|
PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 46500
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$3,628.89 |
| Rate for Payer: Aetna Commercial |
$238.57
|
| Rate for Payer: Aetna Medicare |
$185.16
|
| Rate for Payer: BCBS Complete |
$123.90
|
| Rate for Payer: BCBS MAPPO |
$178.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,628.89
|
| Rate for Payer: BCN Commercial |
$463.76
|
| Rate for Payer: BCN Medicare Advantage |
$178.04
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$256.38
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.04
|
| Rate for Payer: Mclaren Medicaid |
$118.00
|
| Rate for Payer: Meridian Medicaid |
$123.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.94
|
| Rate for Payer: PACE SWMI |
$178.04
|
| Rate for Payer: PHP Medicare Advantage |
$178.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.32
|
| Rate for Payer: Priority Health Medicare |
$178.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.04
|
| Rate for Payer: UHC Medicare Advantage |
$183.38
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
20552
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$82.60 |
| Rate for Payer: Aetna Commercial |
$48.78
|
| Rate for Payer: Aetna Medicare |
$37.86
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: BCBS MAPPO |
$36.40
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: BCN Medicare Advantage |
$36.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$52.42
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.40
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Meridian Medicaid |
$24.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.22
|
| Rate for Payer: PACE SWMI |
$36.40
|
| Rate for Payer: PHP Medicare Advantage |
$36.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.18
|
| Rate for Payer: Priority Health Medicare |
$36.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.40
|
| Rate for Payer: UHC Medicare Advantage |
$37.49
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$71.97 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$100.30
|
| Rate for Payer: BCBS Trust/PPO |
$91.19
|
| Rate for Payer: BCN Commercial |
$91.19
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$101.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Healthscope Commercial |
$106.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.30
|
| Rate for Payer: PHP Commercial |
$100.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.84
|
| Rate for Payer: UHC Core |
$98.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.50
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$204.01 |
| Rate for Payer: Aetna Commercial |
$100.30
|
| Rate for Payer: Aetna Medicare |
$30.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.88
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$29.50
|
| Rate for Payer: BCBS Trust/PPO |
$91.74
|
| Rate for Payer: BCN Commercial |
$91.74
|
| Rate for Payer: BCN Medicare Advantage |
$29.50
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$101.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$106.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.50
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.30
|
| Rate for Payer: PACE Senior Care Partners |
$28.02
|
| Rate for Payer: PACE SWMI |
$29.50
|
| Rate for Payer: PHP Commercial |
$100.30
|
| Rate for Payer: PHP Medicare Advantage |
$29.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.66
|
| Rate for Payer: Priority Health Medicare |
$29.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.97
|
| Rate for Payer: Railroad Medicare Medicare |
$29.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.84
|
| Rate for Payer: UHC Core |
$98.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.50
|
| Rate for Payer: UHC Medicare Advantage |
$30.38
|
| Rate for Payer: VA VA |
$29.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.50
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 20552
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$82.60 |
| Rate for Payer: Aetna Commercial |
$48.78
|
| Rate for Payer: Aetna Medicare |
$37.86
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: BCBS MAPPO |
$36.40
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: BCN Medicare Advantage |
$36.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Cofinity Commercial |
$52.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.40
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Meridian Medicaid |
$24.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.22
|
| Rate for Payer: PACE SWMI |
$36.40
|
| Rate for Payer: PHP Medicare Advantage |
$36.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.18
|
| Rate for Payer: Priority Health Medicare |
$36.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.40
|
| Rate for Payer: UHC Medicare Advantage |
$37.49
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 20553
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$97.30 |
| Rate for Payer: Aetna Commercial |
$55.90
|
| Rate for Payer: Aetna Medicare |
$43.39
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$41.72
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: BCN Medicare Advantage |
$41.72
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$60.08
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.72
|
| Rate for Payer: Mclaren Medicaid |
$26.63
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.81
|
| Rate for Payer: PACE SWMI |
$41.72
|
| Rate for Payer: PHP Medicare Advantage |
$41.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$41.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.72
|
| Rate for Payer: UHC Medicare Advantage |
$42.97
|
|
|
PR INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 20551
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$51.76
|
| Rate for Payer: Aetna Medicare |
$40.18
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS MAPPO |
$38.63
|
| Rate for Payer: BCBS Trust/PPO |
$24.96
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$38.63
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$51.76
|
| Rate for Payer: Cofinity Commercial |
$55.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.63
|
| Rate for Payer: Mclaren Medicaid |
$24.50
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.56
|
| Rate for Payer: PACE SWMI |
$38.63
|
| Rate for Payer: PHP Medicare Advantage |
$38.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.24
