|
PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 57170
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: Aetna Medicare |
$41.55
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$41.55
|
| Rate for Payer: BCN Commercial |
$70.71
|
| Rate for Payer: BCN Medicare Advantage |
$41.55
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$59.83
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.55
|
| Rate for Payer: Healthscope Commercial |
$49.86
|
| Rate for Payer: Healthscope Whirlpool |
$49.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.63
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.70
|
| Rate for Payer: Nomi Health Commercial |
$49.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.50
|
| Rate for Payer: PACE SWMI |
$41.55
|
| Rate for Payer: PHP Medicare Advantage |
$41.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.61
|
| Rate for Payer: Priority Health Medicare |
$41.55
|
| Rate for Payer: Priority Health Narrow Network |
$71.61
|
| Rate for Payer: Railroad Medicare Medicare |
$41.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.55
|
| Rate for Payer: UHC Exchange |
$84.84
|
| Rate for Payer: UHC Medicaid |
$26.41
|
| Rate for Payer: UHCCP DNSP |
$41.55
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
PR DIFFUSING CAPACITY
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 94729
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Aetna Commercial |
$78.58
|
| Rate for Payer: Aetna Commercial |
$78.58
|
| Rate for Payer: Aetna Medicare |
$58.64
|
| Rate for Payer: Aetna Medicare |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$58.64
|
| Rate for Payer: BCN Commercial |
$83.66
|
| Rate for Payer: BCN Commercial |
$83.66
|
| Rate for Payer: BCN Medicare Advantage |
$58.64
|
| Rate for Payer: BCN Medicare Advantage |
$58.64
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$78.58
|
| Rate for Payer: Cofinity Commercial |
$84.44
|
| Rate for Payer: Cofinity Commercial |
$78.58
|
| Rate for Payer: Cofinity Commercial |
$84.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.64
|
| Rate for Payer: Healthscope Commercial |
$70.37
|
| Rate for Payer: Healthscope Commercial |
$70.37
|
| Rate for Payer: Healthscope Whirlpool |
$70.37
|
| Rate for Payer: Healthscope Whirlpool |
$70.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.50
|
| Rate for Payer: Nomi Health Commercial |
$70.37
|
| Rate for Payer: Nomi Health Commercial |
$70.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: PACE SWMI |
$58.64
|
| Rate for Payer: PACE SWMI |
$58.64
|
| Rate for Payer: PHP Medicare Advantage |
$58.64
|
| Rate for Payer: PHP Medicare Advantage |
$58.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$77.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$77.15
|
| Rate for Payer: Priority Health Medicare |
$58.64
|
| Rate for Payer: Priority Health Medicare |
$58.64
|
| Rate for Payer: Priority Health Narrow Network |
$77.15
|
| Rate for Payer: Priority Health Narrow Network |
$77.15
|
| Rate for Payer: Railroad Medicare Medicare |
$58.64
|
| Rate for Payer: Railroad Medicare Medicare |
$58.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.64
|
| Rate for Payer: UHC Exchange |
$85.57
|
| Rate for Payer: UHC Exchange |
$85.57
|
| Rate for Payer: UHCCP DNSP |
$58.64
|
| Rate for Payer: UHCCP DNSP |
$58.64
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$801.00
|
|
|
Service Code
|
HCPCS 95957
|
| Min. Negotiated Rate |
$289.40 |
| Max. Negotiated Rate |
$600.75 |
| Rate for Payer: Aetna Commercial |
$387.80
|
| Rate for Payer: Aetna Medicare |
$289.40
|
| Rate for Payer: BCBS MAPPO |
$289.40
|
| Rate for Payer: BCN Commercial |
$433.74
|
| Rate for Payer: BCN Medicare Advantage |
$289.40
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cofinity Commercial |
$387.80
|
| Rate for Payer: Cofinity Commercial |
$416.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.40
|
| Rate for Payer: Healthscope Commercial |
$347.28
|
| Rate for Payer: Healthscope Whirlpool |
$347.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$318.34
|
| Rate for Payer: Nomi Health Commercial |
