|
PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 45905
|
| Min. Negotiated Rate |
$110.33 |
| Max. Negotiated Rate |
$30,038.00 |
| Rate for Payer: Aetna Commercial |
$218.49
|
| Rate for Payer: Aetna Medicare |
$169.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.79
|
| Rate for Payer: BCBS Complete |
$115.85
|
| Rate for Payer: BCBS MAPPO |
$163.05
|
| Rate for Payer: BCBS Trust/PPO |
$585.88
|
| Rate for Payer: BCN Commercial |
$249.22
|
| Rate for Payer: BCN Medicare Advantage |
$163.05
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$234.79
|
| Rate for Payer: Cofinity Commercial |
$218.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.05
|
| Rate for Payer: Healthscope Commercial |
$301.64
|
| Rate for Payer: Healthscope Commercial |
$260.88
|
| Rate for Payer: Mclaren Medicaid |
$110.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.20
|
| Rate for Payer: Meridian Medicaid |
$115.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,038.00
|
| Rate for Payer: Nomi Health Commercial |
$195.66
|
| Rate for Payer: PACE SWMI |
$163.05
|
| Rate for Payer: PHP Medicare Advantage |
$163.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.65
|
| Rate for Payer: Priority Health Medicare |
$163.05
|
| Rate for Payer: Priority Health Narrow Network |
$306.65
|
| Rate for Payer: Priority Health SBD |
$306.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.05
|
| Rate for Payer: UHC Exchange |
$320.36
|
| Rate for Payer: UHC Medicare Advantage |
$163.05
|
| Rate for Payer: UHCCP Medicaid |
$110.33
|
|
|
PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 42660
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$15,651.00 |
| Rate for Payer: Aetna Commercial |
$100.55
|
| Rate for Payer: Aetna Medicare |
$78.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.06
|
| Rate for Payer: BCBS Complete |
$53.46
|
| Rate for Payer: BCBS MAPPO |
$75.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.03
|
| Rate for Payer: BCN Commercial |
$172.01
|
| Rate for Payer: BCN Medicare Advantage |
$75.04
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$108.06
|
| Rate for Payer: Cofinity Commercial |
$100.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.04
|
| Rate for Payer: Healthscope Commercial |
$138.82
|
| Rate for Payer: Healthscope Commercial |
$120.06
|
| Rate for Payer: Mclaren Medicaid |
$50.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.79
|
| Rate for Payer: Meridian Medicaid |
$53.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,651.00
|
| Rate for Payer: Nomi Health Commercial |
$90.05
|
| Rate for Payer: PACE SWMI |
$75.04
|
| Rate for Payer: PHP Medicare Advantage |
$75.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.12
|
| Rate for Payer: Priority Health Medicare |
$75.04
|
| Rate for Payer: Priority Health Narrow Network |
$155.12
|
| Rate for Payer: Priority Health SBD |
$155.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.04
|
| Rate for Payer: UHC Exchange |
$106.47
|
| Rate for Payer: UHC Medicare Advantage |
$75.04
|
| Rate for Payer: UHCCP Medicaid |
$50.91
|
|
|
PR DILATE ESOPHAGUS,BALLOON RETROGRADE
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 43456
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.20
|
|
|
PR DILATE ESOPH,BALLN,>30MM ACHALASIA
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 43458
|
| Min. Negotiated Rate |
$411.60 |
| Max. Negotiated Rate |
$668.85 |
| Rate for Payer: Aetna Medicare |
$514.50
|
| Rate for Payer: BCBS Complete |
$411.60
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.85
|
|
|
PR DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 53665
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$6,737.00 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna Medicare |
$37.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.24
|
| Rate for Payer: BCBS Complete |
$24.82
|
| Rate for Payer: BCBS MAPPO |
$35.58
|
| Rate for Payer: BCN Commercial |
$54.73
|
| Rate for Payer: BCN Medicare Advantage |
$35.58
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$47.68
|
| Rate for Payer: Cofinity Commercial |
$51.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.58
|
| Rate for Payer: Healthscope Commercial |
$56.93
|
| Rate for Payer: Healthscope Commercial |
$65.82
|
| Rate for Payer: Mclaren Medicaid |
$23.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.36
|
| Rate for Payer: Meridian Medicaid |
$24.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,737.00
|
| Rate for Payer: Nomi Health Commercial |
$42.70
|
| Rate for Payer: PACE SWMI |
$35.58
|
| Rate for Payer: PHP Medicare Advantage |
$35.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.65
|
| Rate for Payer: Priority Health Medicare |
$35.58
|
| Rate for Payer: Priority Health Narrow Network |
$59.65
|
| Rate for Payer: Priority Health SBD |
$59.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.58
