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: PACE SWMI |
$42.73
|
| Rate for Payer: PHP Medicare Advantage |
$42.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.13
|
| Rate for Payer: Priority Health Medicare |
$42.73
|
| Rate for Payer: Priority Health Narrow Network |
$73.13
|
| Rate for Payer: Railroad Medicare Medicare |
$42.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.73
|
| Rate for Payer: UHC Exchange |
$82.35
|
| Rate for Payer: UHC Medicaid |
$27.90
|
| Rate for Payer: UHCCP DNSP |
$42.73
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
|
PR HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL
|
Professional
|
Both
|
$8,744.00
|
|
|
Service Code
|
HCPCS 61548
|
| Min. Negotiated Rate |
$948.28 |
| Max. Negotiated Rate |
$6,558.00 |
| Rate for Payer: Aetna Commercial |
$1,986.38
|
| Rate for Payer: Aetna Medicare |
$1,482.37
|
| Rate for Payer: BCBS Complete |
$995.69
|
| Rate for Payer: BCBS MAPPO |
$1,482.37
|
| Rate for Payer: BCN Commercial |
$3,287.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,482.37
|
| Rate for Payer: Cash Price |
$6,995.20
|
| Rate for Payer: Cash Price |
$6,995.20
|
| Rate for Payer: Cofinity Commercial |
$2,134.61
|
| Rate for Payer: Cofinity Commercial |
$1,986.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,482.37
|
| Rate for Payer: Healthscope Commercial |
$1,778.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,778.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,556.49
|
| Rate for Payer: Meridian Medicaid |
$995.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,630.61
|
| Rate for Payer: Nomi Health Commercial |
$1,778.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,558.00
|
| Rate for Payer: PACE SWMI |
$1,482.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,482.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$948.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,764.15
|
| Rate for Payer: Priority Health Medicare |
$1,482.37
|
| Rate for Payer: Priority Health Narrow Network |
$2,764.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,482.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,760.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,482.37
|
| Rate for Payer: UHC Exchange |
$2,760.41
|
| Rate for Payer: UHC Medicaid |
$948.28
|
| Rate for Payer: UHCCP DNSP |
$1,482.37
|
| Rate for Payer: UHCCP Medicaid |
$948.28
|
|
|
PR HYSTERORRHAPHY RUPTURED UTERUS
|
Professional
|
Both
|
$1,351.00
|
|
|
Service Code
|
HCPCS 59350
|
| Min. Negotiated Rate |
$156.98 |
| Max. Negotiated Rate |
$1,013.25 |
| Rate for Payer: Aetna Commercial |
$334.72
|
| Rate for Payer: Aetna Medicare |
$249.79
|
| Rate for Payer: BCBS Complete |
$164.83
|
| Rate for Payer: BCBS MAPPO |
$249.79
|
| Rate for Payer: BCN Commercial |
$415.32
|
| Rate for Payer: BCN Medicare Advantage |
$249.79
|
| Rate for Payer: Cash Price |
$1,080.80
|
| Rate for Payer: Cash Price |
$1,080.80
|
| Rate for Payer: Cofinity Commercial |
$359.70
|
| Rate for Payer: Cofinity Commercial |
$334.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.79
|
| Rate for Payer: Healthscope Commercial |
$299.75
|
| Rate for Payer: Healthscope Whirlpool |
$299.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$262.28
|
| Rate for Payer: Meridian Medicaid |
$164.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$274.77
|
| Rate for Payer: Nomi Health Commercial |
$299.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,013.25
|
| Rate for Payer: PACE SWMI |
$249.79
|
| Rate for Payer: PHP Medicare Advantage |
$249.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$392.06
|
| Rate for Payer: Priority Health Medicare |
$249.79
|
| Rate for Payer: Priority Health Narrow Network |
$392.06
|
| Rate for Payer: Railroad Medicare Medicare |
$249.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$502.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$249.79
|
| Rate for Payer: UHC Exchange |
$502.41
|
| Rate for Payer: UHC Medicaid |
$156.98
|
| Rate for Payer: UHCCP DNSP |
$249.79
|
| Rate for Payer: UHCCP Medicaid |
$156.98
|
|
|
PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS
|
Professional
|
Both
|
$3,467.00
|
|
|
Service Code
|
HCPCS 58565
|
| Min. Negotiated Rate |
$397.96 |
| Max. Negotiated Rate |
$2,600.25 |
| Rate for Payer: Aetna Commercial |
$533.27
|
| Rate for Payer: Aetna Medicare |
$397.96
|
| Rate for Payer: BCBS Complete |
$1,386.80
|
| Rate for Payer: BCBS MAPPO |
$397.96
|
| Rate for Payer: BCN Commercial |
$685.72
|
| Rate for Payer: BCN Medicare Advantage |
$397.96
|
| Rate for Payer: Cash Price |
$2,773.60
|
| Rate for Payer: Cash Price |
$2,773.60
|
| Rate for Payer: Cofinity Commercial |
$573.06
|
| Rate for Payer: Cofinity Commercial |
$533.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.96
|
| Rate for Payer: Healthscope Commercial |
$477.55
|
| Rate for Payer: Healthscope Whirlpool |
$477.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$437.76
|