$347.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$600.75
|
| Rate for Payer: PACE SWMI |
$289.40
|
| Rate for Payer: PHP Medicare Advantage |
$289.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$400.00
|
| Rate for Payer: Priority Health Medicare |
$289.40
|
| Rate for Payer: Priority Health Narrow Network |
$400.00
|
| Rate for Payer: Railroad Medicare Medicare |
$289.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$289.40
|
| Rate for Payer: UHC Exchange |
$395.29
|
| Rate for Payer: UHCCP DNSP |
$289.40
|
|
|
PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 45905
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$314.29 |
| Rate for Payer: Aetna Commercial |
$219.75
|
| Rate for Payer: Aetna Medicare |
$163.99
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS MAPPO |
$163.99
|
| Rate for Payer: BCN Commercial |
$257.96
|
| Rate for Payer: BCN Medicare Advantage |
$163.99
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$236.15
|
| Rate for Payer: Cofinity Commercial |
$219.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.99
|
| Rate for Payer: Healthscope Commercial |
$196.79
|
| Rate for Payer: Healthscope Whirlpool |
$196.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.19
|
| Rate for Payer: Meridian Medicaid |
$113.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.39
|
| Rate for Payer: Nomi Health Commercial |
$196.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.50
|
| Rate for Payer: PACE SWMI |
$163.99
|
| Rate for Payer: PHP Medicare Advantage |
$163.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$314.29
|
| Rate for Payer: Priority Health Medicare |
$163.99
|
| Rate for Payer: Priority Health Narrow Network |
$314.29
|
| Rate for Payer: Railroad Medicare Medicare |
$163.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.99
|
| Rate for Payer: UHC Exchange |
$293.96
|
| Rate for Payer: UHC Medicaid |
$107.78
|
| Rate for Payer: UHCCP DNSP |
$163.99
|
| Rate for Payer: UHCCP Medicaid |
$107.78
|
|
|
PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 42660
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$91.64
|
| Rate for Payer: Aetna Medicare |
$68.39
|
| Rate for Payer: BCBS Complete |
$46.97
|
| Rate for Payer: BCBS MAPPO |
$68.39
|
| Rate for Payer: BCN Commercial |
$119.02
|
| Rate for Payer: BCN Medicare Advantage |
$68.39
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$91.64
|
| Rate for Payer: Cofinity Commercial |
$98.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.39
|
| Rate for Payer: Healthscope Commercial |
$82.07
|
| Rate for Payer: Healthscope Whirlpool |
$82.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.81
|
| Rate for Payer: Meridian Medicaid |
$46.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.23
|
| Rate for Payer: Nomi Health Commercial |
$82.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.50
|
| Rate for Payer: PACE SWMI |
$68.39
|
| Rate for Payer: PHP Medicare Advantage |
$68.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$145.02
|
| Rate for Payer: Priority Health Medicare |
$68.39
|
| Rate for Payer: Priority Health Narrow Network |
$145.02
|
| Rate for Payer: Railroad Medicare Medicare |
$68.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$68.39
|
| Rate for Payer: UHC Exchange |
$152.41
|
| Rate for Payer: UHC Medicaid |
$44.73
|
| Rate for Payer: UHCCP DNSP |
$68.39
|
| Rate for Payer: UHCCP Medicaid |
$44.73
|
|
|
PR DILATE ESOPHAGUS,BALLOON RETROGRADE
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
HCPCS 43456
|
| Min. Negotiated Rate |
$341.20 |
| Max. Negotiated Rate |
$639.75 |
| Rate for Payer: BCBS Complete |
$341.20
|
| Rate for Payer: Cash Price |
$682.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$639.75
|
|
|
PR DILATE ESOPH,BALLN,>30MM ACHALASIA
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 43458
|
| Min. Negotiated Rate |
$424.00 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: BCBS Complete |
$424.00
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$795.00
|
|
|
PR DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 53665
