|
PR HYALGAN SUPARTZ VISCO-3 DOSE
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS J7321
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$196.95 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Medicare |
$71.52
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: BCBS MAPPO |
$71.52
|
| Rate for Payer: BCN Medicare Advantage |
$71.52
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Cofinity Commercial |
$102.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.52
|
| Rate for Payer: Healthscope Commercial |
$85.82
|
| Rate for Payer: Healthscope Whirlpool |
$85.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.10
|
| Rate for Payer: Nomi Health Commercial |
$85.82
|
| Rate for Payer: PACE SWMI |
$71.52
|
| Rate for Payer: PHP Medicare Advantage |
$71.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health Medicare |
$71.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.52
|
| Rate for Payer: UHC Medicare Advantage |
$71.52
|
| Rate for Payer: UHCCP DNSP |
$71.52
|
|
|
PR HYDROCORTISONE SODIUM SUCC I
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1720
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$30.69 |
| Rate for Payer: Aetna Commercial |
$28.56
|
| Rate for Payer: Aetna Medicare |
$21.31
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$21.31
|
| Rate for Payer: BCN Medicare Advantage |
$21.31
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$30.69
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Healthscope Whirlpool |
$25.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.38
|
| Rate for Payer: Nomi Health Commercial |
$25.57
|
| Rate for Payer: PACE SWMI |
$21.31
|
| Rate for Payer: PHP Medicare Advantage |
$21.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$21.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.31
|
| Rate for Payer: UHC Medicare Advantage |
$21.31
|
| Rate for Payer: UHCCP DNSP |
$21.31
|
|
|
PR HYDROMORPHONE INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J1170
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR HYDROXYPROGESTERONE CAPROATE
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1725
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
|
|
PR HYDROXYZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J3410
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.50
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$20.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Healthscope Whirlpool |
$18.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.07
|
| Rate for Payer: Nomi Health Commercial |
$18.36
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: UHCCP DNSP |
$15.30
|
|
|
PR HYMENOTOMY SIMPLE INCISION
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 56442
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$61.36
|
| Rate for Payer: Aetna Medicare |
$45.79
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$45.79
|
| Rate for Payer: BCN Medicare Advantage |
$45.79
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.79
|
| Rate for Payer: Healthscope Commercial |
$54.95
|
| Rate for Payer: Healthscope Whirlpool |
$54.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.08
|
| Rate for Payer: Nomi Health Commercial |
$54.95
|
| Rate for Payer: PACE SWMI |
$45.79
|
| Rate for Payer: PHP Medicare Advantage |
$45.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$45.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.79
|
| Rate for Payer: UHC Medicare Advantage |
$45.79
|
| Rate for Payer: UHCCP DNSP |
$45.79
|
|
|
PR HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL
|
Professional
|
Both
|
$8,489.00
|
|
|
Service Code
|
HCPCS 61548
|
| Min. Negotiated Rate |
$1,543.76 |
| Max. Negotiated Rate |
$5,517.85 |
| Rate for Payer: Aetna Commercial |
$2,068.64
|
| Rate for Payer: Aetna Medicare |
$1,543.76
|
| Rate for Payer: BCBS Complete |
$3,395.60
|
| Rate for Payer: BCBS MAPPO |
$1,543.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,543.76
|
| Rate for Payer: Cash Price |
$6,791.20
|
| Rate for Payer: Cash Price |
$6,791.20
|
| Rate for Payer: Cofinity Commercial |
$2,223.01
|
| Rate for Payer: Cofinity Commercial |
$2,068.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,543.76
|
| Rate for Payer: Healthscope Commercial |
$1,852.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,852.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,620.95
|
| Rate for Payer: Nomi Health Commercial |
$1,852.51
|
| Rate for Payer: PACE SWMI |
$1,543.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,543.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,517.85
|
| Rate for Payer: Priority Health Medicare |
$1,543.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,543.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,543.76
|
| Rate for Payer: UHCCP DNSP |
$1,543.76
|
|
|
PR HYSTERORRHAPHY RUPTURED UTERUS
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 59350
|
| Min. Negotiated Rate |
$272.69 |
| Max. Negotiated Rate |
$852.80 |
| Rate for Payer: Aetna Commercial |
$365.40
|
| Rate for Payer: Aetna Medicare |
$272.69
|
| Rate for Payer: BCBS Complete |
$524.80
|
| Rate for Payer: BCBS MAPPO |
$272.69
|
| Rate for Payer: BCN Medicare Advantage |
$272.69
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cofinity Commercial |
$392.67
|
| Rate for Payer: Cofinity Commercial |
$365.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.69