|
| Rate for Payer: UHC Exchange |
$55.23
|
| Rate for Payer: UHC Medicare Advantage |
$35.58
|
| Rate for Payer: UHCCP Medicaid |
$23.64
|
|
|
PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 53660
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$7,321.00 |
| Rate for Payer: Aetna Commercial |
$52.61
|
| Rate for Payer: Aetna Medicare |
$40.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.53
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$39.26
|
| Rate for Payer: BCBS Trust/PPO |
$927.17
|
| Rate for Payer: BCN Commercial |
$110.45
|
| Rate for Payer: BCN Medicare Advantage |
$39.26
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$56.53
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.26
|
| Rate for Payer: Healthscope Commercial |
$72.63
|
| Rate for Payer: Healthscope Commercial |
$62.82
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.22
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,321.00
|
| Rate for Payer: Nomi Health Commercial |
$47.11
|
| Rate for Payer: PACE SWMI |
$39.26
|
| Rate for Payer: PHP Medicare Advantage |
$39.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.05
|
| Rate for Payer: Priority Health Medicare |
$39.26
|
| Rate for Payer: Priority Health Narrow Network |
$66.05
|
| Rate for Payer: Priority Health SBD |
$66.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.26
|
| Rate for Payer: UHC Exchange |
$83.11
|
| Rate for Payer: UHC Medicare Advantage |
$39.26
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 53661
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$7,160.00 |
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: Aetna Medicare |
$39.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.88
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS MAPPO |
$38.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.12
|
| Rate for Payer: BCN Commercial |
$108.48
|
| Rate for Payer: BCN Medicare Advantage |
$38.11
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$54.88
|
| Rate for Payer: Cofinity Commercial |
$51.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.11
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Healthscope Commercial |
$60.98
|
| Rate for Payer: Mclaren Medicaid |
$25.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.02
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,160.00
|
| Rate for Payer: Nomi Health Commercial |
$45.73
|
| Rate for Payer: PACE SWMI |
$38.11
|
| Rate for Payer: PHP Medicare Advantage |
$38.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.92
|
| Rate for Payer: Priority Health Medicare |
$38.11
|
| Rate for Payer: Priority Health Narrow Network |
$63.92
|
| Rate for Payer: Priority Health SBD |
$63.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.11
|
| Rate for Payer: UHC Exchange |
$83.51
|
| Rate for Payer: UHC Medicare Advantage |
$38.11
|
| Rate for Payer: UHCCP Medicaid |
$25.56
|
|
|
PR DILATION CERVICAL CANAL INSTRUMENTAL SPX
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 57800
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$8,429.00 |
| Rate for Payer: Aetna Commercial |
$61.71
|
| Rate for Payer: Aetna Medicare |
$47.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.31
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS MAPPO |
$46.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$114.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.05
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cofinity Commercial |
$66.31
|
| Rate for Payer: Cofinity Commercial |
$61.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.05
|
| Rate for Payer: Healthscope Commercial |
$85.19
|
| Rate for Payer: Healthscope Commercial |
$73.68
|
| Rate for Payer: Mclaren Medicaid |
$30.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.35
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,429.00
|
| Rate for Payer: Nomi Health Commercial |
$55.26
|
| Rate for Payer: PACE SWMI |
$46.05
|
| Rate for Payer: PHP Medicare Advantage |
$46.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.93
|
| Rate for Payer: Priority Health Medicare |
$46.05
|
| Rate for Payer: Priority Health Narrow Network |
$71.93
|
| Rate for Payer: Priority Health SBD |
$71.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.05
|
| Rate for Payer: UHC Exchange |
$92.14
|
| Rate for Payer: UHC Medicare Advantage |
$46.05
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
|
|
PR DILATION & CURETTAGE CERVICAL STUMP
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 57558
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$22,766.00 |
| Rate for Payer: Aetna Commercial |
$162.62
|
| Rate for Payer: Aetna Medicare |
$126.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.76
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCBS MAPPO |
$121.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.60
|