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna Commercial |
$44.21
|
| Rate for Payer: Aetna Medicare |
$32.99
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCBS MAPPO |
$32.99
|
| Rate for Payer: BCN Commercial |
$55.28
|
| Rate for Payer: BCN Medicare Advantage |
$32.99
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Cofinity Commercial |
$47.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$39.59
|
| Rate for Payer: Healthscope Whirlpool |
$39.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.64
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.29
|
| Rate for Payer: Nomi Health Commercial |
$39.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.00
|
| Rate for Payer: PACE SWMI |
$32.99
|
| Rate for Payer: PHP Medicare Advantage |
$32.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$60.21
|
| Rate for Payer: Priority Health Medicare |
$32.99
|
| Rate for Payer: Priority Health Narrow Network |
$60.21
|
| Rate for Payer: Railroad Medicare Medicare |
$32.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.99
|
| Rate for Payer: UHC Exchange |
$68.31
|
| Rate for Payer: UHC Medicaid |
$21.09
|
| Rate for Payer: UHCCP DNSP |
$32.99
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
|
|
PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 53660
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna Commercial |
$49.23
|
| Rate for Payer: Aetna Medicare |
$36.74
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$36.74
|
| Rate for Payer: BCN Commercial |
$61.75
|
| Rate for Payer: BCN Medicare Advantage |
$36.74
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$52.91
|
| Rate for Payer: Cofinity Commercial |
$49.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.74
|
| Rate for Payer: Healthscope Commercial |
$44.09
|
| Rate for Payer: Healthscope Whirlpool |
$44.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.58
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.41
|
| Rate for Payer: Nomi Health Commercial |
$44.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PACE SWMI |
$36.74
|
| Rate for Payer: PHP Medicare Advantage |
$36.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.27
|
| Rate for Payer: Priority Health Medicare |
$36.74
|
| Rate for Payer: Priority Health Narrow Network |
$67.27
|
| Rate for Payer: Railroad Medicare Medicare |
$36.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36.74
|
| Rate for Payer: UHC Exchange |
$73.22
|
| Rate for Payer: UHC Medicaid |
$23.86
|
| Rate for Payer: UHCCP DNSP |
$36.74
|
| Rate for Payer: UHCCP Medicaid |
$23.86
|
|
|
PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 53661
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Aetna Commercial |
$47.64
|
| Rate for Payer: Aetna Medicare |
$35.55
|
| Rate for Payer: BCBS Complete |
$24.15
|
| Rate for Payer: BCBS MAPPO |
$35.55
|
| Rate for Payer: BCN Commercial |
$59.76
|
| Rate for Payer: BCN Medicare Advantage |
$35.55
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$51.19
|
| Rate for Payer: Cofinity Commercial |
$47.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.55
|
| Rate for Payer: Healthscope Commercial |
$42.66
|
| Rate for Payer: Healthscope Whirlpool |
$42.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.33
|
| Rate for Payer: Meridian Medicaid |
$24.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.10
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.75
|
| Rate for Payer: PACE SWMI |
$35.55
|
| Rate for Payer: PHP Medicare Advantage |
$35.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.10
|
| Rate for Payer: Priority Health Medicare |
$35.55
|
| Rate for Payer: Priority Health Narrow Network |
$65.10
|
| Rate for Payer: Railroad Medicare Medicare |
$35.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.55
|
| Rate for Payer: UHC Exchange |
$71.55
|
| Rate for Payer: UHC Medicaid |
$23.00
|
| Rate for Payer: UHCCP DNSP |
$35.55
|
| Rate for Payer: UHCCP Medicaid |
$23.00
|
|
|
PR DILATION CERVICAL CANAL INSTRUMENTAL SPX
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 57800
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Aetna Commercial |