|
| Rate for Payer: Healthscope Commercial |
$327.23
|
| Rate for Payer: Healthscope Whirlpool |
$327.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.32
|
| Rate for Payer: Nomi Health Commercial |
$327.23
|
| Rate for Payer: PACE SWMI |
$272.69
|
| Rate for Payer: PHP Medicare Advantage |
$272.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.80
|
| Rate for Payer: Priority Health Medicare |
$272.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.69
|
| Rate for Payer: UHC Medicare Advantage |
$272.69
|
| Rate for Payer: UHCCP DNSP |
$272.69
|
|
|
PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS
|
Professional
|
Both
|
$3,366.00
|
|
|
Service Code
|
HCPCS 58565
|
| Min. Negotiated Rate |
$436.27 |
| Max. Negotiated Rate |
$2,187.90 |
| Rate for Payer: Aetna Commercial |
$584.60
|
| Rate for Payer: Aetna Medicare |
$436.27
|
| Rate for Payer: BCBS Complete |
$1,346.40
|
| Rate for Payer: BCBS MAPPO |
$436.27
|
| Rate for Payer: BCN Medicare Advantage |
$436.27
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cofinity Commercial |
$628.23
|
| Rate for Payer: Cofinity Commercial |
$584.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.27
|
| Rate for Payer: Healthscope Commercial |
$523.52
|
| Rate for Payer: Healthscope Whirlpool |
$523.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.08
|
| Rate for Payer: Nomi Health Commercial |
$523.52
|
| Rate for Payer: PACE SWMI |
$436.27
|
| Rate for Payer: PHP Medicare Advantage |
$436.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.90
|
| Rate for Payer: Priority Health Medicare |
$436.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.27
|
| Rate for Payer: UHC Medicare Advantage |
$436.27
|
| Rate for Payer: UHCCP DNSP |
$436.27
|
|
|
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 |
$222.53 |
| Max. Negotiated Rate |
$891.15 |
| Rate for Payer: Aetna Commercial |
$298.19
|
| Rate for Payer: Aetna Medicare |
$222.53
|
| Rate for Payer: BCBS Complete |
$548.40
|
| Rate for Payer: BCBS MAPPO |
$222.53
|
| Rate for Payer: BCN Medicare Advantage |
$222.53
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$298.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.53
|
| Rate for Payer: Healthscope Commercial |
$267.04
|
| Rate for Payer: Healthscope Whirlpool |
$267.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.66
|
| Rate for Payer: Nomi Health Commercial |
$267.04
|
| Rate for Payer: PACE SWMI |
$222.53
|
| Rate for Payer: PHP Medicare Advantage |
$222.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health Medicare |
$222.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.53
|
| Rate for Payer: UHC Medicare Advantage |
$222.53
|
| Rate for Payer: UHCCP DNSP |
$222.53
|
|
|
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
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 58558
|
| Min. Negotiated Rate |
$222.53 |
| Max. Negotiated Rate |
$891.15 |
| Rate for Payer: Aetna Commercial |
$298.19
|
| Rate for Payer: Aetna Medicare |
$222.53
|
| Rate for Payer: BCBS Complete |
$548.40
|
| Rate for Payer: BCBS MAPPO |
$222.53
|
| Rate for Payer: BCN Medicare Advantage |
$222.53
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$298.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.53
|
| Rate for Payer: Healthscope Commercial |
$267.04
|
| Rate for Payer: Healthscope Whirlpool |
$267.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.66
|
| Rate for Payer: Nomi Health Commercial |
$267.04
|
| Rate for Payer: PACE SWMI |
$222.53
|
| Rate for Payer: PHP Medicare Advantage |
$222.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health Medicare |
$222.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.53
|
| Rate for Payer: UHC Medicare Advantage |
$222.53
|
| Rate for Payer: UHCCP DNSP |
$222.53
|
|
|
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 |
$4,806.44 |
| Rate for Payer: Aetna Commercial |
$1,233.90
|
| Rate for Payer: Aetna Medicare |
$3,100.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: ASR ASR |
$1,329.87
|
| Rate for Payer: ASR Commercial |
$1,329.87
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.71
|
| Rate for Payer: BCN Commercial |
$1,062.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| 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 |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$1,371.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,329.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$1,233.90
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| 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 |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,411.02
|
| Rate for Payer: PHP Medicaid |
$1,662.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| 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 |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$961.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,206.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$4,806.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP DNSP |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
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 DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
58555
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$528.45 |
| Rate for Payer: Aetna Commercial |
$196.02
|
| Rate for Payer: Aetna Medicare |
$146.28
|
| Rate for Payer: BCBS Complete |
