|
PR INJECT THRU CHOLANGIO CATHETER
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 47505
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
|
|
PR INJ ENOXAPARIN SODIUM
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1650
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Aetna Medicare |
$0.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.72
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.54
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$0.78
|
| Rate for Payer: Cofinity Commercial |
$0.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.54
|
| Rate for Payer: Healthscope Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$1.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.66
|
| Rate for Payer: Nomi Health Commercial |
$0.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PACE SWMI |
$0.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.54
|
| Rate for Payer: Priority Health Medicare |
$0.54
|
| Rate for Payer: Railroad Medicare Medicare |
$0.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.54
|
| Rate for Payer: UHC Exchange |
$0.53
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS G0260
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$45.89
|
| Rate for Payer: Aetna Medicare |
$656.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.89
|
| Rate for Payer: BCBS Complete |
$525.20
|
| Rate for Payer: BCN Commercial |
$647.51
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$984.75
|
|
|
PR INJ, FUROSEMIDE, 1 MG
|
Professional
|
Both
|
$3.12
|
|
|
Service Code
|
HCPCS J1938
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS MAPPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.02
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.03
|
| Rate for Payer: Healthscope Commercial |
$0.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.03
|
| Rate for Payer: Nomi Health Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
| Rate for Payer: PACE SWMI |
$0.02
|
| Rate for Payer: PHP Medicare Advantage |
$0.02
|
| Rate for Payer: Priority Health Medicare |
$0.02
|
| Rate for Payer: Railroad Medicare Medicare |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
|
|
PR INJ HEPARIN SODIUM PER 1000U
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1644
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.29
|
| Rate for Payer: Aetna Medicare |
$0.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.32
|
| Rate for Payer: BCBS MAPPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.22
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Cofinity Commercial |
$0.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.41
|
| Rate for Payer: Healthscope Commercial |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.28
|
| Rate for Payer: Nomi Health Commercial |
$0.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.22
|
| Rate for Payer: PHP Medicare Advantage |
$0.22
|
| Rate for Payer: Priority Health Medicare |
$0.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.22
|
| Rate for Payer: UHC Exchange |
$0.18
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$33.50 |
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.08
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$18.42
|
| Rate for Payer: BCN Commercial |
$17.55
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$26.08
|
| Rate for Payer: Cofinity Commercial |
$24.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$28.98
|
| Rate for Payer: Healthscope Commercial |
$33.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.41
|
| Rate for Payer: Nomi Health Commercial |
$21.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: Railroad Medicare Medicare |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.11
|
| Rate for Payer: UHC Exchange |
$18.08
|
|
|
PR INJ, METHYLPRED ACETATE 1 MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1010
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.15
|
| Rate for Payer: Aetna Medicare |
$0.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS MAPPO |
$0.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Medicare Advantage |
$0.11
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Cofinity Commercial |
$0.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.11
|
| Rate for Payer: Healthscope Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.65
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.11
|
| Rate for Payer: Priority Health Medicare |
$0.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.11
|
| Rate for Payer: UHC Exchange |
$0.12
|
|
|
PR INJ, METHYLPRED SOD SUCC 5MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2919
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$0.32
|
| Rate for Payer: Aetna Medicare |
$0.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.35
|
| Rate for Payer: BCBS MAPPO |
$0.24
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Cofinity Commercial |
$0.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.24
|
| Rate for Payer: Healthscope Commercial |
$0.38
|
| Rate for Payer: Healthscope Commercial |
$0.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.95
|
| Rate for Payer: Nomi Health Commercial |
$0.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PACE SWMI |
$0.24
|
| Rate for Payer: PHP Medicare Advantage |
$0.24
|
| Rate for Payer: Priority Health Medicare |
$0.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.26
|
| Rate for Payer: UHC Core |
$0.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.24
|
| Rate for Payer: UHC Exchange |
$0.26
|
|
|
PR INJ PROGESTERONE PER 50 MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J2675
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna Medicare |
$0.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.95
|
| Rate for Payer: BCBS MAPPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.47
|
| Rate for Payer: BCN Commercial |
$0.42
|
