|
PR MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 39401
|
| Min. Negotiated Rate |
$195.53 |
| Max. Negotiated Rate |
$630.50 |
| Rate for Payer: Aetna Commercial |
$398.23
|
| Rate for Payer: Aetna Medicare |
$309.08
|
| Rate for Payer: BCBS Complete |
$205.31
|
| Rate for Payer: BCBS MAPPO |
$297.19
|
| Rate for Payer: BCBS Trust/PPO |
$207.62
|
| Rate for Payer: BCN Commercial |
$442.74
|
| Rate for Payer: BCN Medicare Advantage |
$297.19
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cofinity Commercial |
$427.95
|
| Rate for Payer: Cofinity Commercial |
$398.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.19
|
| Rate for Payer: Mclaren Medicaid |
$195.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.05
|
| Rate for Payer: Meridian Medicaid |
$205.31
|
| Rate for Payer: Nomi Health Commercial |
$356.63
|
| Rate for Payer: PACE SWMI |
$297.19
|
| Rate for Payer: PHP Medicare Advantage |
$297.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.50
|
| Rate for Payer: Priority Health HMO/PPO |
$484.49
|
| Rate for Payer: Priority Health Medicare |
$300.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$484.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.19
|
| Rate for Payer: UHC Exchange |
$297.19
|
| Rate for Payer: UHC Medicare Advantage |
$297.19
|
| Rate for Payer: UHCCP Medicaid |
$195.53
|
|
|
PR MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 39402
|
| Min. Negotiated Rate |
$254.96 |
| Max. Negotiated Rate |
$632.34 |
| Rate for Payer: Aetna Commercial |
$520.72
|
| Rate for Payer: Aetna Medicare |
$404.14
|
| Rate for Payer: BCBS Complete |
$267.71
|
| Rate for Payer: BCBS MAPPO |
$388.60
|
| Rate for Payer: BCBS Trust/PPO |
$487.62
|
| Rate for Payer: BCN Commercial |
$578.11
|
| Rate for Payer: BCN Medicare Advantage |
$388.60
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$559.58
|
| Rate for Payer: Cofinity Commercial |
$520.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.60
|
| Rate for Payer: Mclaren Medicaid |
$254.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.03
|
| Rate for Payer: Meridian Medicaid |
$267.71
|
| Rate for Payer: Nomi Health Commercial |
$466.32
|
| Rate for Payer: PACE SWMI |
$388.60
|
| Rate for Payer: PHP Medicare Advantage |
$388.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.25
|
| Rate for Payer: Priority Health HMO/PPO |
$632.34
|
| Rate for Payer: Priority Health Medicare |
$392.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$632.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.60
|
| Rate for Payer: UHC Exchange |
$388.60
|
| Rate for Payer: UHC Medicare Advantage |
$388.60
|
| Rate for Payer: UHCCP Medicaid |
$254.96
|
|
|
PR MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR
|
Professional
|
Both
|
$2,549.00
|
|
|
Service Code
|
HCPCS 39000
|
| Min. Negotiated Rate |
$323.97 |
| Max. Negotiated Rate |
$1,656.85 |
| Rate for Payer: Aetna Commercial |
$648.87
|
| Rate for Payer: Aetna Medicare |
$503.60
|
| Rate for Payer: BCBS Complete |
$340.17
|
| Rate for Payer: BCBS MAPPO |
$484.23
|
| Rate for Payer: BCBS Trust/PPO |
$418.94
|
| Rate for Payer: BCN Commercial |
$700.27
|
| Rate for Payer: BCN Medicare Advantage |
$484.23
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cofinity Commercial |
$697.29
|
| Rate for Payer: Cofinity Commercial |
$648.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.23
|
| Rate for Payer: Mclaren Medicaid |
$323.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.44
|
| Rate for Payer: Meridian Medicaid |
$340.17
|
| Rate for Payer: Nomi Health Commercial |
$581.08
|
| Rate for Payer: PACE SWMI |
$484.23
|
| Rate for Payer: PHP Medicare Advantage |
$484.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,656.85
|
| Rate for Payer: Priority Health HMO/PPO |
$805.72
|
| Rate for Payer: Priority Health Medicare |
$489.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$805.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.23
|
| Rate for Payer: UHC Exchange |
$484.23
|
| Rate for Payer: UHC Medicare Advantage |
$484.23
|
| Rate for Payer: UHCCP Medicaid |
$323.97
|
|
|
PR MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR
|
Professional
|
Both
|
$5,247.00
|
|
|
Service Code
|
HCPCS 39010
|
| Min. Negotiated Rate |
$502.68 |
| Max. Negotiated Rate |
$3,410.55 |
| Rate for Payer: Aetna Commercial |
$1,018.43
|
| Rate for Payer: Aetna Medicare |
$790.42
|
| Rate for Payer: BCBS Complete |
$527.81
|
| Rate for Payer: BCBS MAPPO |
$760.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,750.26
|
| Rate for Payer: BCN Commercial |
$1,138.13
|
| Rate for Payer: BCN Medicare Advantage |
$760.02
|
| Rate for Payer: Cash Price |
$4,197.60
|
| Rate for Payer: Cash Price |
$4,197.60
|
| Rate for Payer: Cofinity Commercial |
$1,018.43
|
| Rate for Payer: Cofinity Commercial |
$1,094.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.02
|
| Rate for Payer: Mclaren Medicaid |
$502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$798.02
|
| Rate for Payer: Meridian Medicaid |
$527.81
|
| Rate for Payer: Nomi Health Commercial |