| Rate for Payer: BCN Commercial |
$233.59
|
| Rate for Payer: BCN Medicare Advantage |
$121.36
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$174.76
|
| Rate for Payer: Cofinity Commercial |
$162.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.36
|
| Rate for Payer: Healthscope Commercial |
$224.52
|
| Rate for Payer: Healthscope Commercial |
$194.18
|
| Rate for Payer: Mclaren Medicaid |
$82.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.43
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,766.00
|
| Rate for Payer: Nomi Health Commercial |
$145.63
|
| Rate for Payer: PACE SWMI |
$121.36
|
| Rate for Payer: PHP Medicare Advantage |
$121.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.95
|
| Rate for Payer: Priority Health Medicare |
$121.36
|
| Rate for Payer: Priority Health Narrow Network |
$193.95
|
| Rate for Payer: Priority Health SBD |
$193.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.36
|
| Rate for Payer: UHC Exchange |
$153.82
|
| Rate for Payer: UHC Medicare Advantage |
$121.36
|
| Rate for Payer: UHCCP Medicaid |
$82.43
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$543.06 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna Commercial |
$732.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.30
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$603.40
|
| Rate for Payer: Cofinity Commercial |
$741.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.60
|
| Rate for Payer: Healthscope Commercial |
$775.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.70
|
| Rate for Payer: PHP Commercial |
$732.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health SBD |
$543.06
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$248.83 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Commercial |
$732.70
|
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.30
|
| 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: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,404.28
|
| Rate for Payer: BCN Commercial |
$1,404.28
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$741.32
|
| Rate for Payer: Cofinity Commercial |
$603.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$775.80
|
| 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 |
$732.70
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$732.70
|
| 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 |
$560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Priority Health SBD |
$543.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.83
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$41,495.00 |
| Rate for Payer: Aetna Commercial |
$299.05
|
| Rate for Payer: Aetna Medicare |
$232.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.36
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$223.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: BCN Medicare Advantage |
$223.17
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$321.36
|
| Rate for Payer: Cofinity Commercial |
$299.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.17
|
| Rate for Payer: Healthscope Commercial |
$412.86
|
| Rate for Payer: Healthscope Commercial |
$357.07
|
| Rate for Payer: Mclaren Medicaid |
$150.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.33
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,495.00
|
| Rate for Payer: Nomi Health Commercial |
$267.80
|
| Rate for Payer: PACE SWMI |
$223.17
|
| Rate for Payer: PHP Medicare Advantage |
$223.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.21
|
| Rate for Payer: Priority Health Medicare |
$223.17
|
| Rate for Payer: Priority Health Narrow Network |
$350.21
|
| Rate for Payer: Priority Health SBD |
$350.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.17
|
| Rate for Payer: UHC Exchange |
$320.00
|
| Rate for Payer: UHC Medicare Advantage |
$223.17
|
| Rate for Payer: UHCCP Medicaid |
$150.17
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$41,495.00 |
| Rate for Payer: Aetna Commercial |
$299.05
|
| Rate for Payer: Aetna Medicare |
$232.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.36
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$223.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: BCN Medicare Advantage |
$223.17
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$321.36
|
| Rate for Payer: Cofinity Commercial |
$299.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.17
|
| Rate for Payer: Healthscope Commercial |
$412.86
|
| Rate for Payer: Healthscope Commercial |
$357.07
|
| Rate for Payer: Mclaren Medicaid |
$150.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.33
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,495.00
|
| Rate for Payer: Nomi Health Commercial |
$267.80
|
| Rate for Payer: PACE SWMI |
$223.17
|
| Rate for Payer: PHP Medicare Advantage |
$223.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.21
|