| Rate for Payer: BCN Medicare Advantage |
$0.66
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.95
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.66
|
| Rate for Payer: Healthscope Commercial |
$1.22
|
| Rate for Payer: Healthscope Commercial |
$1.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.89
|
| Rate for Payer: Nomi Health Commercial |
$0.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
| Rate for Payer: PACE SWMI |
$0.66
|
| Rate for Payer: PHP Medicare Advantage |
$0.66
|
| Rate for Payer: Priority Health Medicare |
$0.66
|
| Rate for Payer: Railroad Medicare Medicare |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.72
|
| Rate for Payer: UHC Core |
$0.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.72
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Aetna Commercial |
$36.64
|
| Rate for Payer: Aetna Medicare |
$28.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.37
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$27.34
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: BCN Medicare Advantage |
$27.34
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$36.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$50.58
|
| Rate for Payer: Healthscope Commercial |
$43.74
|
| Rate for Payer: Mclaren Medicaid |
$17.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.71
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.67
|
| Rate for Payer: Nomi Health Commercial |
$32.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: PACE SWMI |
$27.34
|
| Rate for Payer: PHP Medicare Advantage |
$27.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.95
|
| Rate for Payer: Priority Health Medicare |
$27.34
|
| Rate for Payer: Priority Health SBD |
$62.95
|
| Rate for Payer: Priority Health Tiered Network |
$62.95
|
| Rate for Payer: Railroad Medicare Medicare |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.68
|
| Rate for Payer: UHC Core |
$59.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.34
|
| Rate for Payer: UHC Exchange |
$59.68
|
| Rate for Payer: UHC Medicaid |
$17.47
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$511.56 |
| Max. Negotiated Rate |
$730.80 |
| Rate for Payer: Aetna Commercial |
$690.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.80
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Advantage |
$568.40
|
| Rate for Payer: Cofinity Commercial |
$698.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.60
|
| Rate for Payer: Healthscope Commercial |
$730.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: PHP Commercial |
$690.20
|
| Rate for Payer: Priority Health SBD |
$511.56
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$690.20
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$107.78
|
| Rate for Payer: BCN Commercial |
$107.78
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Advantage |
$568.40
|
| Rate for Payer: Cofinity Commercial |
$698.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$730.80
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.20
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$690.20
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$511.56
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Aetna Commercial |
$36.64
|
| Rate for Payer: Aetna Medicare |
$28.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.37
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$27.34
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: BCN Medicare Advantage |
$27.34
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$36.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$50.58
|
| Rate for Payer: Healthscope Commercial |
$43.74
|
| Rate for Payer: Mclaren Medicaid |
$17.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.71
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.67
|
| Rate for Payer: Nomi Health Commercial |
$32.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: PACE SWMI |
$27.34
|
| Rate for Payer: PHP Medicare Advantage |
$27.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.95
|
| Rate for Payer: Priority Health Medicare |
$27.34
|
| Rate for Payer: Priority Health SBD |
$62.95
|
| Rate for Payer: Priority Health Tiered Network |
$62.95
|
| Rate for Payer: Railroad Medicare Medicare |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.68
|
| Rate for Payer: UHC Core |
$59.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.34
|
| Rate for Payer: UHC Exchange |
$59.68
|
| Rate for Payer: UHC Medicaid |
$17.47
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
|
|
PR INJ, REMDESIVIR, 1 MG
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS J0248
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$9.25
|
| Rate for Payer: Aetna Medicare |
$7.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: BCBS MAPPO |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$7.02
|
| Rate for Payer: BCN Commercial |
$6.47
|
| Rate for Payer: BCN Medicare Advantage |
$6.90
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$9.25
|
| Rate for Payer: Cofinity Commercial |
$9.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$12.77
|
| Rate for Payer: Healthscope Commercial |
$11.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.06
|
| Rate for Payer: Nomi Health Commercial |
$8.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.50
|
| Rate for Payer: PACE SWMI |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$6.90
|
| Rate for Payer: Priority Health Medicare |
$6.90
|
| Rate for Payer: Railroad Medicare Medicare |
$6.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.90
|
| Rate for Payer: UHC Core |
$6.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.90
|
| Rate for Payer: UHC Exchange |
$6.90
|
|
|
PR INJ, RIMABOTULINUMTOXINB
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J0587
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$24.57 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: Aetna Medicare |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.12