$912.02
|
| Rate for Payer: PACE SWMI |
$760.02
|
| Rate for Payer: PHP Medicare Advantage |
$760.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$502.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,410.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,248.20
|
| Rate for Payer: Priority Health Medicare |
$767.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,248.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.02
|
| Rate for Payer: UHC Exchange |
$760.02
|
| Rate for Payer: UHC Medicare Advantage |
$760.02
|
| Rate for Payer: UHCCP Medicaid |
$502.68
|
|
|
PR MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 97802
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$1,112.07 |
| Rate for Payer: Aetna Commercial |
$40.45
|
| Rate for Payer: Aetna Medicare |
$31.40
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$30.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.07
|
| Rate for Payer: BCN Commercial |
$53.26
|
| Rate for Payer: BCN Medicare Advantage |
$30.19
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$40.45
|
| Rate for Payer: Cofinity Commercial |
$43.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.70
|
| Rate for Payer: Nomi Health Commercial |
$36.23
|
| Rate for Payer: PACE SWMI |
$30.19
|
| Rate for Payer: PHP Medicare Advantage |
$30.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health HMO/PPO |
$33.34
|
| Rate for Payer: Priority Health Medicare |
$30.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.19
|
| Rate for Payer: UHC Exchange |
$30.19
|
| Rate for Payer: UHC Medicare Advantage |
$30.19
|
|
|
PR MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 97803
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$561.58 |
| Rate for Payer: Aetna Commercial |
$34.22
|
| Rate for Payer: Aetna Medicare |
$26.56
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$25.54
|
| Rate for Payer: BCBS Trust/PPO |
$561.58
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$25.54
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$36.78
|
| Rate for Payer: Cofinity Commercial |
$34.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.82
|
| Rate for Payer: Nomi Health Commercial |
$30.65
|
| Rate for Payer: PACE SWMI |
$25.54
|
| Rate for Payer: PHP Medicare Advantage |
$25.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO |
$29.82
|
| Rate for Payer: Priority Health Medicare |
$25.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.54
|
| Rate for Payer: UHC Exchange |
$25.54
|
| Rate for Payer: UHC Medicare Advantage |
$25.54
|
|
|
PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 97804
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$641.36 |
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna Medicare |
$14.93
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$641.36
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: BCN Medicare Advantage |
$14.36
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.08
|
| Rate for Payer: Nomi Health Commercial |
$17.23
|
| Rate for Payer: PACE SWMI |
$14.36
|
| Rate for Payer: PHP Medicare Advantage |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO |
$15.57
|
| Rate for Payer: Priority Health Medicare |
$14.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.36
|
| Rate for Payer: UHC Exchange |
$14.36
|
| Rate for Payer: UHC Medicare Advantage |
$14.36
|
|
|
PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 93463
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$735.92 |
| Rate for Payer: Aetna Commercial |
$122.86
|
| Rate for Payer: Aetna Medicare |
$95.36
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCBS MAPPO |
$91.69
|
| Rate for Payer: BCBS Trust/PPO |
$735.92
|
| Rate for Payer: BCN Commercial |
$140.25
|
| Rate for Payer: BCN Medicare Advantage |
$91.69
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$132.03
|
| Rate for Payer: Cofinity Commercial |
$122.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.69
|
| Rate for Payer: Mclaren Medicaid |
$61.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.27
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Nomi Health Commercial |
$110.03
|
| Rate for Payer: PACE SWMI |
$91.69
|
| Rate for Payer: PHP Medicare Advantage |
$91.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO |
$134.66
|
| Rate for Payer: Priority Health Medicare |
$92.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.69
|
| Rate for Payer: UHC Exchange |
$91.69
|
| Rate for Payer: UHC Medicare Advantage |
$91.69
|
| Rate for Payer: UHCCP Medicaid |
$61.13
|
|
|
PR MEDICATION THERAPY EACH ADDITIONAL 15 MIN
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 99607
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$370.34 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$370.34
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.45
|
|
|
PR MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 99606
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$62.87 |
| Rate for Payer: Aetna Commercial |
$33.89
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$62.87
