|
PR DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 53665
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$49.66
|
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$24.82
|
| Rate for Payer: BCN Commercial |
$54.73
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$24.82
|
| 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 Narrow Network |
$59.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.40
|
| Rate for Payer: UHC Exchange |
$46.40
|
| 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 |
$927.17 |
| Rate for Payer: Aetna Commercial |
$53.15
|
| Rate for Payer: Aetna Medicare |
$72.00
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Trust/PPO |
$927.17
|
| Rate for Payer: BCN Commercial |
$110.45
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| 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 Narrow Network |
$66.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.53
|
| Rate for Payer: UHC Exchange |
$49.53
|
| 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 |
$2,149.12 |
| Rate for Payer: Aetna Commercial |
$51.53
|
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.12
|
| Rate for Payer: BCN Commercial |
$108.48
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| 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 Narrow Network |
$63.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.74
|
| Rate for Payer: UHC Exchange |
$48.74
|
| 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 |
$1,422.71 |
| Rate for Payer: Aetna Commercial |
$57.02
|
| Rate for Payer: Aetna Medicare |
$102.50
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$114.35
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| 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 Narrow Network |
$71.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.14
|
| Rate for Payer: UHC Exchange |
$55.14
|
| 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 |
$1,924.60 |
| Rate for Payer: Aetna Commercial |
$149.43
|
| Rate for Payer: Aetna Medicare |
$136.00
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.60
|
| Rate for Payer: BCN Commercial |
$233.59
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| 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 Narrow Network |
$193.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.67
|
| Rate for Payer: UHC Exchange |
$128.67
|
| Rate for Payer: UHCCP Medicaid |
$82.43
|
|
|
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 |
$4,828.62 |
| Rate for Payer: Aetna Commercial |
$775.80
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$836.14
|
| Rate for Payer: ASR Commercial |
$836.14
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$705.89
|
| Rate for Payer: BCN Commercial |
$668.31
|
| 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: Cofinity Commercial |
$810.28
|
| 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 |
$862.00
|
| Rate for Payer: Healthscope Whirlpool |
$836.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren 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 |
$706.84
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.28
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$604.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$758.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
PR 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 & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Aetna Commercial |
$275.18
|
| Rate for Payer: Aetna Medicare |
$431.00
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| 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 Narrow Network |
$350.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.55
|
| Rate for Payer: UHC Exchange |
$247.55
|
| Rate for Payer: UHCCP Medicaid |
$150.17
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Aetna Commercial |
$275.18
|
| Rate for Payer: Aetna Medicare |
$431.00
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| 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 Narrow Network |
$350.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.55
|
| Rate for Payer: UHC Exchange |
$247.55
|
| 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 |
$1,187.00 |
| Rate for Payer: Aetna Commercial |
$113.71
|
| Rate for Payer: Aetna Medicare |
$258.50
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.34
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| 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 Narrow Network |
$153.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.65
|
| Rate for Payer: UHC Exchange |
$120.65
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
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 |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$104.98
|
| Rate for Payer: Aetna Medicare |
$164.00
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$275.61
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| 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 Narrow Network |
$141.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.05
|
| Rate for Payer: UHC Exchange |
$111.05
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
|
|
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
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$104.98
|
| Rate for Payer: Aetna Medicare |
$164.00
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$275.61
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| 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 Narrow Network |
$141.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.05
|
| Rate for Payer: UHC Exchange |
$111.05
|
| 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 |
$213.20 |
| Max. Negotiated Rate |
$1,423.83 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Medicare |
$918.60
|
| 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: ASR ASR |
$318.16
|
| Rate for Payer: ASR Commercial |
$318.16
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$268.60
|
| Rate for Payer: BCN Commercial |
$254.30
|
| 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: Cofinity Commercial |
$308.32
|
| 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 |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$918.60
|
| Rate for Payer: Mclaren 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 |
$268.96
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$1,010.46
|
| Rate for Payer: PHP Medicaid |
$492.37
|
| 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 |
$287.39
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$229.93
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$1,423.83
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP DNSP |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 68801
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$1,061.88 |
| Rate for Payer: Aetna Commercial |
$100.58
|
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: BCN Commercial |
$112.30
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| 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 Narrow Network |
$139.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.33
|
| Rate for Payer: UHC Exchange |
$110.33
|
| 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 |
$619.17 |
| Rate for Payer: Aetna Commercial |
$75.67
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS Trust/PPO |
$619.17
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Meridian Medicaid |
$40.48
|
| 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 Narrow Network |
$106.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.91
|
| Rate for Payer: UHC Exchange |
$70.91
|
| 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 |
$1,877.58 |
| Rate for Payer: Aetna Commercial |
$156.29
|
| Rate for Payer: Aetna Medicare |
$185.00
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.58
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| 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 Narrow Network |
$193.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.99
|
| Rate for Payer: UHC Exchange |
$153.99
|
| 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 |
$1,149.58 |
| Rate for Payer: Aetna Commercial |
$255.45
|
| Rate for Payer: Aetna Medicare |
$660.00
|
| Rate for Payer: BCBS Complete |
$131.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.58
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Meridian Medicaid |
$131.28
|
| 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 Narrow Network |
$347.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.08
|
| Rate for Payer: UHC Exchange |
$233.08
|
| 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 |
$549.43 |
| Rate for Payer: Aetna Commercial |
$81.77
|
| Rate for Payer: Aetna Medicare |
$86.00
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS Trust/PPO |
$549.43
|
| Rate for Payer: BCN Commercial |
$129.50
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| 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 Narrow Network |
$100.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.42
|
| Rate for Payer: UHC Exchange |
$77.42
|
| 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 |
$244.07 |
| Rate for Payer: Aetna Commercial |
$68.82
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS Trust/PPO |
$244.07
|
| Rate for Payer: BCN Commercial |
$124.13
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| 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 Narrow Network |
$84.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.71
|
| Rate for Payer: UHC Exchange |
$64.71
|
| 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 |
$1,543.16 |
| Rate for Payer: Aetna Commercial |
$111.68
|
| Rate for Payer: Aetna Medicare |
$130.50
|
| Rate for Payer: BCBS Complete |
$58.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: BCN Commercial |
$248.73
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Meridian Medicaid |
$58.15
|
| 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 Narrow Network |
$137.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.43
|
| Rate for Payer: UHC Exchange |
$106.43
|
| Rate for Payer: UHCCP Medicaid |
$55.38
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 53621
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$91.87
|
| Rate for Payer: Aetna Medicare |
$123.00
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: BCN Commercial |
$237.98
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.44
|
| Rate for Payer: Priority Health Narrow Network |
$113.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.48
|
| Rate for Payer: UHC Exchange |
$87.48
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$1,411.09 |
| Rate for Payer: Aetna Commercial |
$82.91
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,411.09
|
| Rate for Payer: BCN Commercial |
$92.36
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.66
|
| Rate for Payer: Priority Health Narrow Network |
$100.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.81
|
| Rate for Payer: UHC Exchange |
$78.81
|
| Rate for Payer: UHCCP Medicaid |
$40.47
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J1200
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$0.83
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.39
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.01
|
| Rate for Payer: UHC Exchange |
$1.01
|
|
|
PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 90700
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$34.91 |
| Rate for Payer: Aetna Commercial |
$29.53
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$34.91
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.87
|
| Rate for Payer: UHC Exchange |
$34.87
|
|
