|
PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 64400
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$285.28 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Medicare |
$51.62
|
| Rate for Payer: BCBS Complete |
$34.67
|
| Rate for Payer: BCBS MAPPO |
$49.63
|
| Rate for Payer: BCBS Trust/PPO |
$285.28
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: BCN Medicare Advantage |
$49.63
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.63
|
| Rate for Payer: Mclaren Medicaid |
$33.02
|
| Rate for Payer: Meridian Medicaid |
$34.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.11
|
| Rate for Payer: PACE SWMI |
$49.63
|
| Rate for Payer: PHP Medicare Advantage |
$49.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.93
|
| Rate for Payer: Priority Health Medicare |
$49.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.63
|
| Rate for Payer: UHC Medicare Advantage |
$51.12
|
|
|
PR INJECTION AA&/STRD VAGUS NERVE
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 64408
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$416.83 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Medicare |
$46.01
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS MAPPO |
$44.24
|
| Rate for Payer: BCBS Trust/PPO |
$416.83
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$44.24
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$63.71
|
| Rate for Payer: Cofinity Commercial |
$59.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.24
|
| Rate for Payer: Mclaren Medicaid |
$28.54
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.45
|
| Rate for Payer: PACE SWMI |
$44.24
|
| Rate for Payer: PHP Medicare Advantage |
$44.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.88
|
| Rate for Payer: Priority Health Medicare |
$44.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.24
|
| Rate for Payer: UHC Medicare Advantage |
$45.57
|
|
|
PR INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 49400
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$2,526.86 |
| Rate for Payer: Aetna Commercial |
$118.72
|
| Rate for Payer: Aetna Medicare |
$92.14
|
| Rate for Payer: BCBS Complete |
$59.04
|
| Rate for Payer: BCBS MAPPO |
$88.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,526.86
|
| Rate for Payer: BCN Commercial |
$219.42
|
| Rate for Payer: BCN Medicare Advantage |
$88.60
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$127.58
|
| Rate for Payer: Cofinity Commercial |
$118.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.60
|
| Rate for Payer: Mclaren Medicaid |
$56.23
|
| Rate for Payer: Meridian Medicaid |
$59.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.03
|
| Rate for Payer: PACE SWMI |
$88.60
|
| Rate for Payer: PHP Medicare Advantage |
$88.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.81
|
| Rate for Payer: Priority Health Medicare |
$88.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.60
|
| Rate for Payer: UHC Medicare Advantage |
$91.26
|
|
|
PR INJECTION ANES AGENT SPHENOPALATINE GANGLION
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 64505
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$210.13 |
| Rate for Payer: Aetna Commercial |
$136.84
|
| Rate for Payer: Aetna Medicare |
$106.20
|
| Rate for Payer: BCBS Complete |
$70.90
|
| Rate for Payer: BCBS MAPPO |
$102.12
|
| Rate for Payer: BCBS Trust/PPO |
$195.47
|
| Rate for Payer: BCN Commercial |
$210.13
|
| Rate for Payer: BCN Medicare Advantage |
$102.12
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$147.05
|
| Rate for Payer: Cofinity Commercial |
$136.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.12
|
| Rate for Payer: Mclaren Medicaid |
$67.52
|
| Rate for Payer: Meridian Medicaid |
$70.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.23
|
| Rate for Payer: PACE SWMI |
$102.12
|
| Rate for Payer: PHP Medicare Advantage |
$102.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.10
|
| Rate for Payer: Priority Health Medicare |
$102.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.12
|
| Rate for Payer: UHC Medicare Advantage |
$105.18
|
|
|
PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 64520
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$335.72 |
| Rate for Payer: Aetna Commercial |
$109.36
|
| Rate for Payer: Aetna Medicare |
$84.87
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$81.61
|
| Rate for Payer: BCBS Trust/PPO |
$224.53
|
| Rate for Payer: BCN Commercial |
$335.72
|
| Rate for Payer: BCN Medicare Advantage |
$81.61
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$117.52
|
| Rate for Payer: Cofinity Commercial |
$109.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.61
|
| Rate for Payer: Mclaren Medicaid |
$54.10
|
| Rate for Payer: Meridian Medicaid |
$56.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.69
|
| Rate for Payer: PACE SWMI |
$81.61
|
| Rate for Payer: PHP Medicare Advantage |
$81.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.99
|
| Rate for Payer: Priority Health Medicare |
$81.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.61
|
| Rate for Payer: UHC Medicare Advantage |
$84.06
|
|
|
PR INJECTION, BUPIVICAINE HYDRO
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS S0020
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
|
|
PR INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 20527
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Aetna Commercial |