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
|
|
PR MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 99605
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$79.81 |
| Rate for Payer: Aetna Commercial |
$67.55
|
| Rate for Payer: Aetna Medicare |
$32.00
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS Trust/PPO |
$79.81
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
|
|
PR MEDROXYPROGESTERONE ACETATE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1050
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.52
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.14
|
| Rate for Payer: BCN Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
|
|
PR MEDROXYPROGESTERONE INJ
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J1051
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
PR MEDRXYPROGESTER ACETATE INJ
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS J1055
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 90734
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$151.33 |
| Rate for Payer: Aetna Commercial |
$151.33
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$147.22
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
|
|
PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 90619
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$168.36 |
| Rate for Payer: Aetna Commercial |
$159.10
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS Trust/PPO |
$168.36
|
| Rate for Payer: BCN Commercial |
$168.36
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
|
|
PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 90620
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$215.42 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: BCBS Trust/PPO |
$198.55
|
| Rate for Payer: BCN Commercial |
$198.55
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.95
|
|
|
PR MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 90621
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$183.17 |
| Rate for Payer: Aetna Commercial |
$183.17
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS Trust/PPO |
$165.84
|
| Rate for Payer: BCN Commercial |
$165.84
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
|
|
PR MEPERIDINE HYDROCHL /100 MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J2175
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Medicare |
$16.32
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$15.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: BCN Medicare Advantage |
$15.69
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$18.83
|
| Rate for Payer: PACE SWMI |
$15.69
|
| Rate for Payer: PHP Medicare Advantage |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$15.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.69
|
| Rate for Payer: UHC Exchange |
$15.69
|
| Rate for Payer: UHC Medicare Advantage |
$15.69
|
|
|
PR MEPERIDINE/PROMETHAZINE INJ
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J2180
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
|
|
PR METATARSECTOMY
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 28140
|
| Min. Negotiated Rate |
$274.34 |
| Max. Negotiated Rate |
$1,034.26 |
| Rate for Payer: Aetna Commercial |
$546.13
|
| Rate for Payer: Aetna Medicare |
$423.86
|
| Rate for Payer: BCBS Complete |
$288.06
|
| Rate for Payer: BCBS MAPPO |
$407.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.26
|
| Rate for Payer: BCN Commercial |
$830.26
|
| Rate for Payer: BCN Medicare Advantage |
$407.56
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$586.89
|
| Rate for Payer: Cofinity Commercial |
$546.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.56
|
| Rate for Payer: Mclaren Medicaid |
$274.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.94
|
| Rate for Payer: Meridian Medicaid |
$288.06
|
| Rate for Payer: Nomi Health Commercial |
$489.07
|
| Rate for Payer: PACE SWMI |
$407.56
|
| Rate for Payer: PHP Medicare Advantage |
$407.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health HMO/PPO |
$653.37
|
| Rate for Payer: Priority Health Medicare |
$411.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.56
|
| Rate for Payer: UHC Exchange |
$407.56
|
| Rate for Payer: UHC Medicare Advantage |
$407.56
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
|
|
PR METHYLPREDNISOLONE 20 MG INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1020
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna Commercial |
$7.25
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR METHYLPREDNISOLONE 40 MG INJ
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1030
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
|
|
PR METHYLPREDNISOLONE 80 MG INJ
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J1040
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$5.37
|
| Rate for Payer: BCN Commercial |
$10.71
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR METHYLPREDNISOLONE INJECTION
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J2930
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$6.06
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
