|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,275.10
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Aetna Commercial |
$45.89
|
| Rate for Payer: Aetna Medicare |
$637.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.89
|
| Rate for Payer: BCBS Complete |
$510.04
|
| Rate for Payer: BCN Commercial |
$596.01
|
| Rate for Payer: Cash Price |
$1,020.08
|
| 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 HEPARIN SODIUM PER 1000U
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1644
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$28.00 |
| 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) |
$0.31
|
| Rate for Payer: BCBS Complete |
$0.40
|
| 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 |
$0.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.35
|
| Rate for Payer: Healthscope Commercial |
$0.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.00
|
| Rate for Payer: Nomi Health Commercial |
$0.26
|
| Rate for Payer: PACE SWMI |
$0.22
|
| Rate for Payer: PHP Medicare Advantage |
$0.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.22
|
| Rate for Payer: UHC Exchange |
$0.21
|
| Rate for Payer: UHC Medicare Advantage |
$0.22
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$1,741.00 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.96
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$18.03
|
| Rate for Payer: BCBS Trust/PPO |
$17.65
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$18.03
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$25.96
|
| Rate for Payer: Cofinity Commercial |
$24.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$33.35
|
| Rate for Payer: Healthscope Commercial |
$28.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.00
|
| Rate for Payer: Nomi Health Commercial |
$21.63
|
| Rate for Payer: PACE SWMI |
$18.03
|
| Rate for Payer: PHP Medicare Advantage |
$18.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.03
|
| Rate for Payer: UHC Exchange |
$18.44
|
| Rate for Payer: UHC Medicare Advantage |
$18.03
|
|
|
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) |
$0.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.17
|
| 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 |
$0.16
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| 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 All Payor (Choice/PPO) |
$0.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.13
|
| 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 |
$0.26 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$0.35
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.35
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| 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 |
$0.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.41
|
| Rate for Payer: Healthscope Commercial |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.95
|
| Rate for Payer: Nomi Health Commercial |
$0.31
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Exchange |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
|
|
PR INJ PROGESTERONE PER 50 MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J2675
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.84
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Medicare Advantage |
$0.63
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.90
|
| Rate for Payer: Cofinity Commercial |
$0.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.63
|
| Rate for Payer: Healthscope Commercial |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$1.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.00
|
| Rate for Payer: Nomi Health Commercial |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.63
|
| Rate for Payer: PHP Medicare Advantage |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.94
|
| Rate for Payer: UHC Medicare Advantage |
$0.63
|
|
|
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 |
$34.01 |
| Max. Negotiated Rate |
$1,237.41 |
| Rate for Payer: Aetna Commercial |
$669.80
|
| Rate for Payer: Aetna Medicare |
$409.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$84.14
|
| Rate for Payer: BCN Commercial |
$84.14
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$630.40
|
| 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 |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$709.20
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.80
|
| Rate for Payer: Nomi Health Commercial |
$1,181.10
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$669.80
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,237.41
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$989.93
|
| Rate for Payer: Priority Health SBD |
$496.44
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.01
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$221.65
|
| Rate for Payer: VA VA |
$393.70
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$5,767.00 |
| 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 |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$30.46
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.70
|
| 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 |
$40.82
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Healthscope Commercial |
$48.74
|
| Rate for Payer: Mclaren Medicaid |
$20.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.98
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,767.00
|
| 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 Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.24