$325.20
|
| Rate for Payer: BCBS MAPPO |
$146.28
|
| Rate for Payer: BCN Medicare Advantage |
$146.28
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Commercial |
$196.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.28
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Healthscope Whirlpool |
$175.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.59
|
| Rate for Payer: Nomi Health Commercial |
$175.54
|
| Rate for Payer: PACE SWMI |
$146.28
|
| Rate for Payer: PHP Medicare Advantage |
$146.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health Medicare |
$146.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.28
|
| Rate for Payer: UHC Medicare Advantage |
$146.28
|
| Rate for Payer: UHCCP DNSP |
$146.28
|
|
|
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 |
$4,806.44 |
| Rate for Payer: Aetna Commercial |
$731.70
|
| Rate for Payer: Aetna Medicare |
$3,100.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: ASR ASR |
$788.61
|
| Rate for Payer: ASR Commercial |
$788.61
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$665.77
|
| Rate for Payer: BCN Commercial |
$630.32
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| 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 |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$813.00
|
| Rate for Payer: Healthscope Whirlpool |
$788.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$731.70
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.05
|
| Rate for Payer: Nomi Health Commercial |
$666.66
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,411.02
|
| Rate for Payer: PHP Medicaid |
$1,662.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| 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 |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$569.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$4,806.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP DNSP |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 58555
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$528.45 |
| Rate for Payer: Aetna Commercial |
$196.02
|
| Rate for Payer: Aetna Medicare |
$146.28
|
| Rate for Payer: BCBS Complete |
$325.20
|
| Rate for Payer: BCBS MAPPO |
$146.28
|
| Rate for Payer: BCN Medicare Advantage |
$146.28
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Commercial |
$196.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.28
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Healthscope Whirlpool |
$175.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.59
|
| Rate for Payer: Nomi Health Commercial |
$175.54
|
| Rate for Payer: PACE SWMI |
$146.28
|
| Rate for Payer: PHP Medicare Advantage |
$146.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health Medicare |
$146.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.28
|
| Rate for Payer: UHC Medicare Advantage |
$146.28
|
| Rate for Payer: UHCCP DNSP |
$146.28
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,673.00
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$1,087.45 |
| Rate for Payer: Aetna Commercial |
$402.40
|
| Rate for Payer: Aetna Medicare |
$300.30
|
| Rate for Payer: BCBS Complete |
$669.20
|
| Rate for Payer: BCBS MAPPO |
$300.30
|
| Rate for Payer: BCN Medicare Advantage |
$300.30
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cofinity Commercial |
$432.43
|
| Rate for Payer: Cofinity Commercial |
$402.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.30
|
| Rate for Payer: Healthscope Commercial |
$360.36
|
| Rate for Payer: Healthscope Whirlpool |
$360.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.31
|
| Rate for Payer: Nomi Health Commercial |
$360.36
|
| Rate for Payer: PACE SWMI |
$300.30
|
| Rate for Payer: PHP Medicare Advantage |
$300.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.45
|
| Rate for Payer: Priority Health Medicare |
$300.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.30
|
| Rate for Payer: UHC Medicare Advantage |
$300.30
|
| Rate for Payer: UHCCP DNSP |
$300.30
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,016.60 |
| Rate for Payer: Aetna Commercial |
$316.27
|
| Rate for Payer: Aetna Medicare |
$236.02
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$236.02
|
| Rate for Payer: BCN Medicare Advantage |
$236.02
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$339.87
|
| Rate for Payer: Cofinity Commercial |
$316.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.02
|
| Rate for Payer: Healthscope Commercial |
$283.22
|
| Rate for Payer: Healthscope Whirlpool |
$283.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.82
|
| Rate for Payer: Nomi Health Commercial |
$283.22
|
| Rate for Payer: PACE SWMI |
$236.02
|
| Rate for Payer: PHP Medicare Advantage |
$236.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$236.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.02
|
| Rate for Payer: UHC Medicare Advantage |
$236.02
|
| Rate for Payer: UHCCP DNSP |
$236.02
|
|
|
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 |
$7,462.35 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: Aetna Medicare |
$4,814.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: ASR ASR |
$1,517.08
|
| Rate for Payer: ASR Commercial |
$1,517.08
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,280.76
|
| Rate for Payer: BCN Commercial |
$1,212.57
