|
PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS
|
Professional
|
Both
|
$3,366.00
|
|
|
Service Code
|
HCPCS 58565
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$2,480.04 |
| Rate for Payer: Aetna Commercial |
$542.07
|
| Rate for Payer: Aetna Medicare |
$1,683.00
|
| Rate for Payer: BCBS Complete |
$1,346.40
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2,480.04
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.53
|
| Rate for Payer: Priority Health Narrow Network |
$686.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.89
|
| Rate for Payer: UHC Exchange |
$494.89
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
58558
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$1,979.15 |
| Rate for Payer: Aetna Commercial |
$276.01
|
| Rate for Payer: Aetna Medicare |
$685.50
|
| Rate for Payer: BCBS Complete |
$155.21
|
| Rate for Payer: BCBS Trust/PPO |
$650.87
|
| Rate for Payer: BCN Commercial |
$1,979.15
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Meridian Medicaid |
$155.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.27
|
| Rate for Payer: Priority Health Narrow Network |
$343.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.64
|
| Rate for Payer: UHC Exchange |
$307.64
|
| Rate for Payer: UHCCP Medicaid |
$147.82
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 58558
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$1,979.15 |
| Rate for Payer: Aetna Commercial |
$276.01
|
| Rate for Payer: Aetna Medicare |
$685.50
|
| Rate for Payer: BCBS Complete |
$155.21
|
| Rate for Payer: BCBS Trust/PPO |
$650.87
|
| Rate for Payer: BCN Commercial |
$1,979.15
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Meridian Medicaid |
$155.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.27
|
| Rate for Payer: Priority Health Narrow Network |
$343.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.64
|
| Rate for Payer: UHC Exchange |
$307.64
|
| Rate for Payer: UHCCP Medicaid |
$147.82
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$891.15 |
| Max. Negotiated Rate |
$1,371.00 |
| Rate for Payer: Aetna Commercial |
$1,233.90
|
| Rate for Payer: ASR ASR |
$1,329.87
|
| Rate for Payer: ASR Commercial |
$1,329.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.23
|
| Rate for Payer: BCN Commercial |
$1,062.94
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$1,288.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.80
|
| Rate for Payer: Healthscope Commercial |
$1,371.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,329.87
|
| Rate for Payer: Mclaren Commercial |
$1,233.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,165.35
|
| Rate for Payer: Nomi Health Commercial |
$1,124.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,206.48
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$891.15 |
| Max. Negotiated Rate |
$4,828.62 |
| Rate for Payer: Aetna Commercial |
$1,233.90
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$1,329.87
|
| Rate for Payer: ASR Commercial |
$1,329.87
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.71
|
| Rate for Payer: BCN Commercial |
$1,062.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$1,288.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$1,371.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,329.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren Commercial |
$1,233.90
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,165.35
|
| Rate for Payer: Nomi Health Commercial |
$1,124.22
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,201.27
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$961.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,206.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$528.45 |
| Max. Negotiated Rate |
$4,828.62 |
| Rate for Payer: Aetna Commercial |
$731.70
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$788.61
|
| Rate for Payer: ASR Commercial |
$788.61
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$665.77
|
| Rate for Payer: BCN Commercial |
$630.32
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$764.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$813.00
|
| Rate for Payer: Healthscope Whirlpool |
$788.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren Commercial |
$731.70
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.05
|
| Rate for Payer: Nomi Health Commercial |
$666.66
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$712.35
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$569.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$1,037.58 |
| Rate for Payer: Aetna Commercial |
$181.23
|
| Rate for Payer: Aetna Medicare |
$406.50
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$536.08
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.71
|
| Rate for Payer: Priority Health Narrow Network |
$224.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.96
|
| Rate for Payer: UHC Exchange |
$217.96
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 58555
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$1,037.58 |
| Rate for Payer: Aetna Commercial |
$181.23
|
| Rate for Payer: Aetna Medicare |
$406.50
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$536.08
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.71
|
| Rate for Payer: Priority Health Narrow Network |
$224.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.96
|
| Rate for Payer: UHC Exchange |
$217.96
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$528.45 |
| Max. Negotiated Rate |
$813.00 |
| Rate for Payer: Aetna Commercial |
$731.70
|
| Rate for Payer: ASR ASR |
$788.61
|
| Rate for Payer: ASR Commercial |
$788.61
|
| Rate for Payer: BCBS Trust/PPO |
$662.51
|
| Rate for Payer: BCN Commercial |
$630.32