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$13.53
|
| Rate for Payer: BCN Commercial |
$13.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$21.25
|
| Rate for Payer: Healthscope Commercial |
$24.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.04
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.29
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.28
|
| Rate for Payer: UHC Exchange |
$13.29
|
|
|
PR INJ RISPERDAL CONSTA, 0.5 MG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2794
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$10.97
|
| Rate for Payer: BCN Commercial |
$10.16
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$17.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.00
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.18
|
| Rate for Payer: UHC Core |
$11.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.80
|
| Rate for Payer: UHC Exchange |
$11.18
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J3111
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$22.55 |
| Rate for Payer: Aetna Commercial |
$16.33
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.55
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.33
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$17.55
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Healthscope Commercial |
$19.50
|
| Rate for Payer: Healthscope Commercial |
$22.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.35
|
| Rate for Payer: Nomi Health Commercial |
$14.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.25
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.11
|
| Rate for Payer: UHC Core |
$12.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.19
|
| Rate for Payer: UHC Exchange |
$12.11
|
|
|
PR INJ TESTOSTERONE CYPIONATE
|
Professional
|
Both
|
$0.16
|
|
|
Service Code
|
HCPCS J1071
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS MAPPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.02
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.03
|
| Rate for Payer: Nomi Health Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.12
|
| Rate for Payer: PACE SWMI |
$0.02
|
| Rate for Payer: PHP Medicare Advantage |
$0.02
|
| Rate for Payer: Priority Health Medicare |
$0.02
|
| Rate for Payer: Railroad Medicare Medicare |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.03
|
|
|
PR INJ, TRIVISC 1 MG
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS J7329
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$18.17 |
| Rate for Payer: Aetna Commercial |
$4.38
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.71
|
| Rate for Payer: BCBS MAPPO |
$3.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Medicare Advantage |
$3.27
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Healthscope Commercial |
$6.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.56
|
| Rate for Payer: Nomi Health Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE SWMI |
$3.27
|
| Rate for Payer: PHP Medicare Advantage |
$3.27
|
| Rate for Payer: Priority Health Medicare |
$3.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.61
|
| Rate for Payer: UHC Core |
$3.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.27
|
| Rate for Payer: UHC Exchange |
$3.61
|
|
|
PR INPT/ED TELECONSULT30
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS G0425
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Aetna Commercial |
$112.29
|
| Rate for Payer: Aetna Medicare |
$87.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS MAPPO |
$83.80
|
| Rate for Payer: BCN Commercial |
$136.95
|
| Rate for Payer: BCN Medicare Advantage |
$83.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$120.67
|
| Rate for Payer: Cofinity Commercial |
$112.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.80
|
| Rate for Payer: Healthscope Commercial |
$155.03
|
| Rate for Payer: Healthscope Commercial |
$134.08
|
| Rate for Payer: Mclaren Medicaid |
$53.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.99
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.54
|
| Rate for Payer: Nomi Health Commercial |
$100.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.25
|
| Rate for Payer: PACE SWMI |
$83.80
|
| Rate for Payer: PHP Medicare Advantage |
$83.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$123.18
|
| Rate for Payer: Priority Health Medicare |
$83.80
|
| Rate for Payer: Priority Health SBD |
$123.18
|
| Rate for Payer: Priority Health Tiered Network |
$123.18
|
| Rate for Payer: Railroad Medicare Medicare |
$83.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.05
|
| Rate for Payer: UHC Core |
$160.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.80
|
| Rate for Payer: UHC Exchange |
$160.05
|
| Rate for Payer: UHC Medicaid |
$53.68
|
| Rate for Payer: UHCCP Medicaid |
$53.68
|
|
|
PR INPT/ED TELECONSULT50
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS G0426
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$217.30 |
| Rate for Payer: Aetna Commercial |
$155.82
|
| Rate for Payer: Aetna Medicare |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.44
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$116.28
|
| Rate for Payer: BCN Commercial |
$193.71
|
| Rate for Payer: BCN Medicare Advantage |
$116.28
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$167.44
|
| Rate for Payer: Cofinity Commercial |
$155.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.28
|
| Rate for Payer: Healthscope Commercial |
$215.12
|
| Rate for Payer: Healthscope Commercial |
$186.05
|
| Rate for Payer: Mclaren Medicaid |
$74.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.09
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.39
|
| Rate for Payer: Nomi Health Commercial |
$139.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.00
|
| Rate for Payer: PACE SWMI |
