|
PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 46500
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$247.71 |
| Rate for Payer: Aetna Commercial |
$230.51
|
| Rate for Payer: Aetna Medicare |
$178.90
|
| Rate for Payer: BCBS Complete |
$139.60
|
| Rate for Payer: BCBS MAPPO |
$172.02
|
| Rate for Payer: BCN Medicare Advantage |
$172.02
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$247.71
|
| Rate for Payer: Cofinity Commercial |
$230.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.62
|
| Rate for Payer: Nomi Health Commercial |
$206.42
|
| Rate for Payer: PACE SWMI |
$172.02
|
| Rate for Payer: PHP Medicare Advantage |
$172.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health Medicare |
$173.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.02
|
| Rate for Payer: UHC Exchange |
$172.02
|
| Rate for Payer: UHC Medicare Advantage |
$172.02
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$97.96
|
| Rate for Payer: BCN Commercial |
$92.74
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$103.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.00
|
| Rate for Payer: Healthscope Commercial |
$108.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.00
|
| Rate for Payer: Nomi Health Commercial |
$98.40
|
| Rate for Payer: PHP Commercial |
$102.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO |
$104.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.60
|
| Rate for Payer: UHC Core |
$100.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.00
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 20552
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$46.38
|
| Rate for Payer: Aetna Medicare |
$35.99
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$34.61
|
| Rate for Payer: BCN Medicare Advantage |
$34.61
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$46.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.34
|
| Rate for Payer: Nomi Health Commercial |
$41.53
|
| Rate for Payer: PACE SWMI |
$34.61
|
| Rate for Payer: PHP Medicare Advantage |
$34.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$34.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.61
|
| Rate for Payer: UHC Exchange |
$34.61
|
| Rate for Payer: UHC Medicare Advantage |
$34.61
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
20552
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$46.38
|
| Rate for Payer: Aetna Medicare |
$35.99
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$34.61
|
| Rate for Payer: BCN Medicare Advantage |
$34.61
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$46.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.34
|
| Rate for Payer: Nomi Health Commercial |
$41.53
|
| Rate for Payer: PACE SWMI |
$34.61
|
| Rate for Payer: PHP Medicare Advantage |
$34.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$34.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.61
|
| Rate for Payer: UHC Exchange |
$34.61
|
| Rate for Payer: UHC Medicare Advantage |
$34.61
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$224.11 |
| Rate for Payer: Aetna Commercial |
$102.00
|
| Rate for Payer: Aetna Medicare |
$31.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.50
|
| Rate for Payer: BCBS Complete |
$224.11
|
| Rate for Payer: BCBS MAPPO |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$93.30
|
| Rate for Payer: BCN Medicare Advantage |
$30.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$103.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.00
|
| Rate for Payer: Healthscope Commercial |
$108.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.00
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.50
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.00
|
| Rate for Payer: Nomi Health Commercial |
$98.40
|
| Rate for Payer: PACE Senior Care Partners |
$28.50
|
| Rate for Payer: PACE SWMI |
$30.00
|
| Rate for Payer: PHP Commercial |
$102.00
|
| Rate for Payer: PHP Medicare Advantage |
$30.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO |
$104.40
|
| Rate for Payer: Priority Health Medicare |
$30.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.40
|
| Rate for Payer: Railroad Medicare Medicare |
$30.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.60
|
| Rate for Payer: UHC Core |
$100.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.00
|
| Rate for Payer: UHC Exchange |
$30.00
|
| Rate for Payer: UHC Medicare Advantage |
$30.00
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
| Rate for Payer: VA VA |
$30.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.00
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 20553
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$92.30 |
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Medicare |
$40.96
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCN Medicare Advantage |
$39.38
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Cofinity Commercial |
