|
PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 90947
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$215.80 |
| Rate for Payer: Aetna Commercial |
$154.98
|
| Rate for Payer: Aetna Medicare |
$115.66
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS MAPPO |
$115.66
|
| Rate for Payer: BCN Medicare Advantage |
$115.66
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$166.55
|
| Rate for Payer: Cofinity Commercial |
$154.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.66
|
| Rate for Payer: Healthscope Commercial |
$138.79
|
| Rate for Payer: Healthscope Whirlpool |
$138.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.44
|
| Rate for Payer: Nomi Health Commercial |
$138.79
|
| Rate for Payer: PACE SWMI |
$115.66
|
| Rate for Payer: PHP Medicare Advantage |
$115.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health Medicare |
$115.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.66
|
| Rate for Payer: UHC Medicare Advantage |
$115.66
|
| Rate for Payer: UHCCP DNSP |
$115.66
|
|
|
PR DIAPHRAGM
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS A4266
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
|
|
PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 57170
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$147.55 |
| Rate for Payer: Aetna Commercial |
$61.40
|
| Rate for Payer: Aetna Medicare |
$45.82
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$45.82
|
| Rate for Payer: BCN Medicare Advantage |
$45.82
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.82
|
| Rate for Payer: Healthscope Commercial |
$54.98
|
| Rate for Payer: Healthscope Whirlpool |
$54.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.11
|
| Rate for Payer: Nomi Health Commercial |
$54.98
|
| Rate for Payer: PACE SWMI |
$45.82
|
| Rate for Payer: PHP Medicare Advantage |
$45.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health Medicare |
$45.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.82
|
| Rate for Payer: UHC Medicare Advantage |
$45.82
|
| Rate for Payer: UHCCP DNSP |
$45.82
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 95957
|
| Min. Negotiated Rate |
$263.30 |
| Max. Negotiated Rate |
$505.70 |
| Rate for Payer: Aetna Commercial |
$352.82
|
| Rate for Payer: Aetna Medicare |
$263.30
|
| Rate for Payer: BCBS Complete |
$311.20
|
| Rate for Payer: BCBS MAPPO |
$263.30
|
| Rate for Payer: BCN Medicare Advantage |
$263.30
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cofinity Commercial |
$379.15
|
| Rate for Payer: Cofinity Commercial |
$352.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.30
|
| Rate for Payer: Healthscope Commercial |
$315.96
|
| Rate for Payer: Healthscope Whirlpool |
$315.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.46
|
| Rate for Payer: Nomi Health Commercial |
$315.96
|
| Rate for Payer: PACE SWMI |
$263.30
|
| Rate for Payer: PHP Medicare Advantage |
$263.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.70
|
| Rate for Payer: Priority Health Medicare |
$263.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.30
|
| Rate for Payer: UHC Medicare Advantage |
$263.30
|
| Rate for Payer: UHCCP DNSP |
$263.30
|
|
|
PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 45905
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$234.79 |
| Rate for Payer: Aetna Commercial |
$218.49
|
| Rate for Payer: Aetna Medicare |
$163.05
|
| Rate for Payer: BCBS Complete |
$143.60
|
| Rate for Payer: BCBS MAPPO |
$163.05
|
| 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 |
$195.66
|
| Rate for Payer: Healthscope Whirlpool |
$195.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.20
|
| 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 Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health Medicare |
$163.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.05
|
| Rate for Payer: UHC Medicare Advantage |
$163.05
|
| Rate for Payer: UHCCP DNSP |
$163.05
|
|
|
PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 42660
|
| Min. Negotiated Rate |
$75.04 |
| Max. Negotiated Rate |
$147.55 |
| Rate for Payer: Aetna Commercial |
$100.55
|
| Rate for Payer: Aetna Medicare |
$75.04
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$75.04
|
| 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 |
$90.05
|
| Rate for Payer: Healthscope Whirlpool |
$90.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.79
|
| 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 Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health Medicare |
$75.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.04
|
| Rate for Payer: UHC Medicare Advantage |
$75.04
|
| Rate for Payer: UHCCP DNSP |
$75.04
|
|
|
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: 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: 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 |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna Medicare |
$35.58
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$35.58
|
| 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 |
$51.24
|
| Rate for Payer: Cofinity Commercial |
$47.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.58
|
| Rate for Payer: Healthscope Commercial |
$42.70
|
| Rate for Payer: Healthscope Whirlpool |
$42.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.36
|
| 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 Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$35.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.58