$116.28
|
| Rate for Payer: PHP Medicare Advantage |
$116.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$174.25
|
| Rate for Payer: Priority Health Medicare |
$116.28
|
| Rate for Payer: Priority Health SBD |
$174.25
|
| Rate for Payer: Priority Health Tiered Network |
$174.25
|
| Rate for Payer: Railroad Medicare Medicare |
$116.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.30
|
| Rate for Payer: UHC Core |
$217.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$116.28
|
| Rate for Payer: UHC Exchange |
$217.30
|
| Rate for Payer: UHC Medicaid |
$74.76
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
PR INPT/ED TELECONSULT70
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS G0427
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$322.26 |
| Rate for Payer: Aetna Commercial |
$223.69
|
| Rate for Payer: Aetna Medicare |
$173.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.38
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCBS MAPPO |
$166.93
|
| Rate for Payer: BCN Commercial |
$275.39
|
| Rate for Payer: BCN Medicare Advantage |
$166.93
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$240.38
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.93
|
| Rate for Payer: Healthscope Commercial |
$308.82
|
| Rate for Payer: Healthscope Commercial |
$267.09
|
| Rate for Payer: Mclaren Medicaid |
$107.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.28
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$183.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.87
|
| Rate for Payer: Nomi Health Commercial |
$200.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.00
|
| Rate for Payer: PACE SWMI |
$166.93
|
| Rate for Payer: PHP Medicare Advantage |
$166.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$247.72
|
| Rate for Payer: Priority Health Medicare |
$166.93
|
| Rate for Payer: Priority Health SBD |
$247.72
|
| Rate for Payer: Priority Health Tiered Network |
$247.72
|
| Rate for Payer: Railroad Medicare Medicare |
$166.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.26
|
| Rate for Payer: UHC Core |
$322.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$166.93
|
| Rate for Payer: UHC Exchange |
$322.26
|
| Rate for Payer: UHC Medicaid |
$107.35
|
| Rate for Payer: UHCCP Medicaid |
$107.35
|
|
|
PR INPT/TELE FOLLOW UP 25
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS G0407
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$116.83 |
| Rate for Payer: Aetna Commercial |
$84.62
|
| Rate for Payer: Aetna Medicare |
$65.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.94
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS MAPPO |
$63.15
|
| Rate for Payer: BCN Commercial |
$107.56
|
| Rate for Payer: BCN Medicare Advantage |
$63.15
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Commercial |
$84.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.15
|
| Rate for Payer: Healthscope Commercial |
$116.83
|
| Rate for Payer: Healthscope Commercial |
$101.04
|
| Rate for Payer: Mclaren Medicaid |
$40.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.31
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.40
|
| Rate for Payer: Nomi Health Commercial |
$75.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.75
|
| Rate for Payer: PACE SWMI |
$63.15
|
| Rate for Payer: PHP Medicare Advantage |
$63.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$99.20
|
| Rate for Payer: Priority Health Medicare |
$63.15
|
| Rate for Payer: Priority Health SBD |
$99.20
|
| Rate for Payer: Priority Health Tiered Network |
$99.20
|
| Rate for Payer: Railroad Medicare Medicare |
$63.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.18
|
| Rate for Payer: UHC Core |
$115.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$63.15
|
| Rate for Payer: UHC Exchange |
$115.18
|
| Rate for Payer: UHC Medicaid |
$40.68
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
PR INPT/TELE FOLLOW UP 35
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS G0408
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$123.95
|
| Rate for Payer: Aetna Medicare |
$96.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.20
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS MAPPO |
$92.50
|
| Rate for Payer: BCN Commercial |
$155.37
|
| Rate for Payer: BCN Medicare Advantage |
$92.50
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$133.20
|
| Rate for Payer: Cofinity Commercial |
$123.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.50
|
| Rate for Payer: Healthscope Commercial |
$171.12
|
| Rate for Payer: Healthscope Commercial |
$148.00
|
| Rate for Payer: Mclaren Medicaid |
$59.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.12
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.04
|
| Rate for Payer: Nomi Health Commercial |
$111.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: PACE SWMI |
$92.50
|
| Rate for Payer: PHP Medicare Advantage |
$92.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$143.28
|
| Rate for Payer: Priority Health Medicare |
$92.50
|
| Rate for Payer: Priority Health SBD |
$143.28
|
| Rate for Payer: Priority Health Tiered Network |
$143.28
|
| Rate for Payer: Railroad Medicare Medicare |
$92.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.65
|
| Rate for Payer: UHC Core |
$165.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$92.50
|
| Rate for Payer: UHC Exchange |
$165.65
|
| Rate for Payer: UHC Medicaid |
$59.64
|
| Rate for Payer: UHCCP Medicaid |
$59.64
|
|
|
PR INSERT CANNULA PROLONG CP INSUFF
|
Professional
|
Both
|
$1,629.00
|
|
|
Service Code
|
HCPCS 36822
|
| Min. Negotiated Rate |
$651.60 |
| Max. Negotiated Rate |
$1,221.75 |
| Rate for Payer: Aetna Medicare |
$814.50
|
| Rate for Payer: BCBS Complete |
$651.60
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,058.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,221.75
|
|