| Rate for Payer: Priority Health Medicare |
$223.17
|
| Rate for Payer: Priority Health Narrow Network |
$350.21
|
| Rate for Payer: Priority Health SBD |
$350.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.17
|
| Rate for Payer: UHC Exchange |
$320.00
|
| Rate for Payer: UHC Medicare Advantage |
$223.17
|
| Rate for Payer: UHCCP Medicaid |
$150.17
|
|
|
PR DILATION ESOPHAGUS GUIDE WIRE
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 43453
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$15,127.00 |
| Rate for Payer: Aetna Commercial |
$109.76
|
| Rate for Payer: Aetna Medicare |
$85.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.95
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCBS MAPPO |
$81.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.34
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: BCN Medicare Advantage |
$81.91
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$117.95
|
| Rate for Payer: Cofinity Commercial |
$109.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.91
|
| Rate for Payer: Healthscope Commercial |
$151.53
|
| Rate for Payer: Healthscope Commercial |
$131.06
|
| Rate for Payer: Mclaren Medicaid |
$55.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.01
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,127.00
|
| Rate for Payer: Nomi Health Commercial |
$98.29
|
| Rate for Payer: PACE SWMI |
$81.91
|
| Rate for Payer: PHP Medicare Advantage |
$81.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.92
|
| Rate for Payer: Priority Health Medicare |
$81.91
|
| Rate for Payer: Priority Health Narrow Network |
$153.92
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.91
|
| Rate for Payer: UHC Exchange |
$299.21
|
| Rate for Payer: UHC Medicare Advantage |
$81.91
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 43450
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$13,981.00 |
| Rate for Payer: Aetna Commercial |
$100.73
|
| Rate for Payer: Aetna Medicare |
$78.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.24
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$75.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$275.61
|
| Rate for Payer: BCN Medicare Advantage |
$75.17
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$100.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.17
|
| Rate for Payer: Healthscope Commercial |
$139.06
|
| Rate for Payer: Healthscope Commercial |
$120.27
|
| Rate for Payer: Mclaren Medicaid |
$50.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.93
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,981.00
|
| Rate for Payer: Nomi Health Commercial |
$90.20
|
| Rate for Payer: PACE SWMI |
$75.17
|
| Rate for Payer: PHP Medicare Advantage |
$75.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.39
|
| Rate for Payer: Priority Health Medicare |
$75.17
|
| Rate for Payer: Priority Health Narrow Network |
$141.39
|
| Rate for Payer: Priority Health SBD |
$141.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.17
|
| Rate for Payer: UHC Exchange |
$157.52
|
| Rate for Payer: UHC Medicare Advantage |
$75.17
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$13,981.00 |
| Rate for Payer: Aetna Commercial |
$100.73
|
| Rate for Payer: Aetna Medicare |
$78.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.24
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$75.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$275.61
|
| Rate for Payer: BCN Medicare Advantage |
$75.17
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$100.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.17
|
| Rate for Payer: Healthscope Commercial |
$139.06
|
| Rate for Payer: Healthscope Commercial |
$120.27
|
| Rate for Payer: Mclaren Medicaid |
$50.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.93
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,981.00
|
| Rate for Payer: Nomi Health Commercial |
$90.20
|
| Rate for Payer: PACE SWMI |
$75.17
|
| Rate for Payer: PHP Medicare Advantage |
$75.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.39
|
| Rate for Payer: Priority Health Medicare |
$75.17
|
| Rate for Payer: Priority Health Narrow Network |
$141.39
|
| Rate for Payer: Priority Health SBD |
$141.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.17
|
| Rate for Payer: UHC Exchange |
$157.52
|
| Rate for Payer: UHC Medicare Advantage |
$75.17
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$83.38 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$394.36
|
| Rate for Payer: BCN Commercial |
$394.36
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.38
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$517.17
|
| Rate for Payer: VA VA |
$918.60
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$206.64 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health SBD |
$206.64
|
|
|
PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 68801