|
| Rate for Payer: Priority Health Medicare |
$30.46
|
| Rate for Payer: Priority Health Narrow Network |
$63.24
|
| Rate for Payer: Priority Health SBD |
$63.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.46
|
| Rate for Payer: UHC Exchange |
$39.97
|
| Rate for Payer: UHC Medicare Advantage |
$30.46
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
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
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$5,767.00 |
| 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 |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$30.46
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.70
|
| 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 |
$56.35
|
| Rate for Payer: Healthscope Commercial |
$48.74
|
| Rate for Payer: Mclaren Medicaid |
$20.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.98
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,767.00
|
| 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 Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.24
|
| Rate for Payer: Priority Health Medicare |
$30.46
|
| Rate for Payer: Priority Health Narrow Network |
$63.24
|
| Rate for Payer: Priority Health SBD |
$63.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.46
|
| Rate for Payer: UHC Exchange |
$39.97
|
| Rate for Payer: UHC Medicare Advantage |
$30.46
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
PR INJ, REMDESIVIR, 1 MG
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J0248
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.69
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$5.61
|
| 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 |
$9.02
|
| Rate for Payer: Cofinity Commercial |
$9.69
|
| 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 |
$606.00
|
| Rate for Payer: Nomi Health Commercial |
$8.07
|
| 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 All Payor (Choice/PPO) |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Exchange |
$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 |
$1,304.00 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Medicare |
$13.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.21
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$13.34
|
| Rate for Payer: BCBS Trust/PPO |
$13.27
|
| Rate for Payer: BCN Commercial |
$12.93
|
| Rate for Payer: BCN Medicare Advantage |
$13.34
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$19.21
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.34
|
| Rate for Payer: Healthscope Commercial |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.00
|
| Rate for Payer: Nomi Health Commercial |
$16.01
|
| Rate for Payer: PACE SWMI |
$13.34
|
| Rate for Payer: PHP Medicare Advantage |
$13.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.34
|
| Rate for Payer: UHC Exchange |
$13.77
|
| Rate for Payer: UHC Medicare Advantage |
$13.34
|
|
|
PR INJ RISPERDAL CONSTA, 0.5 MG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2794
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.76
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$10.94
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.80
|
| Rate for Payer: BCN Medicare Advantage |
$10.94
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$17.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.00
|
| Rate for Payer: Nomi Health Commercial |
$13.13
|
| Rate for Payer: PACE SWMI |
$10.94
|
| Rate for Payer: PHP Medicare Advantage |
$10.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.94
|
| Rate for Payer: UHC Exchange |
$11.65
|
| Rate for Payer: UHC Medicare Advantage |
$10.94
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J3111
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.29
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$10.92
|
| Rate for Payer: BCN Commercial |
$10.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.00
|
| Rate for Payer: Nomi Health Commercial |
$14.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.18
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
|
|
PR INJ TESTOSTERONE CYPIONATE
|
Professional
|
Both
|
$0.16
|
|
|
Service Code
|
HCPCS J1071
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$3.00 |
| 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: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| 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 |
$0.05
|
| Rate for Payer: Healthscope Commercial |
$0.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| 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 All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.03
|
| Rate for Payer: UHC Exchange |
$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 |
$58.58 |
| Max. Negotiated Rate |
$13,754.00 |
| Rate for Payer: Aetna Commercial |
$117.92
|
| Rate for Payer: Aetna Medicare |
$91.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.72
|
| Rate for Payer: BCBS Complete |
$61.51
|
| Rate for Payer: BCBS MAPPO |
$88.00
|
| Rate for Payer: BCBS Trust/PPO |
$491.32
|
| Rate for Payer: BCN Commercial |
$134.38
|
| 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: Mclaren Medicaid |
$58.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.40
|
| Rate for Payer: Meridian Medicaid |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,754.00
|
| 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 Choice Medicaid |
$58.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.40