$57.39
|
| Rate for Payer: Aetna Medicare |
$42.83
|
| Rate for Payer: BCBS Complete |
$29.07
|
| Rate for Payer: BCBS MAPPO |
$42.83
|
| Rate for Payer: BCN Commercial |
$72.21
|
| Rate for Payer: BCN Medicare Advantage |
$42.83
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$61.68
|
| Rate for Payer: Cofinity Commercial |
$57.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.83
|
| Rate for Payer: Healthscope Commercial |
$51.40
|
| Rate for Payer: Healthscope Whirlpool |
$51.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.97
|
| Rate for Payer: Meridian Medicaid |
$29.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.11
|
| Rate for Payer: Nomi Health Commercial |
$51.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.25
|
| Rate for Payer: PACE SWMI |
$42.83
|
| Rate for Payer: PHP Medicare Advantage |
$42.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.13
|
| Rate for Payer: Priority Health Medicare |
$42.83
|
| Rate for Payer: Priority Health Narrow Network |
$73.13
|
| Rate for Payer: Railroad Medicare Medicare |
$42.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.83
|
| Rate for Payer: UHC Exchange |
$84.62
|
| Rate for Payer: UHC Medicaid |
$27.69
|
| Rate for Payer: UHCCP DNSP |
$42.83
|
| Rate for Payer: UHCCP Medicaid |
$27.69
|
|
|
PR DILATION & CURETTAGE CERVICAL STUMP
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 57558
|
| Min. Negotiated Rate |
$72.63 |
| Max. Negotiated Rate |
$213.43 |
| Rate for Payer: Aetna Commercial |
$148.69
|
| Rate for Payer: Aetna Medicare |
$110.96
|
| Rate for Payer: BCBS Complete |
$76.26
|
| Rate for Payer: BCBS MAPPO |
$110.96
|
| Rate for Payer: BCN Commercial |
$192.72
|
| Rate for Payer: BCN Medicare Advantage |
$110.96
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$159.78
|
| Rate for Payer: Cofinity Commercial |
$148.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.96
|
| Rate for Payer: Healthscope Commercial |
$133.15
|
| Rate for Payer: Healthscope Whirlpool |
$133.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.51
|
| Rate for Payer: Meridian Medicaid |
$76.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$122.06
|
| Rate for Payer: Nomi Health Commercial |
$133.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.00
|
| Rate for Payer: PACE SWMI |
$110.96
|
| Rate for Payer: PHP Medicare Advantage |
$110.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$195.18
|
| Rate for Payer: Priority Health Medicare |
$110.96
|
| Rate for Payer: Priority Health Narrow Network |
$195.18
|
| Rate for Payer: Railroad Medicare Medicare |
$110.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.96
|
| Rate for Payer: UHC Exchange |
$213.43
|
| Rate for Payer: UHC Medicaid |
$72.63
|
| Rate for Payer: UHCCP DNSP |
$110.96
|
| Rate for Payer: UHCCP Medicaid |
$72.63
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$133.76 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Aetna Commercial |
$276.54
|
| Rate for Payer: Aetna Medicare |
$206.37
|
| Rate for Payer: BCBS Complete |
$140.45
|
| Rate for Payer: BCBS MAPPO |
$206.37
|
| Rate for Payer: BCN Commercial |
$351.07
|
| Rate for Payer: BCN Medicare Advantage |
$206.37
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cofinity Commercial |
$297.17
|
| Rate for Payer: Cofinity Commercial |
$276.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.37
|
| Rate for Payer: Healthscope Commercial |
$247.64
|
| Rate for Payer: Healthscope Whirlpool |
$247.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.69
|
| Rate for Payer: Meridian Medicaid |
$140.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$227.01
|
| Rate for Payer: Nomi Health Commercial |
$247.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$666.00
|
| Rate for Payer: PACE SWMI |
$206.37
|
| Rate for Payer: PHP Medicare Advantage |
$206.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$355.56
|
| Rate for Payer: Priority Health Medicare |
$206.37
|
| Rate for Payer: Priority Health Narrow Network |
$355.56
|
| Rate for Payer: Railroad Medicare Medicare |