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$764.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.40
|
| Rate for Payer: Healthscope Commercial |
$813.00
|
| Rate for Payer: Healthscope Whirlpool |
$788.61
|
| Rate for Payer: Mclaren Commercial |
$731.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.05
|
| Rate for Payer: Nomi Health Commercial |
$666.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.44
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,673.00
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$1,087.45 |
| Rate for Payer: Aetna Commercial |
$375.75
|
| Rate for Payer: Aetna Medicare |
$836.50
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS Trust/PPO |
$29.58
|
| Rate for Payer: BCN Commercial |
$454.47
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$463.81
|
| Rate for Payer: Priority Health Narrow Network |
$463.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$447.32
|
| Rate for Payer: UHC Exchange |
$447.32
|
| Rate for Payer: UHCCP Medicaid |
$199.16
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$3,149.52 |
| Rate for Payer: Aetna Commercial |
$294.85
|
| Rate for Payer: Aetna Medicare |
$782.00
|
| Rate for Payer: BCBS Complete |
$164.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$3,149.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Meridian Medicaid |
$164.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.59
|
| Rate for Payer: Priority Health Narrow Network |
$364.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.11
|
| Rate for Payer: UHC Exchange |
$396.11
|
| Rate for Payer: UHCCP Medicaid |
$156.77
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$3,149.52 |
| Rate for Payer: Aetna Commercial |
$294.85
|
| Rate for Payer: Aetna Medicare |
$782.00
|
| Rate for Payer: BCBS Complete |
$164.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$3,149.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Meridian Medicaid |
$164.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.59
|
| Rate for Payer: Priority Health Narrow Network |
$364.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.11
|
| Rate for Payer: UHC Exchange |
$396.11
|
| Rate for Payer: UHCCP Medicaid |
$156.77
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$1,016.60 |
| Max. Negotiated Rate |
$7,496.78 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: Aetna Medicare |
$4,836.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: ASR ASR |
$1,517.08
|
| Rate for Payer: ASR Commercial |
$1,517.08
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,280.76
|
| Rate for Payer: BCN Commercial |
$1,212.57
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,470.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Healthscope Commercial |
$1,564.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,836.63
|
| Rate for Payer: Mclaren Commercial |
$1,407.60
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: Nomi Health Commercial |
$1,282.48
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Commercial |
$5,320.29
|
| Rate for Payer: PHP Medicaid |
$2,592.43
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,370.38
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,096.36
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,376.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$7,496.78
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP DNSP |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$1,016.60 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: ASR ASR |
$1,517.08
|
| Rate for Payer: ASR Commercial |
$1,517.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,274.50
|
| Rate for Payer: BCN Commercial |
$1,212.57
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,470.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Healthscope Commercial |
$1,564.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.08
|
| Rate for Payer: Mclaren Commercial |
$1,407.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: Nomi Health Commercial |
$1,282.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,376.32
|
|
|
PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 58559
|
| Min. Negotiated Rate |
$180.84 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$340.58
|
| Rate for Payer: Aetna Medicare |
$757.50
|
| Rate for Payer: BCBS Complete |
$189.88
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$412.93
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Meridian Medicaid |
$189.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.14
|
| Rate for Payer: Priority Health Narrow Network |
$421.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.11
|
| Rate for Payer: UHC Exchange |
$396.11
|
| Rate for Payer: UHCCP Medicaid |
$180.84
|
|
|
PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS 58562
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$765.05 |
| Rate for Payer: Aetna Commercial |
$265.43
|
| Rate for Payer: Aetna Medicare |
$588.50
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCN Commercial |
$639.19
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.88
|
| Rate for Payer: Priority Health Narrow Network |
$328.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.14
|
| Rate for Payer: UHC Exchange |
$335.14
|
| Rate for Payer: UHCCP Medicaid |
$141.22
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$941.00 |
| Rate for Payer: Aetna Commercial |
$846.90
|
| Rate for Payer: ASR ASR |
$912.77
|
| Rate for Payer: ASR Commercial |
$912.77
|
| Rate for Payer: BCBS Trust/PPO |
$766.82
|
| Rate for Payer: BCN Commercial |
$729.56
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$884.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.80
|
| Rate for Payer: Healthscope Commercial |
$941.00
|