|
| Rate for Payer: Priority Health Medicare |
$88.00
|
| Rate for Payer: Priority Health Narrow Network |
$123.40
|
| Rate for Payer: Priority Health SBD |
$123.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.00
|
| Rate for Payer: UHC Medicare Advantage |
$88.00
|
| Rate for Payer: UHCCP Medicaid |
$58.58
|
|
|
PR INPT/ED TELECONSULT50
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS G0426
|
| Min. Negotiated Rate |
$82.86 |
| Max. Negotiated Rate |
$19,239.00 |
| Rate for Payer: Aetna Commercial |
$166.17
|
| Rate for Payer: Aetna Medicare |
$128.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.57
|
| Rate for Payer: BCBS Complete |
$87.00
|
| Rate for Payer: BCBS MAPPO |
$124.01
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCN Commercial |
$188.63
|
| 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 |
$198.42
|
| Rate for Payer: Healthscope Commercial |
$229.42
|
| Rate for Payer: Mclaren Medicaid |
$82.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.21
|
| Rate for Payer: Meridian Medicaid |
$87.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,239.00
|
| 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 Choice Medicaid |
$82.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.55
|
| Rate for Payer: Priority Health Medicare |
$124.01
|
| Rate for Payer: Priority Health Narrow Network |
$174.55
|
| Rate for Payer: Priority Health SBD |
$174.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.01
|
| Rate for Payer: UHC Medicare Advantage |
$124.01
|
| Rate for Payer: UHCCP Medicaid |
$82.86
|
|
|
PR INPT/ED TELECONSULT70
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS G0427
|
| Min. Negotiated Rate |
$117.79 |
| Max. Negotiated Rate |
$27,387.00 |
| Rate for Payer: Aetna Commercial |
$236.43
|
| Rate for Payer: Aetna Medicare |
$183.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.07
|
| Rate for Payer: BCBS Complete |
$123.68
|
| Rate for Payer: BCBS MAPPO |
$176.44
|
| Rate for Payer: BCBS Trust/PPO |
$348.68
|
| Rate for Payer: BCN Commercial |
$268.29
|
| 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: Mclaren Medicaid |
$117.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.26
|
| Rate for Payer: Meridian Medicaid |
$123.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,387.00
|
| 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 Choice Medicaid |
$117.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.79
|
| Rate for Payer: Priority Health Medicare |
$176.44
|
| Rate for Payer: Priority Health Narrow Network |
$246.79
|
| Rate for Payer: Priority Health SBD |
$246.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.44
|
| Rate for Payer: UHC Medicare Advantage |
$176.44
|
| Rate for Payer: UHCCP Medicaid |
$117.79
|
|
|
PR INPT/TELE FOLLOW UP 25
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS G0407
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$10,640.00 |
| Rate for Payer: Aetna Commercial |
$92.12
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.00
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS MAPPO |
$68.75
|
| Rate for Payer: BCN Commercial |
$104.58
|
| 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 |
$110.00
|
| Rate for Payer: Healthscope Commercial |
$127.19
|
| Rate for Payer: Mclaren Medicaid |
$46.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.19
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,640.00
|
| 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 Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.80
|
| Rate for Payer: Priority Health Medicare |
$68.75
|
| Rate for Payer: Priority Health Narrow Network |
$96.80
|
| Rate for Payer: Priority Health SBD |
$96.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.75
|
| Rate for Payer: UHC Medicare Advantage |
$68.75
|
| Rate for Payer: UHCCP Medicaid |
$46.01
|
|
|
PR INPT/TELE FOLLOW UP 35
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G0408
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$15,504.00 |
| Rate for Payer: Aetna Commercial |
$132.85
|
| Rate for Payer: Aetna Medicare |
$103.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.76
|
| Rate for Payer: BCBS Complete |
$69.78
|
| Rate for Payer: BCBS MAPPO |
$99.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,554.26
|
| Rate for Payer: BCN Commercial |
$152.47
|
| 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: Mclaren Medicaid |
$66.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.10
|
| Rate for Payer: Meridian Medicaid |
$69.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,504.00
|
| 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 Choice Medicaid |
$66.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.13
|
| Rate for Payer: Priority Health Medicare |
$99.14
|
| Rate for Payer: Priority Health Narrow Network |
$141.13
|
| Rate for Payer: Priority Health SBD |
$141.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.14
|
| Rate for Payer: UHC Medicare Advantage |
$99.14
|
| Rate for Payer: UHCCP Medicaid |
$66.46
|
|
|
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
|
|
|
PR INSERT GASTROSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 49440
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$35,609.00 |
| Rate for Payer: Aetna Commercial |
$257.24
|
| Rate for Payer: Aetna Medicare |
$199.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.44
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS MAPPO |
$191.97