|
| Rate for Payer: UHC Medicare Advantage |
$35.58
|
| Rate for Payer: UHCCP DNSP |
$35.58
|
|
|
PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 53660
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$52.61
|
| Rate for Payer: Aetna Medicare |
$39.26
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS MAPPO |
$39.26
|
| 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 |
$47.11
|
| Rate for Payer: Healthscope Whirlpool |
$47.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.22
|
| 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 Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$39.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.26
|
| Rate for Payer: UHC Medicare Advantage |
$39.26
|
| Rate for Payer: UHCCP DNSP |
$39.26
|
|
|
PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 53661
|
| Min. Negotiated Rate |
$38.11 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: Aetna Medicare |
$38.11
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS MAPPO |
$38.11
|
| 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 |
$45.73
|
| Rate for Payer: Healthscope Whirlpool |
$45.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.02
|
| 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 Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health Medicare |
$38.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.11
|
| Rate for Payer: UHC Medicare Advantage |
$38.11
|
| Rate for Payer: UHCCP DNSP |
$38.11
|
|
|
PR DILATION CERVICAL CANAL INSTRUMENTAL SPX
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 57800
|
| Min. Negotiated Rate |
$46.05 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$61.71
|
| Rate for Payer: Aetna Medicare |
$46.05
|
| Rate for Payer: BCBS Complete |
$82.00
|
| Rate for Payer: BCBS MAPPO |
$46.05
|
| 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 |
$55.26
|
| Rate for Payer: Healthscope Whirlpool |
$55.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.35
|
| 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 Cigna Priority Health |
$133.25
|
| Rate for Payer: Priority Health Medicare |
$46.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.05
|
| Rate for Payer: UHC Medicare Advantage |
$46.05
|
| Rate for Payer: UHCCP DNSP |
$46.05
|
|
|
PR DILATION & CURETTAGE CERVICAL STUMP
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 57558
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna Commercial |
$162.62
|
| Rate for Payer: Aetna Medicare |
$121.36
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$121.36
|
| 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 |
$145.63
|
| Rate for Payer: Healthscope Whirlpool |
$145.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.43
|
| 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 Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$121.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.36
|
| Rate for Payer: UHC Medicare Advantage |
$121.36
|
| Rate for Payer: UHCCP DNSP |
$121.36
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$560.30 |
| Rate for Payer: Aetna Commercial |
$299.05
|
| Rate for Payer: Aetna Medicare |
$223.17
|
| Rate for Payer: BCBS Complete |
$344.80
|
| Rate for Payer: BCBS MAPPO |
$223.17
|
| 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 |
$267.80
|
| Rate for Payer: Healthscope Whirlpool |
$267.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.33
|
| 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 Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health Medicare |
$223.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.17
|
| Rate for Payer: UHC Medicare Advantage |
$223.17
|
| Rate for Payer: UHCCP DNSP |
$223.17
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$560.30 |
| Max. Negotiated Rate |
$4,806.44 |
| Rate for Payer: Aetna Commercial |
$775.80
|
| 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 |
$836.14
|
| Rate for Payer: ASR Commercial |
$836.14
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$705.89
|
| Rate for Payer: BCN Commercial |
$668.31
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$810.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$862.00
|
| Rate for Payer: Healthscope Whirlpool |
$836.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$775.80
|
| 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 |
$732.70
|
| Rate for Payer: Nomi Health Commercial |
$706.84
|
| 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 |
$560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.28
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$604.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$758.56
|
| 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 DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$560.30 |
| Rate for Payer: Aetna Commercial |
$299.05
|
| Rate for Payer: Aetna Medicare |
$223.17
|
| Rate for Payer: BCBS Complete |
$344.80
|
| Rate for Payer: BCBS MAPPO |
$223.17
|
| 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 |
$267.80
|
| Rate for Payer: Healthscope Whirlpool |
$267.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.33
|
| 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 Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health Medicare |
$223.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.17
|
| Rate for Payer: UHC Medicare Advantage |
$223.17
|
| Rate for Payer: UHCCP DNSP |
$223.17
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$560.30 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Aetna Commercial |