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$13,433.00 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Medicare |
$75.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.20
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS MAPPO |
$72.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: BCN Commercial |
$112.30
|
| Rate for Payer: BCN Medicare Advantage |
$72.54
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$97.20
|
| Rate for Payer: Cofinity Commercial |
$104.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.54
|
| Rate for Payer: Healthscope Commercial |
$134.20
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Mclaren Medicaid |
$50.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.17
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,433.00
|
| Rate for Payer: Nomi Health Commercial |
$87.05
|
| Rate for Payer: PACE SWMI |
$72.54
|
| Rate for Payer: PHP Medicare Advantage |
$72.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$72.54
|
| Rate for Payer: Priority Health Narrow Network |
$139.20
|
| Rate for Payer: Priority Health SBD |
$139.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.54
|
| Rate for Payer: UHC Exchange |
$82.22
|
| Rate for Payer: UHC Medicare Advantage |
$72.54
|
| Rate for Payer: UHCCP Medicaid |
$50.48
|
|
|
PR DILATION SALIVARY DUCT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 42650
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$10,309.00 |
| Rate for Payer: Aetna Commercial |
$75.80
|
| Rate for Payer: Aetna Medicare |
$58.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.46
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS MAPPO |
$56.57
|
| Rate for Payer: BCBS Trust/PPO |
$619.17
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: BCN Medicare Advantage |
$56.57
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$81.46
|
| Rate for Payer: Cofinity Commercial |
$75.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.57
|
| Rate for Payer: Healthscope Commercial |
$90.51
|
| Rate for Payer: Healthscope Commercial |
$104.65
|
| Rate for Payer: Mclaren Medicaid |
$38.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.40
|
| Rate for Payer: Meridian Medicaid |
$40.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,309.00
|
| Rate for Payer: Nomi Health Commercial |
$67.88
|
| Rate for Payer: PACE SWMI |
$56.57
|
| Rate for Payer: PHP Medicare Advantage |
$56.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.19
|
| Rate for Payer: Priority Health Medicare |
$56.57
|
| Rate for Payer: Priority Health Narrow Network |
$106.19
|
| Rate for Payer: Priority Health SBD |
$106.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.57
|
| Rate for Payer: UHC Exchange |
$79.55
|
| Rate for Payer: UHC Medicare Advantage |
$56.57
|
| Rate for Payer: UHCCP Medicaid |
$38.55
|
|
|
PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 57400
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$23,054.00 |
| Rate for Payer: Aetna Commercial |
$167.97
|
| Rate for Payer: Aetna Medicare |
$130.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.50
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$125.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.58
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: BCN Medicare Advantage |
$125.35
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$180.50
|
| Rate for Payer: Cofinity Commercial |
$167.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.35
|
| Rate for Payer: Healthscope Commercial |
$231.90
|
| Rate for Payer: Healthscope Commercial |
$200.56
|
| Rate for Payer: Mclaren Medicaid |
$83.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.62
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,054.00
|
| Rate for Payer: Nomi Health Commercial |
$150.42
|
| Rate for Payer: PACE SWMI |
$125.35
|
| Rate for Payer: PHP Medicare Advantage |
$125.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.95
|
| Rate for Payer: Priority Health Medicare |
$125.35
|
| Rate for Payer: Priority Health Narrow Network |
$193.95
|
| Rate for Payer: Priority Health SBD |
$193.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.35
|
| Rate for Payer: UHC Exchange |
$155.60
|
| Rate for Payer: UHC Medicare Advantage |
$125.35
|
| Rate for Payer: UHCCP Medicaid |
$83.50
|
|
|
PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 45910
|
| Min. Negotiated Rate |
$125.03 |
| Max. Negotiated Rate |
$34,103.00 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$192.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.00
|
| Rate for Payer: BCBS Complete |
$131.28
|
| Rate for Payer: BCBS MAPPO |
$185.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.58
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Medicare Advantage |
$185.42
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$267.00
|
| Rate for Payer: Cofinity Commercial |
