|
PR INJECTION SINUS TRACT DIAGNOSTIC
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 20501
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$193.90 |
| Rate for Payer: Aetna Commercial |
$49.72
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.15
|
| Rate for Payer: Priority Health Narrow Network |
$55.15
|
| Rate for Payer: Priority Health SBD |
$55.15
|
| Rate for Payer: UMR Bronson Commercial |
$127.42
|
|
|
PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 20500
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna Commercial |
$115.24
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS Trust/PPO |
$556.70
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Meridian Medicaid |
$60.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.83
|
| Rate for Payer: Priority Health Narrow Network |
$135.83
|
| Rate for Payer: Priority Health SBD |
$135.83
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 36468
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$1,096.22 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: BCBS Complete |
$98.27
|
| Rate for Payer: BCBS Complete |
$98.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.22
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Meridian Medicaid |
$98.27
|
| Rate for Payer: Meridian Medicaid |
$98.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.75
|
| Rate for Payer: Priority Health Narrow Network |
$80.75
|
| Rate for Payer: Priority Health Narrow Network |
$80.75
|
| Rate for Payer: Priority Health SBD |
$80.75
|
| Rate for Payer: Priority Health SBD |
$80.75
|
| Rate for Payer: UMR Bronson Commercial |
$115.00
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 20526
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$76.12
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.81
|
| Rate for Payer: Priority Health Narrow Network |
$86.81
|
| Rate for Payer: Priority Health SBD |
$86.81
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR INJECTION THRU KIDNEY TUBE FOR XRAY
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 50394
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: UMR Bronson Commercial |
$107.64
|
|
|
PR INJECTION TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 30200
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$504.53 |
| Rate for Payer: Aetna Commercial |
$73.33
|
| Rate for Payer: BCBS Complete |
$40.26
|
| Rate for Payer: BCBS Trust/PPO |
$504.53
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Meridian Medicaid |
$40.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.42
|
| Rate for Payer: Priority Health Narrow Network |
$82.42
|
| Rate for Payer: Priority Health SBD |
$82.42
|
| Rate for Payer: UMR Bronson Commercial |
$97.98
|
|
|
PR INJECTION WRIST ARTHROGRAPHY
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 25246
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$2,365.73 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,365.73
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.79
|
| Rate for Payer: Priority Health Narrow Network |
$109.79
|
| Rate for Payer: Priority Health SBD |
$109.79
|
| Rate for Payer: UMR Bronson Commercial |
$128.80
|
|
|
PR INJECT NERV BLCK,CERV PLEXUS
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 64413
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: UMR Bronson Commercial |
$115.00
|
|
|
PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
HCPCS 27096
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$638.71 |
| Rate for Payer: Aetna Commercial |
$110.93
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$638.71
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.10
|
| Rate for Payer: Priority Health Narrow Network |
$125.10
|
| Rate for Payer: Priority Health SBD |
$125.10
|
| Rate for Payer: UMR Bronson Commercial |
$291.18
|
|
|
PR INJECT THRU CHOLANGIO CATHETER
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 47505
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: UMR Bronson Commercial |
$126.50
|
|
|
PR INJ ENOXAPARIN SODIUM
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1650
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$0.70
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.27
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
OP
|
$1,250.10
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$336.24 |
| Max. Negotiated Rate |
$1,935.09 |
| Rate for Payer: Aetna American Axle |
$812.56
|
| Rate for Payer: Aetna Commercial |
$1,062.58
|
| Rate for Payer: Aetna Medicare |
$639.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$568.60
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$1,000.08
|
| Rate for Payer: Cash Price |
$1,000.08
|
| Rate for Payer: Cofinity Commercial |
$1,075.09
|
| Rate for Payer: Cofinity Commercial |
$875.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$1,125.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$875.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$937.58
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,062.58
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$1,062.58
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$875.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.09
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.07
|
| Rate for Payer: Priority Health SBD |
$787.56
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.70