$52.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.35
|
| Rate for Payer: Nomi Health Commercial |
$47.26
|
| Rate for Payer: PACE SWMI |
$39.38
|
| Rate for Payer: PHP Medicare Advantage |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health Medicare |
$39.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.38
|
| Rate for Payer: UHC Exchange |
$39.38
|
| Rate for Payer: UHC Medicare Advantage |
$39.38
|
|
|
PR INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 20551
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Commercial |
$49.20
|
| Rate for Payer: Aetna Medicare |
$38.19
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS MAPPO |
$36.72
|
| Rate for Payer: BCN Medicare Advantage |
$36.72
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$52.88
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.56
|
| Rate for Payer: Nomi Health Commercial |
$44.06
|
| Rate for Payer: PACE SWMI |
$36.72
|
| Rate for Payer: PHP Medicare Advantage |
$36.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health Medicare |
$37.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.72
|
| Rate for Payer: UHC Exchange |
$36.72
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
|
|
PR INJECTION SINUS TRACT DIAGNOSTIC
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 20501
|
| Min. Negotiated Rate |
$34.23 |
| Max. Negotiated Rate |
$183.95 |
| Rate for Payer: Aetna Commercial |
$45.87
|
| Rate for Payer: Aetna Medicare |
$35.60
|
| Rate for Payer: BCBS Complete |
$113.20
|
| Rate for Payer: BCBS MAPPO |
$34.23
|
| Rate for Payer: BCN Medicare Advantage |
$34.23
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$49.29
|
| Rate for Payer: Cofinity Commercial |
$45.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.94
|
| Rate for Payer: Nomi Health Commercial |
$41.08
|
| Rate for Payer: PACE SWMI |
$34.23
|
| Rate for Payer: PHP Medicare Advantage |
$34.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health Medicare |
$34.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.23
|
| Rate for Payer: UHC Exchange |
$34.23
|
| Rate for Payer: UHC Medicare Advantage |
$34.23
|
|
|
PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 20500
|
| Min. Negotiated Rate |
$85.78 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Commercial |
$114.95
|
| Rate for Payer: Aetna Medicare |
$89.21
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$85.78
|
| Rate for Payer: BCN Medicare Advantage |
$85.78
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$123.52
|
| Rate for Payer: Cofinity Commercial |
$114.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.07
|
| Rate for Payer: Nomi Health Commercial |
$102.94
|
| Rate for Payer: PACE SWMI |
$85.78
|
| Rate for Payer: PHP Medicare Advantage |
$85.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$86.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.78
|
| Rate for Payer: UHC Exchange |
$85.78
|
| Rate for Payer: UHC Medicare Advantage |
$85.78
|
|
|
PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 36468
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
|
|
PR INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 20526
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna Medicare |
$56.63
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$54.45
|
| Rate for Payer: BCN Medicare Advantage |
$54.45
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$72.96
|
| Rate for Payer: Cofinity Commercial |
$78.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.17
|
| Rate for Payer: Nomi Health Commercial |
$65.34
|
| Rate for Payer: PACE SWMI |
$54.45
|
| Rate for Payer: PHP Medicare Advantage |
$54.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$54.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.45
|
| Rate for Payer: UHC Exchange |
$54.45
|
| Rate for Payer: UHC Medicare Advantage |
$54.45
|
|
|
PR INJECTION THRU KIDNEY TUBE FOR XRAY
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 50394
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Medicare |
$119.50
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
|
|
PR INJECTION TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 30200
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Aetna Commercial |
$76.63
|
| Rate for Payer: Aetna Medicare |
$59.48
|
| Rate for Payer: BCBS Complete |
$86.80
|
| Rate for Payer: BCBS MAPPO |
$57.19
|
| Rate for Payer: BCN Medicare Advantage |
$57.19
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Cofinity Commercial |
$76.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.05
|
| Rate for Payer: Nomi Health Commercial |
$68.63
|
| Rate for Payer: PACE SWMI |
$57.19
|
| Rate for Payer: PHP Medicare Advantage |
$57.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health Medicare |
$57.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.19
|
| Rate for Payer: UHC Exchange |