$86.55
|
| Rate for Payer: Aetna Medicare |
$67.17
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS MAPPO |
$64.59
|
| Rate for Payer: BCBS Trust/PPO |
$52.64
|
| Rate for Payer: BCN Commercial |
$128.52
|
| Rate for Payer: BCN Medicare Advantage |
$64.59
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$93.01
|
| Rate for Payer: Cofinity Commercial |
$86.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.59
|
| Rate for Payer: Mclaren Medicaid |
$41.96
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.82
|
| Rate for Payer: PACE SWMI |
$64.59
|
| Rate for Payer: PHP Medicare Advantage |
$64.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.09
|
| Rate for Payer: Priority Health Medicare |
$64.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.59
|
| Rate for Payer: UHC Medicare Advantage |
$66.53
|
|
|
PR INJECTION EPIDURAL BLOOD/CLOT PATCH
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 62273
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Medicare |
$115.25
|
| Rate for Payer: BCBS Complete |
$75.37
|
| Rate for Payer: BCBS MAPPO |
$110.82
|
| Rate for Payer: BCBS Trust/PPO |
$645.05
|
| Rate for Payer: BCN Commercial |
$271.19
|
| Rate for Payer: BCN Medicare Advantage |
$110.82
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$148.50
|
| Rate for Payer: Cofinity Commercial |
$159.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.82
|
| Rate for Payer: Mclaren Medicaid |
$71.78
|
| Rate for Payer: Meridian Medicaid |
$75.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$116.36
|
| Rate for Payer: PACE SWMI |
$110.82
|
| Rate for Payer: PHP Medicare Advantage |
$110.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.11
|
| Rate for Payer: Priority Health Medicare |
$110.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.82
|
| Rate for Payer: UHC Medicare Advantage |
$114.14
|
|
|
PR INJECTION INTRALESIONAL >7 LESIONS
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 11901
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$185.19 |
| Rate for Payer: Aetna Commercial |
$59.68
|
| Rate for Payer: Aetna Medicare |
$46.32
|
| Rate for Payer: BCBS Complete |
$30.20
|
| Rate for Payer: BCBS MAPPO |
$44.54
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$82.07
|
| Rate for Payer: BCN Medicare Advantage |
$44.54
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$64.14
|
| Rate for Payer: Cofinity Commercial |
$59.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.54
|
| Rate for Payer: Mclaren Medicaid |
$28.76
|
| Rate for Payer: Meridian Medicaid |
$30.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.77
|
| Rate for Payer: PACE SWMI |
$44.54
|
| Rate for Payer: PHP Medicare Advantage |
$44.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.49
|
| Rate for Payer: Priority Health Medicare |
$44.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.54
|
| Rate for Payer: UHC Medicare Advantage |
$45.88
|
|
|
PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 11900
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Medicare |
$30.56
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$206.51
|
| Rate for Payer: BCN Commercial |
$67.15
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$42.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Mclaren Medicaid |
$18.96
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.58
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Medicare Advantage |
$30.26
|
|
|
PR INJECTION KNEE ARTHROGRAPHY
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 27370
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: BCBS Complete |
$112.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.00
|
|
|
PR INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 19030
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$242.39 |
| Rate for Payer: Aetna Commercial |
$100.94
|
| Rate for Payer: Aetna Medicare |
$78.34
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS MAPPO |
$75.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.78
|
| Rate for Payer: BCN Commercial |
$242.39
|
| Rate for Payer: BCN Medicare Advantage |
$75.33
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$108.48
|
| Rate for Payer: Cofinity Commercial |
$100.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.33
|
| Rate for Payer: Mclaren Medicaid |
$47.50
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.10
|
| Rate for Payer: PACE SWMI |
$75.33
|
| Rate for Payer: PHP Medicare Advantage |
$75.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.90
|
| Rate for Payer: Priority Health Medicare |
$75.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.33
|
| Rate for Payer: UHC Medicare Advantage |
$77.59
|
|
|
PR INJECTION,ONABOTULINUMTOXINA
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0585
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$6.65
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$6.39
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.27
|
| Rate for Payer: BCN Medicare Advantage |
$6.39
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.71
|
| Rate for Payer: PACE SWMI |
$6.39
|
| Rate for Payer: PHP Medicare Advantage |
$6.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health Medicare |
$6.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.39
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
|
|
PR INJECTION PEYRONIE DISEASE
