|
PR INJECT THRU CHOLANGIO CATHETER
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 47505
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR INJ ENOXAPARIN SODIUM
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1650
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$0.76
|
| Rate for Payer: Aetna Medicare |
$0.59
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$0.57
|
| Rate for Payer: BCBS Trust/PPO |
$0.27
|
| Rate for Payer: BCN Commercial |
$0.42
|
| Rate for Payer: BCN Medicare Advantage |
$0.57
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.68
|
| Rate for Payer: PACE SWMI |
$0.57
|
| Rate for Payer: PHP Medicare Advantage |
$0.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$0.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.57
|
| Rate for Payer: UHC Exchange |
$0.57
|
| Rate for Payer: UHC Medicare Advantage |
$0.57
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$302.81 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: Aetna Medicare |
$331.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$398.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$398.44
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$318.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.18
|
| Rate for Payer: BCN Commercial |
$991.31
|
| Rate for Payer: BCN Medicare Advantage |
$318.75
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$1,096.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,020.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.75
|
| Rate for Payer: Healthscope Commercial |
$1,147.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$956.25
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.69
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,083.75
|
| Rate for Payer: Nomi Health Commercial |
$1,045.50
|
| Rate for Payer: PACE Senior Care Partners |
$302.81
|
| Rate for Payer: PACE SWMI |
$318.75
|
| Rate for Payer: PHP Commercial |
$1,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$318.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,109.25
|
| Rate for Payer: Priority Health Medicare |
$321.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$854.25
|
| Rate for Payer: Railroad Medicare Medicare |
$318.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,122.00
|
| Rate for Payer: UHC Core |
$1,064.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.75
|
| Rate for Payer: UHC Exchange |
$318.75
|
| Rate for Payer: UHC Medicare Advantage |
$318.75
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$318.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$956.25
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$828.75 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,040.78
|
| Rate for Payer: BCN Commercial |
$985.32
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$1,096.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,020.00
|
| Rate for Payer: Healthscope Commercial |
$1,147.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$956.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,083.75
|
| Rate for Payer: Nomi Health Commercial |
$1,045.50
|
| Rate for Payer: PHP Commercial |
$1,083.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,109.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$854.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,122.00
|
| Rate for Payer: UHC Core |
$1,064.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$956.25
|
|
|
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: 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: Priority Health Cigna Priority Health |
$828.82
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,275.10
|
|
|
Service Code
|
HCPCS 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: 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: 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 |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.29
|
| Rate for Payer: Aetna Medicare |
$0.23
|
| 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 |
$0.31
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.23
|
| 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) |
$0.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.22
|
| Rate for Payer: UHC Exchange |
$0.22
|
| 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 |
$25.96 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$18.75
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.93
|
| 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 |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.03
|
| Rate for Payer: UHC Exchange |
$18.03
|
| 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: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.13
|
| 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) |
$0.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Medicare Advantage |
$0.12
|
|
|
PR INJ, METHYLPRED SOD SUCC 5MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2919
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$0.35
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| 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 |
$0.37
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.27
|
| 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) |
$0.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Exchange |
$0.26
|
| 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 |
$3.25 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.65
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.66
|
| 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) |
$0.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| 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 |
$187.15 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Aetna Commercial |
$669.80
|
| Rate for Payer: Aetna Medicare |
$204.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.25
|
| Rate for Payer: BCBS Complete |
$298.90
|
| Rate for Payer: BCBS MAPPO |
$197.00
|
| Rate for Payer: BCBS Trust/PPO |
$647.81
|
| Rate for Payer: BCN Commercial |
$612.67
|
| Rate for Payer: BCN Medicare Advantage |
$197.00
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$677.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.00
|
| Rate for Payer: Healthscope Commercial |
$709.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$591.00
|
| Rate for Payer: Mclaren Medicaid |
$284.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.85
|
| Rate for Payer: Meridian Medicaid |
$298.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.80
|
| Rate for Payer: Nomi Health Commercial |
$646.16
|
| Rate for Payer: PACE Senior Care Partners |
$187.15
|
| Rate for Payer: PACE SWMI |
$197.00
|