$206.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$399.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$206.37
|
| Rate for Payer: UHC Exchange |
$399.03
|
| Rate for Payer: UHC Medicaid |
$133.76
|
| Rate for Payer: UHCCP DNSP |
$206.37
|
| Rate for Payer: UHCCP Medicaid |
$133.76
|
|
|
PR DILATION ESOPHAGUS GUIDE WIRE
|
Professional
|
Both
|
$533.00
|
|
|
Service Code
|
HCPCS 43453
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Aetna Commercial |
$101.88
|
| Rate for Payer: Aetna Medicare |
$76.03
|
| Rate for Payer: BCBS Complete |
$51.89
|
| Rate for Payer: BCBS MAPPO |
$76.03
|
| Rate for Payer: BCN Commercial |
$128.97
|
| Rate for Payer: BCN Medicare Advantage |
$76.03
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cofinity Commercial |
$109.48
|
| Rate for Payer: Cofinity Commercial |
$101.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.03
|
| Rate for Payer: Healthscope Commercial |
$91.24
|
| Rate for Payer: Healthscope Whirlpool |
$91.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.83
|
| Rate for Payer: Meridian Medicaid |
$51.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.63
|
| Rate for Payer: Nomi Health Commercial |
$91.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$399.75
|
| Rate for Payer: PACE SWMI |
$76.03
|
| Rate for Payer: PHP Medicare Advantage |
$76.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$157.15
|
| Rate for Payer: Priority Health Medicare |
$76.03
|
| Rate for Payer: Priority Health Narrow Network |
$157.15
|
| Rate for Payer: Railroad Medicare Medicare |
$76.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.03
|
| Rate for Payer: UHC Exchange |
$150.28
|
| Rate for Payer: UHC Medicaid |
$49.42
|
| Rate for Payer: UHCCP DNSP |
$76.03
|
| Rate for Payer: UHCCP Medicaid |
$49.42
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 43450
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Aetna Commercial |
$95.81
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$48.98
|
| Rate for Payer: BCBS MAPPO |
$71.50
|
| Rate for Payer: BCN Commercial |
$118.52
|
| Rate for Payer: BCN Medicare Advantage |
$71.50
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$95.81
|
| Rate for Payer: Cofinity Commercial |
$102.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.50
|
| Rate for Payer: Healthscope Commercial |
$85.80
|
| Rate for Payer: Healthscope Whirlpool |
$85.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.08
|
| Rate for Payer: Meridian Medicaid |
$48.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.65
|
| Rate for Payer: Nomi Health Commercial |
$85.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PACE SWMI |
$71.50
|
| Rate for Payer: PHP Medicare Advantage |
$71.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$144.40
|
| Rate for Payer: Priority Health Medicare |
$71.50
|
| Rate for Payer: Priority Health Narrow Network |
$144.40
|
| Rate for Payer: Railroad Medicare Medicare |
$71.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.50
|
| Rate for Payer: UHC Exchange |
$137.95
|
| Rate for Payer: UHC Medicaid |
$46.65
|
| Rate for Payer: UHCCP DNSP |
$71.50
|
| Rate for Payer: UHCCP Medicaid |
$46.65
|
|
|
PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 68801
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna Commercial |
$91.45
|
| Rate for Payer: Aetna Medicare |
$68.25
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS MAPPO |
$68.25
|
| Rate for Payer: BCN Commercial |
$93.07
|
| Rate for Payer: BCN Medicare Advantage |
$68.25
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cofinity Commercial |
$98.28
|
| Rate for Payer: Cofinity Commercial |
$91.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.25
|
| Rate for Payer: Healthscope Commercial |
$81.90
|
| Rate for Payer: Healthscope Whirlpool |
$81.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.66
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.08
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.50
|
| Rate for Payer: PACE SWMI |
$68.25
|
| Rate for Payer: PHP Medicare Advantage |
$68.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.24
|
| Rate for Payer: Priority Health Medicare |