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| 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 |
$4,814.42
|
| Rate for Payer: Healthscope Commercial |
$1,564.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,814.42
|
| Rate for Payer: Mclaren Commercial |
$1,407.60
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| 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 |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Commercial |
$5,295.86
|
| Rate for Payer: PHP Medicaid |
$2,580.53
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| 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 |
$4,814.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,096.36
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,376.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Exchange |
$7,462.35
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP DNSP |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,580.53
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,016.60 |
| Rate for Payer: Aetna Commercial |
$316.27
|
| Rate for Payer: Aetna Medicare |
$236.02
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$236.02
|
| Rate for Payer: BCN Medicare Advantage |
$236.02
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$339.87
|
| Rate for Payer: Cofinity Commercial |
$316.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.02
|
| Rate for Payer: Healthscope Commercial |
$283.22
|
| Rate for Payer: Healthscope Whirlpool |
$283.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.82
|
| Rate for Payer: Nomi Health Commercial |
$283.22
|
| Rate for Payer: PACE SWMI |
$236.02
|
| Rate for Payer: PHP Medicare Advantage |
$236.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$236.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.02
|
| Rate for Payer: UHC Medicare Advantage |
$236.02
|
| Rate for Payer: UHCCP DNSP |
$236.02
|
|
|
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 |
$272.52 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$365.18
|
| Rate for Payer: Aetna Medicare |
$272.52
|
| Rate for Payer: BCBS Complete |
$606.00
|
| Rate for Payer: BCBS MAPPO |
$272.52
|
| Rate for Payer: BCN Medicare Advantage |
$272.52
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cofinity Commercial |
$392.43
|
| Rate for Payer: Cofinity Commercial |
$365.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.52
|
| Rate for Payer: Healthscope Commercial |
$327.02
|
| Rate for Payer: Healthscope Whirlpool |
$327.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.15
|
| Rate for Payer: Nomi Health Commercial |
$327.02
|
| Rate for Payer: PACE SWMI |
$272.52
|
| Rate for Payer: PHP Medicare Advantage |
$272.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.75
|
| Rate for Payer: Priority Health Medicare |
$272.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.52
|
| Rate for Payer: UHC Medicare Advantage |
$272.52
|
| Rate for Payer: UHCCP DNSP |
$272.52
|
|
|
PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS 58562
|
| Min. Negotiated Rate |
$212.48 |
| Max. Negotiated Rate |
$765.05 |
| Rate for Payer: Aetna Commercial |
$284.72
|
| Rate for Payer: Aetna Medicare |
$212.48
|
| Rate for Payer: BCBS Complete |
$470.80
|
| Rate for Payer: BCBS MAPPO |
$212.48
|
| Rate for Payer: BCN Medicare Advantage |
$212.48
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$284.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.48
|
| Rate for Payer: Healthscope Commercial |
$254.98
|
| Rate for Payer: Healthscope Whirlpool |
$254.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.10
|
| Rate for Payer: Nomi Health Commercial |
$254.98
|
| Rate for Payer: PACE SWMI |
$212.48
|
| Rate for Payer: PHP Medicare Advantage |
$212.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.05
|
| Rate for Payer: Priority Health Medicare |
$212.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.48
|
| Rate for Payer: UHC Medicare Advantage |
$212.48
|
| Rate for Payer: UHCCP DNSP |
$212.48
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$7,462.35 |
| Rate for Payer: Aetna Commercial |
$846.90
|
| Rate for Payer: Aetna Medicare |
$4,814.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: ASR ASR |
$912.77
|
| Rate for Payer: ASR Commercial |
$912.77
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCBS Trust/PPO |
$770.58
|
| Rate for Payer: BCN Commercial |
$729.56
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| 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 |
$4,814.42
|
| Rate for Payer: Healthscope Commercial |
$941.00
|
| Rate for Payer: Healthscope Whirlpool |
$912.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,814.42
|
| Rate for Payer: Mclaren Commercial |
$846.90
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.85
|
| Rate for Payer: Nomi Health Commercial |
$771.62
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Commercial |
$5,295.86
|
| Rate for Payer: PHP Medicaid |
$2,580.53
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| 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 |
$4,814.42
|
| Rate for Payer: Priority Health Narrow Network |
$659.64
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$828.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Exchange |
$7,462.35
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP DNSP |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,580.53
|
| Rate for Payer: VA VA |
$4,814.42
|
|