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$1,231.95
|
| Rate for Payer: BCN Medicare Advantage |
$191.97
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$276.44
|
| Rate for Payer: Cofinity Commercial |
$257.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.97
|
| Rate for Payer: Healthscope Commercial |
$307.15
|
| Rate for Payer: Healthscope Commercial |
$355.14
|
| Rate for Payer: Mclaren Medicaid |
$128.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.57
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,609.00
|
| Rate for Payer: Nomi Health Commercial |
$230.36
|
| Rate for Payer: PACE SWMI |
$191.97
|
| Rate for Payer: PHP Medicare Advantage |
$191.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.77
|
| Rate for Payer: Priority Health Medicare |
$191.97
|
| Rate for Payer: Priority Health Narrow Network |
$353.77
|
| Rate for Payer: Priority Health SBD |
$353.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.97
|
| Rate for Payer: UHC Medicare Advantage |
$191.97
|
| Rate for Payer: UHCCP Medicaid |
$128.01
|
|
|
PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY
|
Professional
|
Both
|
$1,714.00
|
|
|
Service Code
|
HCPCS 19340
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$134,176.00 |
| Rate for Payer: Aetna Commercial |
$975.45
|
| Rate for Payer: Aetna Medicare |
$757.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.45
|
| Rate for Payer: BCBS Complete |
$516.41
|
| Rate for Payer: BCBS MAPPO |
$727.95
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$1,112.23
|
| Rate for Payer: BCN Medicare Advantage |
$727.95
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cofinity Commercial |
$975.45
|
| Rate for Payer: Cofinity Commercial |
$1,048.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$727.95
|
| Rate for Payer: Healthscope Commercial |
$1,346.71
|
| Rate for Payer: Healthscope Commercial |
$1,164.72
|
| Rate for Payer: Mclaren Medicaid |
$491.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.35
|
| Rate for Payer: Meridian Medicaid |
$516.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134,176.00
|
| Rate for Payer: Nomi Health Commercial |
$873.54
|
| Rate for Payer: PACE SWMI |
$727.95
|
| Rate for Payer: PHP Medicare Advantage |
$727.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,114.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,032.63
|
| Rate for Payer: Priority Health Medicare |
$727.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,032.63
|
| Rate for Payer: Priority Health SBD |
$1,032.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$727.95
|
| Rate for Payer: UHC Exchange |
$438.75
|
| Rate for Payer: UHC Medicare Advantage |
$727.95
|
| Rate for Payer: UHCCP Medicaid |
$491.82
|
|
|
PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 59200
|
| Min. Negotiated Rate |
$61.94 |
| Max. Negotiated Rate |
$7,985.00 |
| Rate for Payer: Aetna Commercial |
$88.37
|
| Rate for Payer: Aetna Medicare |
$68.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.97
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$65.95
|
| Rate for Payer: BCBS Trust/PPO |
$90.87
|
| Rate for Payer: BCN Commercial |
$155.89
|
| Rate for Payer: BCN Medicare Advantage |
$65.95
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$94.97
|
| Rate for Payer: Cofinity Commercial |
$88.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.95
|
| Rate for Payer: Healthscope Commercial |
$105.52
|
| Rate for Payer: Healthscope Commercial |
$122.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,985.00
|
| Rate for Payer: Nomi Health Commercial |
$79.14
|
| Rate for Payer: PACE SWMI |
$65.95
|
| Rate for Payer: PHP Medicare Advantage |
$65.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.94
|
| Rate for Payer: Priority Health Medicare |
$65.95
|
| Rate for Payer: Priority Health Narrow Network |
$61.94
|
| Rate for Payer: Priority Health SBD |
$61.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.95
|
| Rate for Payer: UHC Exchange |
$134.22
|
| Rate for Payer: UHC Medicare Advantage |
$65.95
|
|
|
PR INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 11981
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$11,156.00 |
| Rate for Payer: Aetna Commercial |
$81.42
|
| Rate for Payer: Aetna Medicare |
$63.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.49
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$60.76
|
| Rate for Payer: BCBS Trust/PPO |
$977.96
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: BCN Medicare Advantage |
$60.76
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$87.49
|
| Rate for Payer: Cofinity Commercial |
$81.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$97.22
|
| Rate for Payer: Healthscope Commercial |
$112.41
|
| Rate for Payer: Mclaren Medicaid |
$40.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.80
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,156.00
|
| Rate for Payer: Nomi Health Commercial |
$72.91
|
| Rate for Payer: PACE SWMI |
$60.76
|
| Rate for Payer: PHP Medicare Advantage |
$60.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.44
|
| Rate for Payer: Priority Health Medicare |
$60.76
|
| Rate for Payer: Priority Health Narrow Network |
$84.44
|
| Rate for Payer: Priority Health SBD |
$84.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.76
|
| Rate for Payer: UHC Exchange |
$134.16
|
| Rate for Payer: UHC Medicare Advantage |
$60.76
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