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.63
|
| Rate for Payer: UHC Medicare Advantage |
$39.79
|
|
|
PR INJECTION SINUS TRACT DIAGNOSTIC
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 20501
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$211.59 |
| Rate for Payer: Aetna Commercial |
$48.27
|
| Rate for Payer: Aetna Medicare |
$37.46
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS MAPPO |
$36.02
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$211.59
|
| Rate for Payer: BCN Medicare Advantage |
$36.02
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$51.87
|
| Rate for Payer: Cofinity Commercial |
$48.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.02
|
| Rate for Payer: Mclaren Medicaid |
$22.79
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.82
|
| Rate for Payer: PACE SWMI |
$36.02
|
| Rate for Payer: PHP Medicare Advantage |
$36.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.15
|
| Rate for Payer: Priority Health Medicare |
$36.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.02
|
| Rate for Payer: UHC Medicare Advantage |
$37.10
|
|
|
PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 20500
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna Commercial |
$116.49
|
| Rate for Payer: Aetna Medicare |
$90.41
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS MAPPO |
$86.93
|
| Rate for Payer: BCBS Trust/PPO |
$556.70
|
| Rate for Payer: BCN Commercial |
$181.79
|
| Rate for Payer: BCN Medicare Advantage |
$86.93
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$125.18
|
| Rate for Payer: Cofinity Commercial |
$116.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.93
|
| Rate for Payer: Mclaren Medicaid |
$57.30
|
| Rate for Payer: Meridian Medicaid |
$60.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.28
|
| Rate for Payer: PACE SWMI |
$86.93
|
| Rate for Payer: PHP Medicare Advantage |
$86.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.83
|
| Rate for Payer: Priority Health Medicare |
$86.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.93
|
| Rate for Payer: UHC Medicare Advantage |
$89.54
|
|
|
PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 36468
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$1,096.22 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: BCBS Complete |
$98.27
|
| Rate for Payer: BCBS Complete |
$98.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.22
|
| Rate for Payer: BCN Commercial |
$345.09
|
| Rate for Payer: BCN Commercial |
$345.09
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Mclaren Medicaid |
$93.59
|
| Rate for Payer: Mclaren Medicaid |
$93.59
|
| Rate for Payer: Meridian Medicaid |
$98.27
|
| Rate for Payer: Meridian Medicaid |
$98.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.75
|
|
|
PR INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 20526
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$75.47
|
| Rate for Payer: Aetna Medicare |
$58.57
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCBS MAPPO |
$56.32
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: BCN Medicare Advantage |
$56.32
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$81.10
|
| Rate for Payer: Cofinity Commercial |
$75.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.32
|
| Rate for Payer: Mclaren Medicaid |
$36.21
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.14
|
| Rate for Payer: PACE SWMI |
$56.32
|
| Rate for Payer: PHP Medicare Advantage |
$56.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.81
|
| Rate for Payer: Priority Health Medicare |
$56.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.32
|
| Rate for Payer: UHC Medicare Advantage |
$58.01
|
|
|
PR INJECTION THRU KIDNEY TUBE FOR XRAY
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 50394
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
|
|
PR INJECTION TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 30200
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$504.53 |
| Rate for Payer: Aetna Commercial |
$77.61
|
| Rate for Payer: Aetna Medicare |
$60.24
|
| Rate for Payer: BCBS Complete |
$40.26
|
| Rate for Payer: BCBS MAPPO |
$57.92
|
| Rate for Payer: BCBS Trust/PPO |
$504.53
|
| Rate for Payer: BCN Commercial |
$131.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.92
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Cofinity Commercial |
$83.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.92
|
| Rate for Payer: Mclaren Medicaid |
$38.34
|
| Rate for Payer: Meridian Medicaid |
$40.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.82
|
| Rate for Payer: PACE SWMI |
$57.92
|
| Rate for Payer: PHP Medicare Advantage |
$57.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.42
|
| Rate for Payer: Priority Health Medicare |
$57.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.92
|
| Rate for Payer: UHC Medicare Advantage |
$59.66
|
|
|
PR INJECTION WRIST ARTHROGRAPHY
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 25246
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$2,365.73 |
| Rate for Payer: Aetna Commercial |
$95.85
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,365.73
|
| Rate for Payer: BCN Commercial |
$290.27
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$95.85
|
| Rate for Payer: Cofinity Commercial |
$103.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Mclaren Medicaid |
$46.01
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.11
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.79
|
| Rate for Payer: Priority Health Medicare |
$71.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.53
|
| Rate for Payer: UHC Medicare Advantage |
$73.68
|
|
|
PR INJECT NERV BLCK,CERV PLEXUS
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 64413
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
HCPCS 27096
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$638.71 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$84.12
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS MAPPO |
$80.88
|
| Rate for Payer: BCBS Trust/PPO |
$638.71
|
| Rate for Payer: BCN Commercial |
$237.98
|
| Rate for Payer: BCN Medicare Advantage |
$80.88
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cofinity Commercial |
$116.47
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.88
|
| Rate for Payer: Mclaren Medicaid |
$52.61
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.92
|
| Rate for Payer: PACE SWMI |
$80.88
|