| Rate for Payer: Nomi Health Commercial |
$477.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,600.25
|
| Rate for Payer: PACE SWMI |
$397.96
|
| Rate for Payer: PHP Medicare Advantage |
$397.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$694.48
|
| Rate for Payer: Priority Health Medicare |
$397.96
|
| Rate for Payer: Priority Health Narrow Network |
$694.48
|
| Rate for Payer: Railroad Medicare Medicare |
$397.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$789.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$397.96
|
| Rate for Payer: UHC Exchange |
$789.19
|
| Rate for Payer: UHCCP DNSP |
$397.96
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,059.00 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: Aetna Commercial |
$1,270.80
|
| Rate for Payer: ASR ASR |
$1,369.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.53
|
| Rate for Payer: BCN Commercial |
$1,159.53
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cofinity Commercial |
$1,327.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.60
|
| Rate for Payer: Healthscope Commercial |
$1,369.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,412.00
|
| Rate for Payer: Mclaren Commercial |
$1,270.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.20
|
| Rate for Payer: Nomi Health Commercial |
$1,157.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.00
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$989.81 |
| Max. Negotiated Rate |
$4,031.86 |
| Rate for Payer: Aetna Commercial |
$1,270.80
|
| Rate for Payer: Aetna Medicare |
$3,225.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: ASR ASR |
$1,369.64
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.19
|
| Rate for Payer: BCN Commercial |
$1,164.19
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cofinity Commercial |
$1,327.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$1,369.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,412.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,225.49
|
| Rate for Payer: Mclaren Commercial |
$1,270.80
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$1,771.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.20
|
| Rate for Payer: Nomi Health Commercial |
$1,157.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.00
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,548.04
|
| Rate for Payer: PHP Medicaid |
$1,728.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,237.19
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Narrow Network |
$989.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP DNSP |
$3,225.49
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
58558
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$1,059.00 |
| Rate for Payer: Aetna Commercial |
$272.89
|
| Rate for Payer: Aetna Medicare |
$203.65
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCBS MAPPO |
$203.65
|
| Rate for Payer: BCN Commercial |
$345.59
|
| Rate for Payer: BCN Medicare Advantage |
$203.65
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cofinity Commercial |
$293.26
|
| Rate for Payer: Cofinity Commercial |
$272.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.65
|
| Rate for Payer: Healthscope Commercial |
$244.38
|
| Rate for Payer: Healthscope Whirlpool |
$244.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.83
|
| Rate for Payer: Meridian Medicaid |
$136.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$224.01
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.00
|
| Rate for Payer: PACE SWMI |
$203.65
|
| Rate for Payer: PHP Medicare Advantage |
$203.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$350.01
|
| Rate for Payer: Priority Health Medicare |
$203.65
|
| Rate for Payer: Priority Health Narrow Network |
$350.01
|
| Rate for Payer: Railroad Medicare Medicare |
$203.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$203.65
|
| Rate for Payer: UHC Exchange |
$412.90
|
| Rate for Payer: UHC Medicaid |
$130.36
|
| Rate for Payer: UHCCP DNSP |
$203.65
|
| Rate for Payer: UHCCP Medicaid |
$130.36
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
HCPCS 58558
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$1,059.00 |
| Rate for Payer: Aetna Commercial |
$272.89
|
| Rate for Payer: Aetna Medicare |
$203.65
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCBS MAPPO |
$203.65
|
| Rate for Payer: BCN Commercial |
$345.59
|
| Rate for Payer: BCN Medicare Advantage |
$203.65
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cofinity Commercial |
$293.26
|
| Rate for Payer: Cofinity Commercial |
$272.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.65
|
| Rate for Payer: Healthscope Commercial |
$244.38
|
| Rate for Payer: Healthscope Whirlpool |
$244.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.83
|
| Rate for Payer: Meridian Medicaid |
$136.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$224.01
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.00
|
| Rate for Payer: PACE SWMI |