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: UMR Bronson Commercial |
$462.54
|
| Rate for Payer: VA VA |
$614.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$937.58
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
IP
|
$1,250.10
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$550.04 |
| Max. Negotiated Rate |
$1,125.09 |
| Rate for Payer: Aetna American Axle |
$812.56
|
| Rate for Payer: Aetna Commercial |
$1,062.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.56
|
| Rate for Payer: Cash Price |
$1,000.08
|
| Rate for Payer: Cofinity Commercial |
$1,075.09
|
| Rate for Payer: Cofinity Commercial |
$875.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.08
|
| Rate for Payer: Healthscope Commercial |
$1,125.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$875.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$937.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,062.58
|
| Rate for Payer: PHP Commercial |
$1,062.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$875.07
|
| Rate for Payer: Priority Health SBD |
$787.56
|
| Rate for Payer: UMR Bronson Commercial |
$550.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$937.58
|
|
|
PR INJ HEPARIN SODIUM PER 1000U
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1644
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna Commercial |
$0.28
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.65
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR INJ PROGESTERONE PER 50 MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J2675
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$340.12 |
| Max. Negotiated Rate |
$695.70 |
| Rate for Payer: Aetna American Axle |
$502.45
|
| Rate for Payer: Aetna Commercial |
$657.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.45
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$541.10
|
| Rate for Payer: Cofinity Commercial |
$664.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.40
|
| Rate for Payer: Healthscope Commercial |
$695.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.05
|
| Rate for Payer: PHP Commercial |
$657.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health SBD |
$486.99
|
| Rate for Payer: UMR Bronson Commercial |
$340.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.75
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$1,154.12 |
| Rate for Payer: Aetna American Axle |
$502.45
|
| Rate for Payer: Aetna Commercial |
$657.05
|
| Rate for Payer: Aetna Medicare |
$381.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$139.79
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$664.78
|
| Rate for Payer: Cofinity Commercial |
$541.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$695.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.75
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.05
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$657.05
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,154.12
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$923.30
|
| Rate for Payer: Priority Health SBD |
$486.99
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.61
|
| Rate for Payer: UHC Exchange |
$31.11
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: UMR Bronson Commercial |
$286.01
|
| Rate for Payer: VA VA |
$366.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.75
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$672.53 |
| Rate for Payer: Aetna Commercial |
$41.33
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.53
|
| Rate for Payer: Priority Health Narrow Network |
$69.53
|
| Rate for Payer: Priority Health SBD |
$69.53
|
| Rate for Payer: UMR Bronson Commercial |
$355.58
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$672.53 |
| Rate for Payer: Aetna Commercial |
$41.33
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.53
|
| Rate for Payer: Priority Health Narrow Network |
$69.53
|
| Rate for Payer: Priority Health SBD |
$69.53
|
| Rate for Payer: UMR Bronson Commercial |
$355.58
|
|
|
PR INJ, RIMABOTULINUMTOXINB
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J0587
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Aetna Commercial |
$13.42
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$13.27
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: UMR Bronson Commercial |
$6.44
|
|
|
PR INJ RISPERDAL CONSTA, 0.5 MG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2794
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$12.52 |
| Rate for Payer: Aetna Commercial |
$12.52
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J3111
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$11.05
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.92
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.70
|
| Rate for Payer: UMR Bronson Commercial |
$5.06
|
|
|
PR INJ TESTOSTERONE CYPIONATE
|
Professional
|
Both
|
$0.16
|
|
|
Service Code
|
HCPCS J1071
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.11
|
| Rate for Payer: UMR Bronson Commercial |
$0.07
|
|
|
PR INSERT CANNULA PROLONG CP INSUFF
|
Professional
|
Both
|
$1,551.00
|
|
|
Service Code
|
HCPCS 36822
|
| Min. Negotiated Rate |
$620.40 |
| Max. Negotiated Rate |
$1,085.70 |
| Rate for Payer: BCBS Complete |
$620.40
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,085.70
|
| Rate for Payer: UMR Bronson Commercial |
$713.46
|
|
