|
PR INJ ENOXAPARIN SODIUM
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1650
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.79
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$0.59
|
| Rate for Payer: BCN Medicare Advantage |
$0.59
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Cofinity Commercial |
$0.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.59
|
| Rate for Payer: Healthscope Commercial |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.75
|
| Rate for Payer: Nomi Health Commercial |
$0.71
|
| Rate for Payer: PACE SWMI |
$0.59
|
| Rate for Payer: PHP Medicare Advantage |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.59
|
| Rate for Payer: UHC Medicare Advantage |
$0.59
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,275.10
|
|
|
Service Code
|
HCPCS G0260
|
| Min. Negotiated Rate |
$510.04 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Aetna Medicare |
$637.55
|
| Rate for Payer: BCBS Complete |
$510.04
|
| Rate for Payer: Cash Price |
$1,020.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.82
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,275.10
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$510.04 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Aetna Medicare |
$637.55
|
| Rate for Payer: BCBS Complete |
$510.04
|
| Rate for Payer: Cash Price |
$1,020.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.82
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$803.25 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.75
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$1,096.50
|
| Rate for Payer: Cofinity Commercial |
$892.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$892.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,020.00
|
| Rate for Payer: Healthscope Commercial |
$1,147.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,083.75
|
| Rate for Payer: PHP Commercial |
$1,083.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.75
|
| Rate for Payer: Priority Health SBD |
$803.25
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,901.18 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: Aetna Medicare |
$702.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$892.50
|
| Rate for Payer: Cofinity Commercial |
$1,096.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$892.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,020.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$1,147.50
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,083.75
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$1,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.75
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health SBD |
$803.25
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$380.25
|
| Rate for Payer: VA VA |
$675.40
|
|
|
PR INJ HEPARIN SODIUM PER 1000U
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1644
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.28
|
| Rate for Payer: Aetna Medicare |
$0.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.28
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.21
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Cofinity Commercial |
$0.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.21
|
| Rate for Payer: Healthscope Commercial |
$0.39
|
| Rate for Payer: Healthscope Commercial |
$0.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.65
|
| Rate for Payer: Nomi Health Commercial |
$0.25
|
| Rate for Payer: PACE SWMI |
$0.21
|
| Rate for Payer: PHP Medicare Advantage |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.21
|
| Rate for Payer: UHC Medicare Advantage |
$0.21
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$12.40 |
| 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) |
$26.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.27
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| 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: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Nomi Health Commercial |
$21.73
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.11
|
| Rate for Payer: UHC Medicare Advantage |
$18.11
|
|
|
PR INJ, METHYLPRED ACETATE 1 MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1010
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.12
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.65
|
| Rate for Payer: Nomi Health Commercial |
$0.14
|
| Rate for Payer: PACE SWMI |
$0.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.12
|
| Rate for Payer: UHC Medicare Advantage |
$0.12
|
|
|
PR INJ, METHYLPRED SOD SUCC 5MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2919
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$0.28
|
| Rate for Payer: Aetna Medicare |
$0.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.28
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.21
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Cofinity Commercial |
$0.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.21
|
| Rate for Payer: Healthscope Commercial |
$0.34
|
| Rate for Payer: Healthscope Commercial |
$0.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.95
|
| Rate for Payer: Nomi Health Commercial |
$0.25
|
| Rate for Payer: PACE SWMI |
$0.21
|
| Rate for Payer: PHP Medicare Advantage |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health Medicare |
$0.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.21
|
| Rate for Payer: UHC Medicare Advantage |
$0.21
|
|
|
PR INJ PROGESTERONE PER 50 MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J2675
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.94
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.70
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.01
|
| Rate for Payer: Cofinity Commercial |
$0.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.70
|
| Rate for Payer: Healthscope Commercial |
$1.29
|
| Rate for Payer: Healthscope Commercial |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: PACE SWMI |
$0.70
|
