|
PR INJECTION PX ONLY MAMMARY DUCTOGRAM/GALACTOGRAM
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 19030
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$74.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.22
|
| Rate for Payer: BCBS Complete |
$132.00
|
| Rate for Payer: BCBS MAPPO |
$71.68
|
| Rate for Payer: BCN Medicare Advantage |
$71.68
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$96.05
|
| Rate for Payer: Cofinity Commercial |
$103.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.68
|
| Rate for Payer: Healthscope Commercial |
$132.61
|
| Rate for Payer: Healthscope Commercial |
$114.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.50
|
| Rate for Payer: Nomi Health Commercial |
$86.02
|
| Rate for Payer: PACE SWMI |
$71.68
|
| Rate for Payer: PHP Medicare Advantage |
$71.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health Medicare |
$71.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.68
|
| Rate for Payer: UHC Medicare Advantage |
$71.68
|
|
|
PR INJECTION PX PEYRONIE DS W/SURG EXPOSURE PLAQUE
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 54205
|
| Min. Negotiated Rate |
$436.40 |
| Max. Negotiated Rate |
$941.32 |
| Rate for Payer: Aetna Commercial |
$681.82
|
| Rate for Payer: Aetna Medicare |
$529.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.82
|
| Rate for Payer: BCBS Complete |
$436.40
|
| Rate for Payer: BCBS MAPPO |
$508.82
|
| Rate for Payer: BCN Medicare Advantage |
$508.82
|
| Rate for Payer: Cash Price |
$872.80
|
| Rate for Payer: Cash Price |
$872.80
|
| Rate for Payer: Cofinity Commercial |
$732.70
|
| Rate for Payer: Cofinity Commercial |
$681.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.82
|
| Rate for Payer: Healthscope Commercial |
$814.11
|
| Rate for Payer: Healthscope Commercial |
$941.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$709.15
|
| Rate for Payer: Nomi Health Commercial |
$610.58
|
| Rate for Payer: PACE SWMI |
$508.82
|
| Rate for Payer: PHP Medicare Advantage |
$508.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.15
|
| Rate for Payer: Priority Health Medicare |
$508.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.82
|
| Rate for Payer: UHC Medicare Advantage |
$508.82
|
|
|
PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 36002
|
| Min. Negotiated Rate |
$98.57 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$132.08
|
| Rate for Payer: Aetna Medicare |
$102.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.08
|
| Rate for Payer: BCBS Complete |
$182.40
|
| Rate for Payer: BCBS MAPPO |
$98.57
|
| Rate for Payer: BCN Medicare Advantage |
$98.57
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$141.94
|
| Rate for Payer: Cofinity Commercial |
$132.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.57
|
| Rate for Payer: Healthscope Commercial |
$182.35
|
| Rate for Payer: Healthscope Commercial |
$157.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.40
|
| Rate for Payer: Nomi Health Commercial |
$118.28
|
| Rate for Payer: PACE SWMI |
$98.57
|
| Rate for Payer: PHP Medicare Advantage |
$98.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.40
|
| Rate for Payer: Priority Health Medicare |
$98.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.57
|
| Rate for Payer: UHC Medicare Advantage |
$98.57
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 36471
|
| Min. Negotiated Rate |
$72.49 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$97.14
|
| Rate for Payer: Aetna Medicare |
$75.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.39
|
| Rate for Payer: BCBS Complete |
$135.20
|
| Rate for Payer: BCBS MAPPO |
$72.49
|
| Rate for Payer: BCN Medicare Advantage |
$72.49
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$97.14
|
| Rate for Payer: Cofinity Commercial |
$104.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.49
|
| Rate for Payer: Healthscope Commercial |
$115.98
|
| Rate for Payer: Healthscope Commercial |
$134.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Nomi Health Commercial |
$86.99
|
| Rate for Payer: PACE SWMI |
$72.49
|
| Rate for Payer: PHP Medicare Advantage |
$72.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health Medicare |
$72.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.49
|
| Rate for Payer: UHC Medicare Advantage |
$72.49
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$72.49 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$97.14
|
| Rate for Payer: Aetna Medicare |
$75.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.14
|
| Rate for Payer: BCBS Complete |
$135.20
|
| Rate for Payer: BCBS MAPPO |
$72.49
|
| Rate for Payer: BCN Medicare Advantage |
$72.49
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$97.14
|
| Rate for Payer: Cofinity Commercial |
$104.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.49
|
| Rate for Payer: Healthscope Commercial |
$115.98
|
| Rate for Payer: Healthscope Commercial |
$134.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Nomi Health Commercial |
$86.99
|
| Rate for Payer: PACE SWMI |
$72.49
|
| Rate for Payer: PHP Medicare Advantage |
$72.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health Medicare |
$72.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.49
|
| Rate for Payer: UHC Medicare Advantage |
$72.49
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$287.30
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$236.60
|
| Rate for Payer: Cofinity Commercial |
$290.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$304.20
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.30
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$287.30
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$212.94
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna Commercial |
$287.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.70
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$236.60
|
| Rate for Payer: Cofinity Commercial |
$290.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Healthscope Commercial |
$304.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.30
|
| Rate for Payer: PHP Commercial |
$287.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health SBD |
$212.94
|
|
|
PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 36470
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$49.73