$248.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.42
|
| Rate for Payer: Healthscope Commercial |
$343.03
|
| Rate for Payer: Healthscope Commercial |
$296.67
|
| Rate for Payer: Mclaren Medicaid |
$125.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.69
|
| Rate for Payer: Meridian Medicaid |
$131.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,103.00
|
| Rate for Payer: Nomi Health Commercial |
$222.50
|
| Rate for Payer: PACE SWMI |
$185.42
|
| Rate for Payer: PHP Medicare Advantage |
$185.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.21
|
| Rate for Payer: Priority Health Medicare |
$185.42
|
| Rate for Payer: Priority Health Narrow Network |
$347.21
|
| Rate for Payer: Priority Health SBD |
$347.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.42
|
| Rate for Payer: UHC Exchange |
$380.31
|
| Rate for Payer: UHC Medicare Advantage |
$185.42
|
| Rate for Payer: UHCCP Medicaid |
$125.03
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$11,331.00 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$63.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS MAPPO |
$61.12
|
| Rate for Payer: BCBS Trust/PPO |
$549.43
|
| Rate for Payer: BCN Commercial |
$129.50
|
| Rate for Payer: BCN Medicare Advantage |
$61.12
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$88.01
|
| Rate for Payer: Cofinity Commercial |
$81.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.12
|
| Rate for Payer: Healthscope Commercial |
$97.79
|
| Rate for Payer: Healthscope Commercial |
$113.07
|
| Rate for Payer: Mclaren Medicaid |
$40.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.18
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,331.00
|
| Rate for Payer: Nomi Health Commercial |
$73.34
|
| Rate for Payer: PACE SWMI |
$61.12
|
| Rate for Payer: PHP Medicare Advantage |
$61.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.13
|
| Rate for Payer: Priority Health Medicare |
$61.12
|
| Rate for Payer: Priority Health Narrow Network |
$100.13
|
| Rate for Payer: Priority Health SBD |
$100.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.12
|
| Rate for Payer: UHC Exchange |
$97.36
|
| Rate for Payer: UHC Medicare Advantage |
$61.12
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$9,376.00 |
| Rate for Payer: Aetna Commercial |
$68.43
|
| Rate for Payer: Aetna Medicare |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.54
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$244.07
|
| Rate for Payer: BCN Commercial |
$124.13
|
| Rate for Payer: BCN Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$73.54
|
| Rate for Payer: Cofinity Commercial |
$68.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$94.48
|
| Rate for Payer: Healthscope Commercial |
$81.71
|
| Rate for Payer: Mclaren Medicaid |
$34.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,376.00
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: PACE SWMI |
$51.07
|
| Rate for Payer: PHP Medicare Advantage |
$51.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.14
|
| Rate for Payer: Priority Health Medicare |
$51.07
|
| Rate for Payer: Priority Health Narrow Network |
$84.14
|
| Rate for Payer: Priority Health SBD |
$84.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.07
|
| Rate for Payer: UHC Exchange |
$93.00
|
| Rate for Payer: UHC Medicare Advantage |
$51.07
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 53620
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$15,241.00 |
| Rate for Payer: Aetna Commercial |
$111.18
|
| Rate for Payer: Aetna Medicare |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.48
|
| Rate for Payer: BCBS Complete |
$58.15
|
| Rate for Payer: BCBS MAPPO |
$82.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: BCN Commercial |
$248.73
|
| Rate for Payer: BCN Medicare Advantage |
$82.97
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$119.48
|
| Rate for Payer: Cofinity Commercial |
$111.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.97
|
| Rate for Payer: Healthscope Commercial |
$153.49
|
| Rate for Payer: Healthscope Commercial |
$132.75
|
| Rate for Payer: Mclaren Medicaid |
$55.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.12
|
| Rate for Payer: Meridian Medicaid |
$58.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,241.00
|
| Rate for Payer: Nomi Health Commercial |
$99.56
|
| Rate for Payer: PACE SWMI |
$82.97
|
| Rate for Payer: PHP Medicare Advantage |
$82.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.41
|
| Rate for Payer: Priority Health Medicare |
$82.97
|
| Rate for Payer: Priority Health Narrow Network |
$137.41
|
| Rate for Payer: Priority Health SBD |
$137.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.97
|
| Rate for Payer: UHC Exchange |
$149.61
|
| Rate for Payer: UHC Medicare Advantage |
$82.97
|
| Rate for Payer: UHCCP Medicaid |
$55.38
|
|