| Rate for Payer: PHP Medicare Advantage |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$0.70
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$496.44 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Aetna Commercial |
$669.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.20
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$551.60
|
| Rate for Payer: Cofinity Commercial |
$677.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$551.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.40
|
| Rate for Payer: Healthscope Commercial |
$709.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.80
|
| Rate for Payer: PHP Commercial |
$669.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health SBD |
$496.44
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$512.20 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$31.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.86
|
| Rate for Payer: BCBS Complete |
$315.20
|
| Rate for Payer: BCBS MAPPO |
$30.46
|
| Rate for Payer: BCN Medicare Advantage |
$30.46
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$40.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$48.74
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.20
|
| Rate for Payer: Nomi Health Commercial |
$36.55
|
| Rate for Payer: PACE SWMI |
$30.46
|
| Rate for Payer: PHP Medicare Advantage |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health Medicare |
$30.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.46
|
| Rate for Payer: UHC Medicare Advantage |
$30.46
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$512.20 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$31.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.82
|
| Rate for Payer: BCBS Complete |
$315.20
|
| Rate for Payer: BCBS MAPPO |
$30.46
|
| Rate for Payer: BCN Medicare Advantage |
$30.46
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$40.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$48.74
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.20
|
| Rate for Payer: Nomi Health Commercial |
$36.55
|
| Rate for Payer: PACE SWMI |
$30.46
|
| Rate for Payer: PHP Medicare Advantage |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health Medicare |
$30.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.46
|
| Rate for Payer: UHC Medicare Advantage |
$30.46
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$669.80
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$551.60
|
| Rate for Payer: Cofinity Commercial |
$677.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$551.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$709.20
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.80
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$669.80
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$496.44
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
PR INJ, REMDESIVIR, 1 MG
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J0248
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$9.69
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Healthscope Commercial |
$12.45
|
| Rate for Payer: Healthscope Commercial |
$10.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.05
|
| Rate for Payer: Nomi Health Commercial |
$8.08
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
|
|
PR INJ, RIMABOTULINUMTOXINB
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J0587
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$24.59 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna Medicare |
$13.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.81
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$13.29
|
| Rate for Payer: BCN Medicare Advantage |
$13.29
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.29
|
| Rate for Payer: Healthscope Commercial |
$21.26
|
| Rate for Payer: Healthscope Commercial |
$24.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.10
|
| Rate for Payer: Nomi Health Commercial |
$15.95
|
| Rate for Payer: PACE SWMI |
$13.29
|
| Rate for Payer: PHP Medicare Advantage |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$13.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.29
|
| Rate for Payer: UHC Medicare Advantage |
$13.29
|
|
|
PR INJ RISPERDAL CONSTA, 0.5 MG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2794
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna Commercial |
$14.71
|
| Rate for Payer: Aetna Medicare |
$11.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.71
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$10.98
|
| Rate for Payer: BCN Medicare Advantage |
$10.98
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$17.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.20
|
| Rate for Payer: Nomi Health Commercial |
$13.18
|
| Rate for Payer: PACE SWMI |
$10.98
|
| Rate for Payer: PHP Medicare Advantage |
$10.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$10.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.98
|
| Rate for Payer: UHC Medicare Advantage |
$10.98
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J3111
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$22.33 |
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.17
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$12.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.07
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$17.38
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.07
|
| Rate for Payer: Healthscope Commercial |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$22.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.15
|
| Rate for Payer: Nomi Health Commercial |
$14.48
|
| Rate for Payer: PACE SWMI |
$12.07
|
| Rate for Payer: PHP Medicare Advantage |
$12.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health Medicare |
$12.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.07
|
| Rate for Payer: UHC Medicare Advantage |
$12.07
|
|
|
PR INJ TESTOSTERONE CYPIONATE
|
Professional
|
Both
|
$0.16
|
|
|
Service Code
|