|
| Rate for Payer: Aetna Medicare |
$38.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS MAPPO |
$37.11
|
| Rate for Payer: BCN Medicare Advantage |
$37.11
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$53.44
|
| Rate for Payer: Cofinity Commercial |
$49.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.11
|
| Rate for Payer: Healthscope Commercial |
$68.65
|
| Rate for Payer: Healthscope Commercial |
$59.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.50
|
| Rate for Payer: Nomi Health Commercial |
$44.53
|
| Rate for Payer: PACE SWMI |
$37.11
|
| Rate for Payer: PHP Medicare Advantage |
$37.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$37.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.11
|
| Rate for Payer: UHC Medicare Advantage |
$37.11
|
|
|
PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 46500
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$318.24 |
| Rate for Payer: Aetna Commercial |
$230.51
|
| Rate for Payer: Aetna Medicare |
$178.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.51
|
| Rate for Payer: BCBS Complete |
$139.60
|
| Rate for Payer: BCBS MAPPO |
$172.02
|
| Rate for Payer: BCN Medicare Advantage |
$172.02
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$247.71
|
| Rate for Payer: Cofinity Commercial |
$230.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.02
|
| Rate for Payer: Healthscope Commercial |
$275.23
|
| Rate for Payer: Healthscope Commercial |
$318.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.85
|
| Rate for Payer: Nomi Health Commercial |
$206.42
|
| Rate for Payer: PACE SWMI |
$172.02
|
| Rate for Payer: PHP Medicare Advantage |
$172.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health Medicare |
$172.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.02
|
| Rate for Payer: UHC Medicare Advantage |
$172.02
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
20552
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$46.38
|
| Rate for Payer: Aetna Medicare |
$35.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$34.61
|
| Rate for Payer: BCN Medicare Advantage |
$34.61
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$46.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.61
|
| Rate for Payer: Healthscope Commercial |
$55.38
|
| Rate for Payer: Healthscope Commercial |
$64.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.00
|
| Rate for Payer: Nomi Health Commercial |
$41.53
|
| Rate for Payer: PACE SWMI |
$34.61
|
| Rate for Payer: PHP Medicare Advantage |
$34.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$34.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.61
|
| Rate for Payer: UHC Medicare Advantage |
$34.61
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$102.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.00
|
| Rate for Payer: Healthscope Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.00
|
| Rate for Payer: PHP Commercial |
$102.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health SBD |
$75.60
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna Commercial |
$102.00
|
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$108.00
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.00
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$102.00
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health SBD |
$75.60
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$162.08
|
| Rate for Payer: VA VA |
$287.89
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 20552
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$46.38
|
| Rate for Payer: Aetna Medicare |
$35.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.38
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$34.61
|
| Rate for Payer: BCN Medicare Advantage |
$34.61
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$46.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.61
|
| Rate for Payer: Healthscope Commercial |
$64.03
|
| Rate for Payer: Healthscope Commercial |
$55.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.00
|
| Rate for Payer: Nomi Health Commercial |
$41.53
|
| Rate for Payer: PACE SWMI |
$34.61
|
| Rate for Payer: PHP Medicare Advantage |
$34.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$34.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.61
|
| Rate for Payer: UHC Medicare Advantage |
$34.61
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 20553
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$92.30 |
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Medicare |
$40.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.77
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCN Medicare Advantage |
$39.38
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Cofinity Commercial |
$52.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$63.01
|
| Rate for Payer: Healthscope Commercial |
$72.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.30
|
| Rate for Payer: Nomi Health Commercial |
$47.26
|
| Rate for Payer: PACE SWMI |
$39.38
|
| Rate for Payer: PHP Medicare Advantage |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health Medicare |
$39.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.38
|
| Rate for Payer: UHC Medicare Advantage |
$39.38
|
|
|
PR INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 20551
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$49.20
|
| Rate for Payer: Aetna Medicare |
$38.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.20
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS MAPPO |
$36.72
|
| Rate for Payer: BCN Medicare Advantage |
$36.72
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$52.88
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.10
|
| Rate for Payer: Nomi Health Commercial |
$44.06
|
| Rate for Payer: PACE SWMI |
$36.72
|
| Rate for Payer: PHP Medicare Advantage |
$36.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health Medicare |
$36.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.72
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
|
|
PR INJECTION SINUS TRACT DIAGNOSTIC
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 20501
|
| Min. Negotiated Rate |
$34.23 |
| Max. Negotiated Rate |
$183.95 |
| Rate for Payer: Aetna Commercial |
$45.87
|
| Rate for Payer: Aetna Medicare |