| Rate for Payer: Healthscope Whirlpool |
$912.77
|
| Rate for Payer: Mclaren Commercial |
$846.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.85
|
| Rate for Payer: Nomi Health Commercial |
$771.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$828.08
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$633.08 |
| Rate for Payer: Aetna Commercial |
$428.81
|
| Rate for Payer: Aetna Medicare |
$470.50
|
| Rate for Payer: BCBS Complete |
$239.31
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$520.44
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.78
|
| Rate for Payer: Priority Health Narrow Network |
$530.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.08
|
| Rate for Payer: UHC Exchange |
$633.08
|
| Rate for Payer: UHCCP Medicaid |
$227.91
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$7,496.78 |
| Rate for Payer: Aetna Commercial |
$846.90
|
| Rate for Payer: Aetna Medicare |
$4,836.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: ASR ASR |
$912.77
|
| Rate for Payer: ASR Commercial |
$912.77
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$770.58
|
| Rate for Payer: BCN Commercial |
$729.56
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$884.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Healthscope Commercial |
$941.00
|
| Rate for Payer: Healthscope Whirlpool |
$912.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,836.63
|
| Rate for Payer: Mclaren Commercial |
$846.90
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.85
|
| Rate for Payer: Nomi Health Commercial |
$771.62
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Commercial |
$5,320.29
|
| Rate for Payer: PHP Medicaid |
$2,592.43
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.50
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$659.64
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$828.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$7,496.78
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP DNSP |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 58561
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$633.08 |
| Rate for Payer: Aetna Commercial |
$428.81
|
| Rate for Payer: Aetna Medicare |
$470.50
|
| Rate for Payer: BCBS Complete |
$239.31
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$520.44
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.78
|
| Rate for Payer: Priority Health Narrow Network |
$530.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.08
|
| Rate for Payer: UHC Exchange |
$633.08
|
| Rate for Payer: UHCCP Medicaid |
$227.91
|
|
|
PR HYSTEROTOMY ABDOMINAL
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 59100
|
| Min. Negotiated Rate |
$130.49 |
| Max. Negotiated Rate |
$1,260.30 |
| Rate for Payer: Aetna Commercial |
$936.56
|
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: BCBS Complete |
$578.80
|
| Rate for Payer: BCBS Trust/PPO |
$130.49
|
| Rate for Payer: BCN Commercial |
$1,260.30
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Meridian Medicaid |
$578.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$551.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,208.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,208.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$949.76
|
| Rate for Payer: UHC Exchange |
$949.76
|
| Rate for Payer: UHCCP Medicaid |
$551.24
|
|
|
PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 90750
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$237.48 |
| Rate for Payer: Aetna Commercial |
$187.08
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS Trust/PPO |
$175.26
|
| Rate for Payer: BCN Commercial |
$172.01
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.48
|
| Rate for Payer: UHC Exchange |
$237.48
|
|
|
PR I131 IODIDE CAP, RX
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS A9517
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$2,124.29 |
| Rate for Payer: Aetna Commercial |
$40.43
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,124.29
|
| Rate for Payer: BCN Commercial |
$23.73
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.84
|
| Rate for Payer: UHC Exchange |
$42.84
|
|
|
PR ICAR CATH ABLATION DISCRETE MECHANISM ARRHYTHMIA
|
Professional
|
Both
|
$1,492.00
|
|
|
Service Code
|
HCPCS 93655
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$2,991.76 |
| Rate for Payer: Aetna Commercial |
$570.63
|
| Rate for Payer: Aetna Medicare |
$746.00
|
| Rate for Payer: BCBS Complete |
$200.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,991.76
|
| Rate for Payer: BCN Commercial |
$442.74
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Meridian Medicaid |
$200.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.39
|
| Rate for Payer: Priority Health Narrow Network |
$421.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.29
|
| Rate for Payer: UHC Exchange |
$558.29
|
| Rate for Payer: UHCCP Medicaid |
$191.27
|
|
|
PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION
|
Professional
|
Both
|
$1,840.00
|
|
|
Service Code
|
HCPCS 93650
|
| Min. Negotiated Rate |
$363.17 |
| Max. Negotiated Rate |
$2,821.65 |
| Rate for Payer: Aetna Commercial |
$791.77
|
| Rate for Payer: Aetna Medicare |
$920.00
|
| Rate for Payer: BCBS Complete |
$381.33
|
| Rate for Payer: BCBS Trust/PPO |
$2,821.65
|
| Rate for Payer: BCN Commercial |
$840.53
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Meridian Medicaid |
$381.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,196.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$800.43
|
| Rate for Payer: Priority Health Narrow Network |
$800.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.55
|
| Rate for Payer: UHC Exchange |
$792.55
|
| Rate for Payer: UHCCP Medicaid |
$363.17
|
|