| Rate for Payer: PHP Medicare Advantage |
$80.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.10
|
| Rate for Payer: Priority Health Medicare |
$80.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.88
|
| Rate for Payer: UHC Medicare Advantage |
$83.31
|
|
|
PR INJECT THRU CHOLANGIO CATHETER
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 47505
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
|
|
PR INJ ENOXAPARIN SODIUM
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1650
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$0.91
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.27
|
| Rate for Payer: BCN Commercial |
$0.42
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$0.91
|
| Rate for Payer: Cofinity Commercial |
$0.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.70
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
IP
|
$1,250.10
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$762.44 |
| Max. Negotiated Rate |
$1,125.09 |
| Rate for Payer: Aetna Commercial |
$1,062.58
|
| Rate for Payer: BCBS Trust/PPO |
$966.08
|
| Rate for Payer: BCN Commercial |
$966.08
|
| Rate for Payer: Cash Price |
$1,000.08
|
| Rate for Payer: Cofinity Commercial |
$1,075.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.08
|
| Rate for Payer: Healthscope Commercial |
$1,125.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$937.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,062.58
|
| Rate for Payer: PHP Commercial |
$1,062.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$875.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,087.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$762.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,100.09
|
| Rate for Payer: UHC Core |
$1,043.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$937.58
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
OP
|
$1,250.10
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$296.90 |
| Max. Negotiated Rate |
$1,125.09 |
| Rate for Payer: Aetna Commercial |
$1,062.58
|
| Rate for Payer: Aetna Medicare |
$325.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$390.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$390.66
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$312.52
|
| Rate for Payer: BCBS Trust/PPO |
$971.95
|
| Rate for Payer: BCN Commercial |
$971.95
|
| Rate for Payer: BCN Medicare Advantage |
$312.52
|
| Rate for Payer: Cash Price |
$1,000.08
|
| Rate for Payer: Cash Price |
$1,000.08
|
| Rate for Payer: Cofinity Commercial |
$1,075.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.52
|
| Rate for Payer: Healthscope Commercial |
$1,125.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$937.58
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$328.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$359.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,062.58
|
| Rate for Payer: PACE Senior Care Partners |
$296.90
|
| Rate for Payer: PACE SWMI |
$312.52
|
| Rate for Payer: PHP Commercial |
$1,062.58
|
| Rate for Payer: PHP Medicare Advantage |
$312.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$875.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,087.59
|
| Rate for Payer: Priority Health Medicare |
$312.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$762.44
|
| Rate for Payer: Railroad Medicare Medicare |
$312.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,100.09
|
| Rate for Payer: UHC Core |
$1,043.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.52
|
| Rate for Payer: UHC Medicare Advantage |
$321.90
|
| Rate for Payer: VA VA |
$312.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$937.58
|
|
|
PR INJ HEPARIN SODIUM PER 1000U
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1644
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna Commercial |
$0.35
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.38
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.27
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Aetna Medicare |
$17.86
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$17.18
|
| Rate for Payer: BCBS Trust/PPO |
$17.65
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$24.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.03
|
| Rate for Payer: PACE SWMI |
$17.18
|
| Rate for Payer: PHP Medicare Advantage |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Medicare |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.18
|
| Rate for Payer: UHC Medicare Advantage |
$17.69
|
|
|
PR INJ PROGESTERONE PER 50 MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J2675
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$1.30
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.97
|
| Rate for Payer: UHC Medicare Advantage |
$1.00
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$672.53 |
| Rate for Payer: Aetna Commercial |
$42.93
|
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$32.04
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.70
|
| Rate for Payer: BCN Medicare Advantage |
$32.04
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$46.14
|
| Rate for Payer: Cofinity Commercial |
$42.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.04
|
| Rate for Payer: Mclaren Medicaid |
$20.24
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.64
|
| Rate for Payer: PACE SWMI |
$32.04
|
| Rate for Payer: PHP Medicare Advantage |
$32.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.53
|
| Rate for Payer: Priority Health Medicare |
$32.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.04
|
| Rate for Payer: UHC Medicare Advantage |
$33.00
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$672.53 |
| Rate for Payer: Aetna Commercial |
$42.93
|
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$32.04
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.70
|
| Rate for Payer: BCN Medicare Advantage |
$32.04
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$46.14
|
| Rate for Payer: Cofinity Commercial |
$42.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.04
|
| Rate for Payer: Mclaren Medicaid |
$20.24
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.64
|
| Rate for Payer: PACE SWMI |
$32.04
|
| Rate for Payer: PHP Medicare Advantage |
$32.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.53
|
| Rate for Payer: Priority Health Medicare |
$32.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.04
|
| Rate for Payer: UHC Medicare Advantage |
$33.00
|
|