$203.65
|
| Rate for Payer: PHP Medicare Advantage |
$203.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$350.01
|
| Rate for Payer: Priority Health Medicare |
$203.65
|
| Rate for Payer: Priority Health Narrow Network |
$350.01
|
| Rate for Payer: Railroad Medicare Medicare |
$203.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$203.65
|
| Rate for Payer: UHC Exchange |
$412.90
|
| Rate for Payer: UHC Medicaid |
$130.36
|
| Rate for Payer: UHCCP DNSP |
$203.65
|
| Rate for Payer: UHCCP Medicaid |
$130.36
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$837.00
|
|
|
Service Code
|
HCPCS 58555
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$627.75 |
| Rate for Payer: Aetna Commercial |
$179.08
|
| Rate for Payer: Aetna Medicare |
$133.64
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$133.64
|
| Rate for Payer: BCN Commercial |
$227.58
|
| Rate for Payer: BCN Medicare Advantage |
$133.64
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cofinity Commercial |
$192.44
|
| Rate for Payer: Cofinity Commercial |
$179.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.64
|
| Rate for Payer: Healthscope Commercial |
$160.37
|
| Rate for Payer: Healthscope Whirlpool |
$160.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.32
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.00
|
| Rate for Payer: Nomi Health Commercial |
$160.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$627.75
|
| Rate for Payer: PACE SWMI |
$133.64
|
| Rate for Payer: PHP Medicare Advantage |
$133.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$230.48
|
| Rate for Payer: Priority Health Medicare |
$133.64
|
| Rate for Payer: Priority Health Narrow Network |
$230.48
|
| Rate for Payer: Railroad Medicare Medicare |
$133.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.64
|
| Rate for Payer: UHC Exchange |
$270.33
|
| Rate for Payer: UHC Medicaid |
$85.84
|
| Rate for Payer: UHCCP DNSP |
$133.64
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,723.00
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$1,292.25 |
| Rate for Payer: Aetna Commercial |
$367.82
|
| Rate for Payer: Aetna Medicare |
$274.49
|
| Rate for Payer: BCBS Complete |
$184.06
|
| Rate for Payer: BCBS MAPPO |
$274.49
|
| Rate for Payer: BCN Commercial |
$465.61
|
| Rate for Payer: BCN Medicare Advantage |
$274.49
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Cofinity Commercial |
$395.27
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.49
|
| Rate for Payer: Healthscope Commercial |
$329.39
|
| Rate for Payer: Healthscope Whirlpool |
$329.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.21
|
| Rate for Payer: Meridian Medicaid |
$184.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$301.94
|
| Rate for Payer: Nomi Health Commercial |
$329.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,292.25
|
| Rate for Payer: PACE SWMI |
$274.49
|
| Rate for Payer: PHP Medicare Advantage |
$274.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$471.56
|
| Rate for Payer: Priority Health Medicare |
$274.49
|
| Rate for Payer: Priority Health Narrow Network |
$471.56
|
| Rate for Payer: Railroad Medicare Medicare |
$274.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$561.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$274.49
|
| Rate for Payer: UHC Exchange |
$561.76
|
| Rate for Payer: UHC Medicaid |
$175.30
|
| Rate for Payer: UHCCP DNSP |
$274.49
|
| Rate for Payer: UHCCP Medicaid |
$175.30
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,611.00
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Aetna Commercial |
$290.12
|
| Rate for Payer: Aetna Medicare |
$216.51
|
| Rate for Payer: BCBS Complete |
$145.37
|
| Rate for Payer: BCBS MAPPO |
$216.51
|
| Rate for Payer: BCN Commercial |
$366.51
|
| Rate for Payer: BCN Medicare Advantage |
$216.51
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cofinity Commercial |
$311.77
|
| Rate for Payer: Cofinity Commercial |
$290.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.51
|
| Rate for Payer: Healthscope Commercial |
$259.81
|
| Rate for Payer: Healthscope Whirlpool |
$259.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.34
|
| Rate for Payer: Meridian Medicaid |
$145.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$238.16
|
| Rate for Payer: Nomi Health Commercial |
$259.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.25
|
| Rate for Payer: PACE SWMI |
$216.51
|
| Rate for Payer: PHP Medicare Advantage |
$216.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$371.20
|
| Rate for Payer: Priority Health Medicare |
$216.51
|
| Rate for Payer: Priority Health Narrow Network |
$371.20
|
| Rate for Payer: Railroad Medicare Medicare |
$216.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$216.51
|
| Rate for Payer: UHC Exchange |
$439.99
|
| Rate for Payer: UHC Medicaid |
$138.45
|
| Rate for Payer: UHCCP DNSP |
$216.51
|
| Rate for Payer: UHCCP Medicaid |
$138.45
|
|