$68.25
|
| Rate for Payer: Priority Health Narrow Network |
$138.24
|
| Rate for Payer: Railroad Medicare Medicare |
$68.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$68.25
|
| Rate for Payer: UHC Exchange |
$129.89
|
| Rate for Payer: UHC Medicaid |
$45.80
|
| Rate for Payer: UHCCP DNSP |
$68.25
|
| Rate for Payer: UHCCP Medicaid |
$45.80
|
|
|
PR DILATION SALIVARY DUCT
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 42650
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$109.83 |
| Rate for Payer: Aetna Commercial |
$69.37
|
| Rate for Payer: Aetna Medicare |
$51.77
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$51.77
|
| Rate for Payer: BCN Commercial |
$90.13
|
| Rate for Payer: BCN Medicare Advantage |
$51.77
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$74.55
|
| Rate for Payer: Cofinity Commercial |
$69.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.77
|
| Rate for Payer: Healthscope Commercial |
$62.12
|
| Rate for Payer: Healthscope Whirlpool |
$62.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.36
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.95
|
| Rate for Payer: Nomi Health Commercial |
$62.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.75
|
| Rate for Payer: PACE SWMI |
$51.77
|
| Rate for Payer: PHP Medicare Advantage |
$51.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.83
|
| Rate for Payer: Priority Health Medicare |
$51.77
|
| Rate for Payer: Priority Health Narrow Network |
$109.83
|
| Rate for Payer: Railroad Medicare Medicare |
$51.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.77
|
| Rate for Payer: UHC Exchange |
$99.49
|
| Rate for Payer: UHC Medicaid |
$34.08
|
| Rate for Payer: UHCCP DNSP |
$51.77
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
HCPCS 57400
|
| Min. Negotiated Rate |
$73.70 |
| Max. Negotiated Rate |
$285.75 |
| Rate for Payer: Aetna Commercial |
$153.76
|
| Rate for Payer: Aetna Medicare |
$114.75
|
| Rate for Payer: BCBS Complete |
$77.39
|
| Rate for Payer: BCBS MAPPO |
$114.75
|
| Rate for Payer: BCN Commercial |
$195.21
|
| Rate for Payer: BCN Medicare Advantage |
$114.75
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cofinity Commercial |
$165.24
|
| Rate for Payer: Cofinity Commercial |
$153.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.75
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Healthscope Whirlpool |
$137.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.49
|
| Rate for Payer: Meridian Medicaid |
$77.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.22
|
| Rate for Payer: Nomi Health Commercial |
$137.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.75
|
| Rate for Payer: PACE SWMI |
$114.75
|
| Rate for Payer: PHP Medicare Advantage |
$114.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$197.71
|
| Rate for Payer: Priority Health Medicare |
$114.75
|
| Rate for Payer: Priority Health Narrow Network |
$197.71
|
| Rate for Payer: Railroad Medicare Medicare |
$114.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$114.75
|
| Rate for Payer: UHC Exchange |
$232.88
|
| Rate for Payer: UHC Medicaid |
$73.70
|
| Rate for Payer: UHCCP DNSP |
$114.75
|
| Rate for Payer: UHCCP Medicaid |
$73.70
|
|
|
PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 45910
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$245.53
|
| Rate for Payer: Aetna Medicare |
$183.23
|
| Rate for Payer: BCBS Complete |
$125.92
|
| Rate for Payer: BCBS MAPPO |
$183.23
|
| Rate for Payer: BCN Commercial |
$292.32
|
| Rate for Payer: BCN Medicare Advantage |
$183.23
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cofinity Commercial |
$263.85
|
| Rate for Payer: Cofinity Commercial |
$245.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.23
|
| Rate for Payer: Healthscope Commercial |
$219.88
|
| Rate for Payer: Healthscope Whirlpool |
$219.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.39
|
| Rate for Payer: Meridian Medicaid |
$125.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$201.55
|
| Rate for Payer: Nomi Health Commercial |