| Rate for Payer: PHP Commercial |
$669.80
|
| Rate for Payer: PHP Medicare Advantage |
$197.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health HMO/PPO |
$685.56
|
| Rate for Payer: Priority Health Medicare |
$198.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$527.96
|
| Rate for Payer: Railroad Medicare Medicare |
$197.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.44
|
| Rate for Payer: UHC Core |
$657.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.00
|
| Rate for Payer: UHC Exchange |
$197.00
|
| Rate for Payer: UHC Medicare Advantage |
$197.00
|
| Rate for Payer: UHCCP Medicaid |
$284.65
|
| Rate for Payer: VA VA |
$197.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$591.00
|
|
|
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 |
$512.20 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Aetna Commercial |
$669.80
|
| Rate for Payer: BCBS Trust/PPO |
$643.24
|
| Rate for Payer: BCN Commercial |
$608.97
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$677.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.40
|
| Rate for Payer: Healthscope Commercial |
$709.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$591.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.80
|
| Rate for Payer: Nomi Health Commercial |
$646.16
|
| Rate for Payer: PHP Commercial |
$669.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health HMO/PPO |
$685.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$527.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.44
|
| Rate for Payer: UHC Core |
$657.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$591.00
|
|
|
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 |
$672.53 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$31.68
|
| 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: 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: 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 |
$63.24
|
| Rate for Payer: Priority Health Medicare |
$30.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.46
|
| Rate for Payer: UHC Exchange |
$30.46
|
| Rate for Payer: UHC Medicare Advantage |
$30.46
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
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 |
$672.53 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$31.68
|
| 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: 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: 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 |
$63.24
|
| Rate for Payer: Priority Health Medicare |
$30.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.46
|
| Rate for Payer: UHC Exchange |
$30.46
|
| 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 |
$11.05 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| 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 |
$9.69
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| 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 |
$6.80
|
| 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 |
$19.21 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Medicare |
$13.88
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.01
|
| 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 |
$13.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.34
|
| Rate for Payer: UHC Exchange |
$13.34
|
| 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 |
$15.76 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| 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 |
$15.76
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.49
|
| 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 |
$11.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.94
|
| Rate for Payer: UHC Exchange |
$10.94
|
| 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 |
$17.29 |
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| 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 |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| 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 |
$0.10 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.03
|
| 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 |
$491.32 |
| Rate for Payer: Aetna Commercial |
$117.92
|
| Rate for Payer: Aetna Medicare |
$91.52
|
| 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: 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: 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 |
$123.40
|
| Rate for Payer: Priority Health Medicare |
$88.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.00
|
| Rate for Payer: UHC Exchange |
$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 |
$562.64 |
| Rate for Payer: Aetna Commercial |
$166.17
|
| Rate for Payer: Aetna Medicare |
$128.97
|
| 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: 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: 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 |
$174.55
|
| Rate for Payer: Priority Health Medicare |
$125.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.01
|
| Rate for Payer: UHC Exchange |
$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 |
$348.68 |
| Rate for Payer: Aetna Commercial |
$236.43
|
| Rate for Payer: Aetna Medicare |
$183.50
|
| 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 |
$236.43
|
| Rate for Payer: Cofinity Commercial |
$254.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.44
|
| 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: 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 |
$246.79
|
| Rate for Payer: Priority Health Medicare |
$178.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.44
|
| Rate for Payer: UHC Exchange |
$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 |
$104.58 |
| Rate for Payer: Aetna Commercial |
$92.12
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| 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: 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: 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 |
$96.80
|
| Rate for Payer: Priority Health Medicare |
$69.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.75
|
| Rate for Payer: UHC Exchange |
$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 |
$1,554.26 |
| Rate for Payer: Aetna Commercial |
$132.85
|
| Rate for Payer: Aetna Medicare |
$103.11
|
| 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: 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: 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 |
$141.13
|
| Rate for Payer: Priority Health Medicare |
$100.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.14
|
| Rate for Payer: UHC Exchange |
$99.14
|
| Rate for Payer: UHC Medicare Advantage |
$99.14
|
| Rate for Payer: UHCCP Medicaid |
$66.46
|
|