$57.19
|
| Rate for Payer: UHC Medicare Advantage |
$57.19
|
|
|
PR INJECTION WRIST ARTHROGRAPHY
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 25246
|
| Min. Negotiated Rate |
$69.10 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$92.59
|
| Rate for Payer: Aetna Medicare |
$71.86
|
| Rate for Payer: BCBS Complete |
$114.40
|
| Rate for Payer: BCBS MAPPO |
$69.10
|
| Rate for Payer: BCN Medicare Advantage |
$69.10
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$92.59
|
| Rate for Payer: Cofinity Commercial |
$99.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.56
|
| Rate for Payer: Nomi Health Commercial |
$82.92
|
| Rate for Payer: PACE SWMI |
$69.10
|
| Rate for Payer: PHP Medicare Advantage |
$69.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.90
|
| Rate for Payer: Priority Health Medicare |
$69.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.10
|
| Rate for Payer: UHC Exchange |
$69.10
|
| Rate for Payer: UHC Medicare Advantage |
$69.10
|
|
|
PR INJECT NERV BLCK,CERV PLEXUS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 64413
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 27096
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Commercial |
$106.13
|
| Rate for Payer: Aetna Medicare |
$82.37
|
| Rate for Payer: BCBS Complete |
$258.40
|
| Rate for Payer: BCBS MAPPO |
$79.20
|
| Rate for Payer: BCN Medicare Advantage |
$79.20
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cofinity Commercial |
$106.13
|
| Rate for Payer: Cofinity Commercial |
$114.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.16
|
| Rate for Payer: Nomi Health Commercial |
$95.04
|
| Rate for Payer: PACE SWMI |
$79.20
|
| Rate for Payer: PHP Medicare Advantage |
$79.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.90
|
| Rate for Payer: Priority Health Medicare |
$79.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.20
|
| Rate for Payer: UHC Exchange |
$79.20
|
| Rate for Payer: UHC Medicare Advantage |
$79.20
|
|
|
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 |
$0.59 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$0.59
|
| Rate for Payer: BCN Medicare Advantage |
$0.59
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Cofinity Commercial |
$0.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.62
|
| Rate for Payer: Nomi Health Commercial |
$0.71
|
| Rate for Payer: PACE SWMI |
$0.59
|
| Rate for Payer: PHP Medicare Advantage |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$0.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.59
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Medicare Advantage |
$0.59
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,275.10
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$510.04 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Aetna Medicare |
$637.55
|
| Rate for Payer: BCBS Complete |
$510.04
|
| Rate for Payer: Cash Price |
$1,020.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.82
|
|
|
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 |
$525.76
|
| 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 |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.69
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| 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 |
$500.69
|
| 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 |
$500.69
|
| Rate for Payer: VA VA |
$318.75
|
| 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
|
| Min. Negotiated Rate |
$510.04 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Aetna Medicare |
$637.55
|
| Rate for Payer: BCBS Complete |
$510.04
|
| Rate for Payer: Cash Price |
$1,020.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.82
|
|
|
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 HEPARIN SODIUM PER 1000U
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1644
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.28
|
| Rate for Payer: Aetna Medicare |
$0.22
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.21
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Cofinity Commercial |
$0.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.22
|
| Rate for Payer: Nomi Health Commercial |
$0.25
|
| Rate for Payer: PACE SWMI |
$0.21
|
| Rate for Payer: PHP Medicare Advantage |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.21
|
| Rate for Payer: UHC Exchange |
$0.21
|
| Rate for Payer: UHC Medicare Advantage |
$0.21
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$24.27
|
| Rate for Payer: Cofinity Commercial |
$26.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.02
|
| Rate for Payer: Nomi Health Commercial |
$21.73
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$18.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.11
|
| Rate for Payer: UHC Exchange |
$18.11
|
| Rate for Payer: UHC Medicare Advantage |
$18.11
|
|
|
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
|
|