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 54200
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$189.66 |
| Rate for Payer: Aetna Commercial |
$111.85
|
| Rate for Payer: Aetna Medicare |
$86.81
|
| Rate for Payer: BCBS Complete |
$59.04
|
| Rate for Payer: BCBS MAPPO |
$83.47
|
| Rate for Payer: BCBS Trust/PPO |
$189.66
|
| Rate for Payer: BCN Commercial |
$169.08
|
| Rate for Payer: BCN Medicare Advantage |
$83.47
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$111.85
|
| Rate for Payer: Cofinity Commercial |
$120.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.47
|
| Rate for Payer: Mclaren Medicaid |
$56.23
|
| Rate for Payer: Meridian Medicaid |
$59.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.64
|
| Rate for Payer: PACE SWMI |
$83.47
|
| Rate for Payer: PHP Medicare Advantage |
$83.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.87
|
| Rate for Payer: Priority Health Medicare |
$83.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.47
|
| Rate for Payer: UHC Medicare Advantage |
$85.97
|
|
|
PR INJECTION, PLATELET RICH PLASMA, ANY SITE INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 00671
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
|
|
PR INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 24220
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$281.97 |
| Rate for Payer: Aetna Commercial |
$87.84
|
| Rate for Payer: Aetna Medicare |
$68.17
|
| Rate for Payer: BCBS Complete |
$43.84
|
| Rate for Payer: BCBS MAPPO |
$65.55
|
| Rate for Payer: BCBS Trust/PPO |
$70.79
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Medicare Advantage |
$65.55
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$87.84
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$41.75
|
| Rate for Payer: Meridian Medicaid |
$43.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.83
|
| Rate for Payer: PACE SWMI |
$65.55
|
| Rate for Payer: PHP Medicare Advantage |
$65.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.60
|
| Rate for Payer: Priority Health Medicare |
$65.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.55
|
| Rate for Payer: UHC Medicare Advantage |
$67.52
|
|
|
PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 62284
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$499.24 |
| Rate for Payer: Aetna Commercial |
$110.58
|
| Rate for Payer: Aetna Medicare |
$85.82
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS MAPPO |
$82.52
|
| Rate for Payer: BCBS Trust/PPO |
$499.24
|
| Rate for Payer: BCN Commercial |
$308.31
|
| Rate for Payer: BCN Medicare Advantage |
$82.52
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$110.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.52
|
| Rate for Payer: Mclaren Medicaid |
$52.40
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.65
|
| Rate for Payer: PACE SWMI |
$82.52
|
| Rate for Payer: PHP Medicare Advantage |
$82.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.99
|
| Rate for Payer: Priority Health Medicare |
$82.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.52
|
| Rate for Payer: UHC Medicare Advantage |
$85.00
|
|
|
PR INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
HCPCS 62290
|
| Min. Negotiated Rate |
$98.62 |
| Max. Negotiated Rate |
$988.40 |
| Rate for Payer: Aetna Commercial |
$206.51
|
| Rate for Payer: Aetna Medicare |
$160.27
|
| Rate for Payer: BCBS Complete |
$103.55
|
| Rate for Payer: BCBS MAPPO |
$154.11
|
| Rate for Payer: BCBS Trust/PPO |
$675.17
|
| Rate for Payer: BCN Commercial |
$565.52
|
| Rate for Payer: BCN Medicare Advantage |
$154.11
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cofinity Commercial |
$206.51
|
| Rate for Payer: Cofinity Commercial |
$221.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.11
|
| Rate for Payer: Mclaren Medicaid |
$98.62
|
| Rate for Payer: Meridian Medicaid |
$103.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.82
|
| Rate for Payer: PACE SWMI |
$154.11
|
| Rate for Payer: PHP Medicare Advantage |
$154.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.30
|
| Rate for Payer: Priority Health Medicare |
$154.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.11
|
| Rate for Payer: UHC Medicare Advantage |
$158.73
|
|
|
PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 36002
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$797.73 |
| Rate for Payer: Aetna Commercial |
$136.75
|
| Rate for Payer: Aetna Medicare |
$106.13
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$102.05
|
| Rate for Payer: BCBS Trust/PPO |
$797.73
|
| Rate for Payer: BCN Commercial |
$221.37
|
| Rate for Payer: BCN Medicare Advantage |
$102.05
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cofinity Commercial |
$146.95
|
| Rate for Payer: Cofinity Commercial |
$136.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.05
|
| Rate for Payer: Mclaren Medicaid |
$65.18
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.15
|
| Rate for Payer: PACE SWMI |
$102.05
|
| Rate for Payer: PHP Medicare Advantage |
$102.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.77
|
| Rate for Payer: Priority Health Medicare |
$102.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.05
|
| Rate for Payer: UHC Medicare Advantage |
$105.11
|
|
|
PR INJECTION, REMDESIVIR, 1 MG
|
Professional
|
Both
|
$16.32
|
|
|
Service Code
|
HCPCS J0248