$35.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.87
|
| Rate for Payer: BCBS Complete |
$113.20
|
| Rate for Payer: BCBS MAPPO |
$34.23
|
| Rate for Payer: BCN Medicare Advantage |
$34.23
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$49.29
|
| Rate for Payer: Cofinity Commercial |
$45.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.23
|
| Rate for Payer: Healthscope Commercial |
$54.77
|
| Rate for Payer: Healthscope Commercial |
$63.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$41.08
|
| Rate for Payer: PACE SWMI |
$34.23
|
| Rate for Payer: PHP Medicare Advantage |
$34.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health Medicare |
$34.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.23
|
| Rate for Payer: UHC Medicare Advantage |
$34.23
|
|
|
PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 20500
|
| Min. Negotiated Rate |
$85.78 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Commercial |
$114.95
|
| Rate for Payer: Aetna Medicare |
$89.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.95
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$85.78
|
| Rate for Payer: BCN Medicare Advantage |
$85.78
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$123.52
|
| Rate for Payer: Cofinity Commercial |
$114.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.78
|
| Rate for Payer: Healthscope Commercial |
$137.25
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.55
|
| Rate for Payer: Nomi Health Commercial |
$102.94
|
| Rate for Payer: PACE SWMI |
$85.78
|
| Rate for Payer: PHP Medicare Advantage |
$85.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$85.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.78
|
| Rate for Payer: UHC Medicare Advantage |
$85.78
|
|
|
PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 36468
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
|
|
PR INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 20526
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna Medicare |
$56.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.96
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$54.45
|
| Rate for Payer: BCN Medicare Advantage |
$54.45
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$78.41
|
| Rate for Payer: Cofinity Commercial |
$72.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.45
|
| Rate for Payer: Healthscope Commercial |
$100.73
|
| Rate for Payer: Healthscope Commercial |
$87.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.40
|
| Rate for Payer: Nomi Health Commercial |
$65.34
|
| Rate for Payer: PACE SWMI |
$54.45
|
| Rate for Payer: PHP Medicare Advantage |
$54.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$54.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.45
|
| Rate for Payer: UHC Medicare Advantage |
$54.45
|
|
|
PR INJECTION THRU KIDNEY TUBE FOR XRAY
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 50394
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Medicare |
$119.50
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
|
|
PR INJECTION TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 30200
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Aetna Commercial |
$76.63
|
| Rate for Payer: Aetna Medicare |
$59.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.35
|
| Rate for Payer: BCBS Complete |
$86.80
|
| Rate for Payer: BCBS MAPPO |
$57.19
|
| Rate for Payer: BCN Medicare Advantage |
$57.19
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$76.63
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.19
|
| Rate for Payer: Healthscope Commercial |
$105.80
|
| Rate for Payer: Healthscope Commercial |
$91.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.05
|
| Rate for Payer: Nomi Health Commercial |
$68.63
|
| Rate for Payer: PACE SWMI |
$57.19
|
| Rate for Payer: PHP Medicare Advantage |
$57.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health Medicare |
$57.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.19
|
| Rate for Payer: UHC Medicare Advantage |
$57.19
|
|
|
PR INJECTION WRIST ARTHROGRAPHY
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 25246
|
| Min. Negotiated Rate |
$69.10 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$92.59
|
| Rate for Payer: Aetna Medicare |
$71.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.59
|
| Rate for Payer: BCBS Complete |
$114.40
|
| Rate for Payer: BCBS MAPPO |
$69.10
|
| Rate for Payer: BCN Medicare Advantage |
$69.10
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$99.50
|
| Rate for Payer: Cofinity Commercial |
$92.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.10
|
| Rate for Payer: Healthscope Commercial |
$110.56
|
| Rate for Payer: Healthscope Commercial |
$127.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.90
|
| Rate for Payer: Nomi Health Commercial |
$82.92
|
| Rate for Payer: PACE SWMI |
$69.10
|
| Rate for Payer: PHP Medicare Advantage |
$69.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.90
|
| Rate for Payer: Priority Health Medicare |
$69.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.10
|
| Rate for Payer: UHC Medicare Advantage |
$69.10
|
|
|
PR INJECT NERV BLCK,CERV PLEXUS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 64413
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 27096
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Commercial |
$106.13
|
| Rate for Payer: Aetna Medicare |
$82.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.05
|
| Rate for Payer: BCBS Complete |
$258.40
|
| Rate for Payer: BCBS MAPPO |
$79.20
|
| Rate for Payer: BCN Medicare Advantage |
$79.20
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cofinity Commercial |
$106.13
|
| Rate for Payer: Cofinity Commercial |
$114.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$146.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.90
|
| Rate for Payer: Nomi Health Commercial |
$95.04
|
| Rate for Payer: PACE SWMI |
$79.20
|
| Rate for Payer: PHP Medicare Advantage |
$79.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.90
|
| Rate for Payer: Priority Health Medicare |
$79.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.20
|
| Rate for Payer: UHC Medicare Advantage |
$79.20
|
|
|
PR INJECT THRU CHOLANGIO CATHETER
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 47505
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
