|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna Medicare |
$32.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.75
|
| Rate for Payer: BCBS Complete |
$22.95
|
| Rate for Payer: BCBS MAPPO |
$31.00
|
| Rate for Payer: BCBS Trust/PPO |
$101.94
|
| Rate for Payer: BCN Commercial |
$101.94
|
| Rate for Payer: BCN Medicare Advantage |
$31.00
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.00
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Mclaren Medicaid |
$21.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.55
|
| Rate for Payer: Meridian Medicaid |
$22.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: Nomi Health Commercial |
$101.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: PACE Senior Care Partners |
$29.45
|
| Rate for Payer: PACE SWMI |
$31.00
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: PHP Medicare Advantage |
$31.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.88
|
| Rate for Payer: Priority Health Medicare |
$31.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.30
|
| Rate for Payer: Railroad Medicare Medicare |
$31.00
|
| Rate for Payer: UHC Core |
$103.54
|
| Rate for Payer: UHC Exchange |
$31.00
|
| Rate for Payer: UHC Medicaid |
$21.86
|
| Rate for Payer: UHC Medicare Advantage |
$31.00
|
| Rate for Payer: UHCCP Medicaid |
$21.86
|
| Rate for Payer: VA VA |
$31.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 20553
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Aetna Commercial |
$57.07
|
| Rate for Payer: Aetna Medicare |
$73.00
|
| Rate for Payer: BCBS Complete |
$27.29
|
| Rate for Payer: BCN Commercial |
$48.69
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Mclaren Medicaid |
$25.99
|
| Rate for Payer: Meridian Medicaid |
$27.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.01
|
| Rate for Payer: UHC Medicaid |
$25.99
|
| Rate for Payer: UHCCP Medicaid |
$25.99
|
|
|
PR INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 20551
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Aetna Commercial |
$52.78
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCN Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.22
|
| Rate for Payer: UHC Medicaid |
$21.09
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
|
|
PR INJECTION SINUS TRACT DIAGNOSTIC
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 20501
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Aetna Commercial |
$49.72
|
| Rate for Payer: Aetna Medicare |
$145.50
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCN Commercial |
$53.29
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Mclaren Medicaid |
$19.81
|
| Rate for Payer: Meridian Medicaid |
$20.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.96
|
| Rate for Payer: UHC Medicaid |
$19.81
|
| Rate for Payer: UHCCP Medicaid |
$19.81
|
|
|
PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PX
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 20500
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Aetna Commercial |
$115.24
|
| Rate for Payer: Aetna Medicare |
$127.00
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCN Commercial |
$136.44
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Mclaren Medicaid |
$53.25
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.86
|
| Rate for Payer: UHC Medicaid |
$53.25
|
| Rate for Payer: UHCCP Medicaid |
$53.25
|
|
|
PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 36468
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$373.56 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: BCBS Complete |
$98.27
|
| Rate for Payer: BCBS Complete |
$98.27
|
| Rate for Payer: BCN Commercial |
$373.56
|
| Rate for Payer: BCN Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| 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: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| 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/HMO/PPO |
$169.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.76
|
| Rate for Payer: UHC Medicaid |
$93.59
|
| Rate for Payer: UHC Medicaid |
$93.59
|
| Rate for Payer: UHCCP Medicaid |
$93.59
|
| Rate for Payer: UHCCP Medicaid |
$93.59
|
|
|
PR INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 20526
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Aetna Commercial |
$76.12
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: BCBS Complete |
$33.10
|
| Rate for Payer: BCN Commercial |
$67.15
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Mclaren Medicaid |
$31.52
|
| Rate for Payer: Meridian Medicaid |
$33.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.02
|
| Rate for Payer: UHC Medicaid |
$31.52
|
| Rate for Payer: UHCCP Medicaid |
$31.52
|
|
|
PR INJECTION THRU KIDNEY TUBE FOR XRAY
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 50394
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna Medicare |
$123.00
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.50
|
|
|
PR INJECTION TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 30200
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$73.33
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$36.24
|
| Rate for Payer: BCN Commercial |
$71.86
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Mclaren Medicaid |
$34.51
|
| Rate for Payer: Meridian Medicaid |
$36.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$85.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.81
|
| Rate for Payer: UHC Medicaid |
$34.51
|
| Rate for Payer: UHCCP Medicaid |
$34.51
|
|
|
PR INJECTION WRIST ARTHROGRAPHY
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 25246
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$221.25 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Medicare |
$147.50
|
| Rate for Payer: BCBS Complete |
$41.15