$775.80
|
| Rate for Payer: ASR ASR |
$836.14
|
| Rate for Payer: ASR Commercial |
$836.14
|
| Rate for Payer: BCBS Trust/PPO |
$702.44
|
| Rate for Payer: BCN Commercial |
$668.31
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$810.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.60
|
| Rate for Payer: Healthscope Commercial |
$862.00
|
| Rate for Payer: Healthscope Whirlpool |
$836.14
|
| Rate for Payer: Mclaren Commercial |
$775.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.70
|
| Rate for Payer: Nomi Health Commercial |
$706.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$758.56
|
|
|
PR DILATION ESOPHAGUS GUIDE WIRE
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 43453
|
| Min. Negotiated Rate |
$81.91 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$109.76
|
| Rate for Payer: Aetna Medicare |
$81.91
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS MAPPO |
$81.91
|
| 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 |
$98.29
|
| Rate for Payer: Healthscope Whirlpool |
$98.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.01
|
| 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 Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health Medicare |
$81.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.91
|
| Rate for Payer: UHC Medicare Advantage |
$81.91
|
| Rate for Payer: UHCCP DNSP |
$81.91
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 43450
|
| Min. Negotiated Rate |
$75.17 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$100.73
|
| Rate for Payer: Aetna Medicare |
$75.17
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$75.17
|
| 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 |
$90.20
|
| Rate for Payer: Healthscope Whirlpool |
$90.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.93
|
| 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 Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$75.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.17
|
| Rate for Payer: UHC Medicare Advantage |
$75.17
|
| Rate for Payer: UHCCP DNSP |
$75.17
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: ASR Commercial |
$318.16
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$268.60
|
| Rate for Payer: BCN Commercial |
$254.30
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$308.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.39
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$229.93
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: ASR Commercial |
$318.16
|
| Rate for Payer: BCBS Trust/PPO |
$267.29
|
| Rate for Payer: BCN Commercial |
$254.30
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$308.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$75.17 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$100.73
|
| Rate for Payer: Aetna Medicare |
$75.17
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$75.17
|
| 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 |
$90.20
|
| Rate for Payer: Healthscope Whirlpool |
$90.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.93
|
| 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 Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$75.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.17
|
| Rate for Payer: UHC Medicare Advantage |
$75.17
|
| Rate for Payer: UHCCP DNSP |
$75.17
|
|
|
PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 68801
|
| Min. Negotiated Rate |
$72.54 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$72.54
|
| 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 |
$87.05
|
| Rate for Payer: Healthscope Whirlpool |
$87.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.17
|
| 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 Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$72.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.54
|
| Rate for Payer: UHC Medicare Advantage |
$72.54
|
| Rate for Payer: UHCCP DNSP |
$72.54
|
|
|
PR DILATION SALIVARY DUCT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 42650
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.46 |
| Rate for Payer: Aetna Commercial |
$75.80
|
| Rate for Payer: Aetna Medicare |
$56.57
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$56.57
|
| 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 |
$67.88
|
| Rate for Payer: Healthscope Whirlpool |
$67.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.40
|
| 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 Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$56.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.57
|
| Rate for Payer: UHC Medicare Advantage |
$56.57
|
| Rate for Payer: UHCCP DNSP |
$56.57
|
|
|
PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 57400
|
| Min. Negotiated Rate |
$125.35 |
| Max. Negotiated Rate |
$240.50 |
| Rate for Payer: Aetna Commercial |
$167.97
|
| Rate for Payer: Aetna Medicare |
$125.35
|
| Rate for Payer: BCBS Complete |
$148.00
|
| Rate for Payer: BCBS MAPPO |
$125.35
|
| 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 |
$150.42
|
| Rate for Payer: Healthscope Whirlpool |
$150.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.62
|
| 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 Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health Medicare |
$125.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.35
|
| Rate for Payer: UHC Medicare Advantage |
$125.35
|
| Rate for Payer: UHCCP DNSP |
$125.35
|
|