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna Medicare |
$6.30
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS MAPPO |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$5.61
|
| Rate for Payer: BCN Medicare Advantage |
$6.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$8.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.36
|
| Rate for Payer: PACE SWMI |
$6.06
|
| Rate for Payer: PHP Medicare Advantage |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.06
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$751.77 |
| Rate for Payer: Aetna Commercial |
$100.49
|
| Rate for Payer: Aetna Medicare |
$77.99
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS MAPPO |
$74.99
|
| Rate for Payer: BCBS Trust/PPO |
$751.77
|
| Rate for Payer: BCN Commercial |
$234.81
|
| Rate for Payer: BCN Medicare Advantage |
$74.99
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$100.49
|
| Rate for Payer: Cofinity Commercial |
$107.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.99
|
| Rate for Payer: Mclaren Medicaid |
$47.50
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.74
|
| Rate for Payer: PACE SWMI |
$74.99
|
| Rate for Payer: PHP Medicare Advantage |
$74.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.63
|
| Rate for Payer: Priority Health Medicare |
$74.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.99
|
| Rate for Payer: UHC Medicare Advantage |
$77.24
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 36471
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$751.77 |
| Rate for Payer: Aetna Commercial |
$100.49
|
| Rate for Payer: Aetna Medicare |
$77.99
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS MAPPO |
$74.99
|
| Rate for Payer: BCBS Trust/PPO |
$751.77
|
| Rate for Payer: BCN Commercial |
$234.81
|
| Rate for Payer: BCN Medicare Advantage |
$74.99
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$107.99
|
| Rate for Payer: Cofinity Commercial |
$100.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.99
|
| Rate for Payer: Mclaren Medicaid |
$47.50
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.74
|
| Rate for Payer: PACE SWMI |
$74.99
|
| Rate for Payer: PHP Medicare Advantage |
$74.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.63
|
| Rate for Payer: Priority Health Medicare |
$74.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.99
|
| Rate for Payer: UHC Medicare Advantage |
$77.24
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna Commercial |
$281.35
|
| Rate for Payer: BCBS Trust/PPO |
$255.80
|
| Rate for Payer: BCN Commercial |
$255.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$284.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.80
|
| Rate for Payer: Healthscope Commercial |
$297.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.35
|
| Rate for Payer: PHP Commercial |
$281.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.28
|
| Rate for Payer: UHC Core |
$276.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.25
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$78.61 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna Commercial |
$281.35
|
| Rate for Payer: Aetna Medicare |
$86.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.44
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$82.75
|
| Rate for Payer: BCBS Trust/PPO |
$257.35
|
| Rate for Payer: BCN Commercial |
$257.35
|
| Rate for Payer: BCN Medicare Advantage |
$82.75
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$284.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.75
|
| Rate for Payer: Healthscope Commercial |
$297.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.25
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.35
|
| Rate for Payer: PACE Senior Care Partners |
$78.61
|
| Rate for Payer: PACE SWMI |
$82.75
|
| Rate for Payer: PHP Commercial |
$281.35
|
| Rate for Payer: PHP Medicare Advantage |
$82.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.97
|
| Rate for Payer: Priority Health Medicare |
$82.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.88
|
| Rate for Payer: Railroad Medicare Medicare |
$82.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.28
|
| Rate for Payer: UHC Core |
$276.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.75
|
| Rate for Payer: UHC Medicare Advantage |
$85.23
|
| Rate for Payer: VA VA |
$82.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.25
|
|
|
PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 36470
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$701.05 |
| Rate for Payer: Aetna Commercial |
$51.47
|
| Rate for Payer: Aetna Medicare |
$39.95
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$38.41
|
| Rate for Payer: BCBS Trust/PPO |
$701.05
|
| Rate for Payer: BCN Commercial |
$135.86
|
| Rate for Payer: BCN Medicare Advantage |
$38.41
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$55.31
|
| Rate for Payer: Cofinity Commercial |
$51.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.41
|
| Rate for Payer: Mclaren Medicaid |
$23.86
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.33
|
| Rate for Payer: PACE SWMI |
$38.41
|
| Rate for Payer: PHP Medicare Advantage |
$38.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.64
|
| Rate for Payer: Priority Health Medicare |
$38.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.41
|
| Rate for Payer: UHC Medicare Advantage |
$39.56
|
|