|
| Rate for Payer: BCN Commercial |
$107.56
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Mclaren Medicaid |
$39.19
|
| Rate for Payer: Meridian Medicaid |
$41.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.99
|
| Rate for Payer: UHC Medicaid |
$39.19
|
| Rate for Payer: UHCCP Medicaid |
$39.19
|
|
|
PR INJECT NERV BLCK,CERV PLEXUS
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 64413
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
|
|
PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 27096
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$110.93
|
| Rate for Payer: Aetna Medicare |
$332.50
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCN Commercial |
$124.50
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Mclaren Medicaid |
$47.07
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.09
|
| Rate for Payer: UHC Medicaid |
$47.07
|
| Rate for Payer: UHCCP Medicaid |
$47.07
|
|
|
PR INJECT THRU CHOLANGIO CATHETER
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 47505
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
|
|
PR INJ ENOXAPARIN SODIUM
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1650
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Aetna Commercial |
$0.70
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS G0260
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$45.89
|
| Rate for Payer: Aetna Medicare |
$656.50
|
| Rate for Payer: BCBS Complete |
$525.20
|
| Rate for Payer: BCN Commercial |
$647.51
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$984.75
|
|
|
PR INJ, FUROSEMIDE, 1 MG
|
Professional
|
Both
|
$3.12
|
|
|
Service Code
|
HCPCS J1938
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
|
|
PR INJ HEPARIN SODIUM PER 1000U
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1644
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.28
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$18.42
|
| Rate for Payer: BCN Commercial |
$17.55
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
|
|
PR INJ, METHYLPRED ACETATE 1 MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1010
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
|
|
PR INJ, METHYLPRED SOD SUCC 5MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2919
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
|
|
PR INJ PROGESTERONE PER 50 MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J2675
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.47
|
| Rate for Payer: BCN Commercial |
$0.42
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$143.16 |
| Max. Negotiated Rate |
$730.80 |
| Rate for Payer: Aetna Commercial |
$690.20
|
| Rate for Payer: Aetna Medicare |
$211.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$253.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$253.75
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCBS MAPPO |
$203.00
|
| Rate for Payer: BCBS Trust/PPO |
$667.55
|
| Rate for Payer: BCN Commercial |
$667.55
|
| Rate for Payer: BCN Medicare Advantage |
$203.00
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$698.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$730.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$609.00
|
| Rate for Payer: Mclaren Medicaid |
$143.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.15
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$223.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.20
|
| Rate for Payer: Nomi Health Commercial |
$665.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: PACE Senior Care Partners |
$192.85
|
| Rate for Payer: PACE SWMI |
$203.00
|
| Rate for Payer: PHP Commercial |
$690.20
|
| Rate for Payer: PHP Medicare Advantage |
$203.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$706.44
|
| Rate for Payer: Priority Health Medicare |
$205.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$565.15
|
| Rate for Payer: Railroad Medicare Medicare |
$203.00
|
| Rate for Payer: UHC Core |
$678.02
|
| Rate for Payer: UHC Exchange |
$203.00
|
| Rate for Payer: UHC Medicaid |
$143.16
|
| Rate for Payer: UHC Medicare Advantage |
$203.00
|
| Rate for Payer: UHCCP Medicaid |
$143.16
|
| Rate for Payer: VA VA |
$203.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$609.00
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Aetna Commercial |
$41.33
|
| Rate for Payer: Aetna Medicare |
$406.00
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Mclaren Medicaid |
$17.47
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.95
|
| Rate for Payer: UHC Medicaid |
$17.47
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$565.15 |
| Max. Negotiated Rate |
$730.80 |
| Rate for Payer: Aetna Commercial |
$690.20
|
| Rate for Payer: BCBS Trust/PPO |
$670.63
|
| Rate for Payer: BCN Commercial |
$670.63
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$698.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.60
|
| Rate for Payer: Healthscope Commercial |
$730.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$609.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.20
|
| Rate for Payer: Nomi Health Commercial |
$665.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: PHP Commercial |
$690.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$706.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$565.15
|
| Rate for Payer: UHC Core |
$678.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$609.00
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Aetna Commercial |
$41.33
|
| Rate for Payer: Aetna Medicare |
$406.00
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Mclaren Medicaid |
$17.47
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.95
|
| Rate for Payer: UHC Medicaid |
$17.47
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
|