$219.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,020.00
|
| Rate for Payer: PACE SWMI |
$183.23
|
| Rate for Payer: PHP Medicare Advantage |
$183.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$356.16
|
| Rate for Payer: Priority Health Medicare |
$183.23
|
| Rate for Payer: Priority Health Narrow Network |
$356.16
|
| Rate for Payer: Railroad Medicare Medicare |
$183.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$183.23
|
| Rate for Payer: UHC Exchange |
$335.96
|
| Rate for Payer: UHC Medicaid |
$119.92
|
| Rate for Payer: UHCCP DNSP |
$183.23
|
| Rate for Payer: UHCCP Medicaid |
$119.92
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$132.75 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Aetna Medicare |
$55.74
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS MAPPO |
$55.74
|
| Rate for Payer: BCN Commercial |
$95.12
|
| Rate for Payer: BCN Medicare Advantage |
$55.74
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$80.27
|
| Rate for Payer: Cofinity Commercial |
$74.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Healthscope Whirlpool |
$66.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.53
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.31
|
| Rate for Payer: Nomi Health Commercial |
$66.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.75
|
| Rate for Payer: PACE SWMI |
$55.74
|
| Rate for Payer: PHP Medicare Advantage |
$55.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$103.61
|
| Rate for Payer: Priority Health Medicare |
$55.74
|
| Rate for Payer: Priority Health Narrow Network |
$103.61
|
| Rate for Payer: Railroad Medicare Medicare |
$55.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$55.74
|
| Rate for Payer: UHC Exchange |
$112.30
|
| Rate for Payer: UHC Medicaid |
$35.78
|
| Rate for Payer: UHCCP DNSP |
$55.74
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$63.33
|
| Rate for Payer: Aetna Medicare |
$47.26
|
| Rate for Payer: BCBS Complete |
$31.98
|
| Rate for Payer: BCBS MAPPO |
$47.26
|
| Rate for Payer: BCN Commercial |
$79.68
|
| Rate for Payer: BCN Medicare Advantage |
$47.26
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$68.05
|
| Rate for Payer: Cofinity Commercial |
$63.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.26
|
| Rate for Payer: Healthscope Commercial |
$56.71
|
| Rate for Payer: Healthscope Whirlpool |
$56.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.62
|
| Rate for Payer: Meridian Medicaid |
$31.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.99
|
| Rate for Payer: Nomi Health Commercial |
$56.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE SWMI |
$47.26
|
| Rate for Payer: PHP Medicare Advantage |
$47.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.79
|
| Rate for Payer: Priority Health Medicare |
$47.26
|
| Rate for Payer: Priority Health Narrow Network |
$86.79
|
| Rate for Payer: Railroad Medicare Medicare |
$47.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.26
|
| Rate for Payer: UHC Exchange |
$94.29
|
| Rate for Payer: UHC Medicaid |
$30.46
|
| Rate for Payer: UHCCP DNSP |
$47.26
|
| Rate for Payer: UHCCP Medicaid |
$30.46
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 53620
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$76.48
|
| Rate for Payer: BCBS Complete |
$51.66
|
| Rate for Payer: BCBS MAPPO |
$76.48
|
| Rate for Payer: BCN Commercial |
$129.48
|
| Rate for Payer: BCN Medicare Advantage |
$76.48
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$110.13
|
| Rate for Payer: Cofinity Commercial |
$102.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.48
|
| Rate for Payer: Healthscope Commercial |
$91.78
|
| Rate for Payer: Healthscope Whirlpool |
$91.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.30
|
| Rate for Payer: Meridian Medicaid |
$51.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.13
|
| Rate for Payer: Nomi Health Commercial |
$91.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.75
|
| Rate for Payer: PACE SWMI |
$76.48
|
| Rate for Payer: PHP Medicare Advantage |
$76.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$141.04
|