HCPCS J1071
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.04
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS MAPPO |
$0.03
|
| Rate for Payer: BCN Medicare Advantage |
$0.03
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.03
|
| Rate for Payer: Healthscope Commercial |
$0.06
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.10
|
| Rate for Payer: Nomi Health Commercial |
$0.04
|
| Rate for Payer: PACE SWMI |
$0.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.10
|
| Rate for Payer: Priority Health Medicare |
$0.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.03
|
| Rate for Payer: UHC Medicare Advantage |
$0.03
|
|
|
PR INPT/ED TELECONSULT30
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS G0425
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$162.80 |
| Rate for Payer: Aetna Commercial |
$117.92
|
| Rate for Payer: Aetna Medicare |
$91.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.92
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: BCBS MAPPO |
$88.00
|
| Rate for Payer: BCN Medicare Advantage |
$88.00
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$126.72
|
| Rate for Payer: Cofinity Commercial |
$117.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$162.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.65
|
| Rate for Payer: Nomi Health Commercial |
$105.60
|
| Rate for Payer: PACE SWMI |
$88.00
|
| Rate for Payer: PHP Medicare Advantage |
$88.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health Medicare |
$88.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.00
|
| Rate for Payer: UHC Medicare Advantage |
$88.00
|
|
|
PR INPT/ED TELECONSULT50
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS G0426
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$229.42 |
| Rate for Payer: Aetna Commercial |
$166.17
|
| Rate for Payer: Aetna Medicare |
$128.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.17
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$124.01
|
| Rate for Payer: BCN Medicare Advantage |
$124.01
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$178.57
|
| Rate for Payer: Cofinity Commercial |
$166.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.01
|
| Rate for Payer: Healthscope Commercial |
$229.42
|
| Rate for Payer: Healthscope Commercial |
$198.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Nomi Health Commercial |
$148.81
|
| Rate for Payer: PACE SWMI |
$124.01
|
| Rate for Payer: PHP Medicare Advantage |
$124.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$124.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.01
|
| Rate for Payer: UHC Medicare Advantage |
$124.01
|
|
|
PR INPT/ED TELECONSULT70
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS G0427
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$326.41 |
| Rate for Payer: Aetna Commercial |
$236.43
|
| Rate for Payer: Aetna Medicare |
$183.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.43
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS MAPPO |
$176.44
|
| Rate for Payer: BCN Medicare Advantage |
$176.44
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$254.07
|
| Rate for Payer: Cofinity Commercial |
$236.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.44
|
| Rate for Payer: Healthscope Commercial |
$282.30
|
| Rate for Payer: Healthscope Commercial |
$326.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.60
|
| Rate for Payer: Nomi Health Commercial |
$211.73
|
| Rate for Payer: PACE SWMI |
$176.44
|
| Rate for Payer: PHP Medicare Advantage |
$176.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health Medicare |
$176.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.44
|
| Rate for Payer: UHC Medicare Advantage |
$176.44
|
|
|
PR INPT/TELE FOLLOW UP 25
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS G0407
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$127.19 |
| Rate for Payer: Aetna Commercial |
$92.12
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.12
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$68.75
|
| Rate for Payer: BCN Medicare Advantage |
$68.75
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.75
|
| Rate for Payer: Healthscope Commercial |
$127.19
|
| Rate for Payer: Healthscope Commercial |
$110.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.85
|
| Rate for Payer: Nomi Health Commercial |
$82.50
|
| Rate for Payer: PACE SWMI |
$68.75
|
| Rate for Payer: PHP Medicare Advantage |
$68.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Medicare |
$68.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.75
|
| Rate for Payer: UHC Medicare Advantage |
$68.75
|
|
|
PR INPT/TELE FOLLOW UP 35
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G0408
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$183.41 |
| Rate for Payer: Aetna Commercial |
$132.85
|
| Rate for Payer: Aetna Medicare |
$103.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.85
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$99.14
|
| Rate for Payer: BCN Medicare Advantage |
$99.14
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Cofinity Commercial |
$132.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.14
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Healthscope Commercial |
$183.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.60
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE SWMI |
$99.14
|
| Rate for Payer: PHP Medicare Advantage |
$99.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$99.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.14
|
| Rate for Payer: UHC Medicare Advantage |
$99.14
|
|
|
PR INSERT CANNULA PROLONG CP INSUFF
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 36822
|
| Min. Negotiated Rate |
$632.80 |
| Max. Negotiated Rate |
$1,028.30 |
| Rate for Payer: Aetna Medicare |
$791.00
|
| Rate for Payer: BCBS Complete |
$632.80
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,028.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.30
|
|