| Rate for Payer: Priority Health Medicare |
$76.48
|
| Rate for Payer: Priority Health Narrow Network |
$141.04
|
| Rate for Payer: Railroad Medicare Medicare |
$76.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.48
|
| Rate for Payer: UHC Exchange |
$153.82
|
| Rate for Payer: UHC Medicaid |
$49.20
|
| Rate for Payer: UHCCP DNSP |
$76.48
|
| Rate for Payer: UHCCP Medicaid |
$49.20
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 53621
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Aetna Commercial |
$84.84
|
| Rate for Payer: Aetna Medicare |
$63.31
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS MAPPO |
$63.31
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: BCN Medicare Advantage |
$63.31
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cofinity Commercial |
$91.17
|
| Rate for Payer: Cofinity Commercial |
$84.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.31
|
| Rate for Payer: Healthscope Commercial |
$75.97
|
| Rate for Payer: Healthscope Whirlpool |
$75.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.48
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.64
|
| Rate for Payer: Nomi Health Commercial |
$75.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.75
|
| Rate for Payer: PACE SWMI |
$63.31
|
| Rate for Payer: PHP Medicare Advantage |
$63.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$116.08
|
| Rate for Payer: Priority Health Medicare |
$63.31
|
| Rate for Payer: Priority Health Narrow Network |
$116.08
|
| Rate for Payer: Railroad Medicare Medicare |
$63.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$63.31
|
| Rate for Payer: UHC Exchange |
$126.93
|
| Rate for Payer: UHC Medicaid |
$40.68
|
| Rate for Payer: UHCCP DNSP |
$63.31
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$115.07 |
| Rate for Payer: Aetna Commercial |
$74.65
|
| Rate for Payer: Aetna Medicare |
$55.71
|
| Rate for Payer: BCBS Complete |
$37.35
|
| Rate for Payer: BCBS MAPPO |
$55.71
|
| Rate for Payer: BCN Commercial |
$94.61
|
| Rate for Payer: BCN Medicare Advantage |
$55.71
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$80.22
|
| Rate for Payer: Cofinity Commercial |
$74.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.71
|
| Rate for Payer: Healthscope Commercial |
$66.85
|
| Rate for Payer: Healthscope Whirlpool |
$66.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.50
|
| Rate for Payer: Meridian Medicaid |
$37.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.28
|
| Rate for Payer: Nomi Health Commercial |
$66.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.75
|
| Rate for Payer: PACE SWMI |
$55.71
|
| Rate for Payer: PHP Medicare Advantage |
$55.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$103.07
|
| Rate for Payer: Priority Health Medicare |
$55.71
|
| Rate for Payer: Priority Health Narrow Network |
$103.07
|
| Rate for Payer: Railroad Medicare Medicare |
$55.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$55.71
|
| Rate for Payer: UHC Exchange |
$115.07
|
| Rate for Payer: UHC Medicaid |
$35.57
|
| Rate for Payer: UHCCP DNSP |
$55.71
|
| Rate for Payer: UHCCP Medicaid |
$35.57
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J1200
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Aetna Medicare |
$0.69
|
| Rate for Payer: BCBS MAPPO |
$0.69
|
| Rate for Payer: BCBS Trust/PPO |
$0.27
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Medicare Advantage |
$0.69
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$0.92
|
| Rate for Payer: Cofinity Commercial |
$0.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.69
|
| Rate for Payer: Healthscope Commercial |
$0.83
|
| Rate for Payer: Healthscope Whirlpool |
$0.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.76
|
| Rate for Payer: Nomi Health Commercial |
$0.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: PACE SWMI |
$0.69
|
| Rate for Payer: PHP Medicare Advantage |
$0.69
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Railroad Medicare Medicare |
$0.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.69
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHCCP DNSP |
$0.69
|
|
