|
PR INJECTION EPIDURAL BLOOD/CLOT PATCH
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 62273
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Medicare |
$110.82
|
| Rate for Payer: BCBS Complete |
$75.37
|
| Rate for Payer: BCBS MAPPO |
$110.82
|
| Rate for Payer: BCBS Trust/PPO |
$645.05
|
| Rate for Payer: BCN Commercial |
$271.19
|
| Rate for Payer: BCN Medicare Advantage |
$110.82
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$159.58
|
| Rate for Payer: Cofinity Commercial |
$148.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.82
|
| Rate for Payer: Healthscope Commercial |
$132.98
|
| Rate for Payer: Healthscope Whirlpool |
$132.98
|
| Rate for Payer: Meridian Medicaid |
$75.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$116.36
|
| Rate for Payer: PACE SWMI |
$110.82
|
| Rate for Payer: PHP Medicare Advantage |
$110.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.11
|
| Rate for Payer: Priority Health Medicare |
$110.82
|
| Rate for Payer: Priority Health Narrow Network |
$189.11
|
| Rate for Payer: UHC Medicare Advantage |
$114.14
|
|
|
PR INJECTION INTRALESIONAL >7 LESIONS
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 11901
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$185.19 |
| Rate for Payer: Aetna Commercial |
$59.68
|
| Rate for Payer: Aetna Medicare |
$44.54
|
| Rate for Payer: BCBS Complete |
$30.20
|
| Rate for Payer: BCBS MAPPO |
$44.54
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$82.07
|
| Rate for Payer: BCN Medicare Advantage |
$44.54
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$64.14
|
| Rate for Payer: Cofinity Commercial |
$59.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$53.45
|
| Rate for Payer: Healthscope Whirlpool |
$53.45
|
| Rate for Payer: Meridian Medicaid |
$30.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.77
|
| Rate for Payer: PACE SWMI |
$44.54
|
| Rate for Payer: PHP Medicare Advantage |
$44.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.49
|
| Rate for Payer: Priority Health Medicare |
$44.54
|
| Rate for Payer: Priority Health Narrow Network |
$55.49
|
| Rate for Payer: UHC Medicare Advantage |
$45.88
|
|
|
PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 11900
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$206.51
|
| Rate for Payer: BCN Commercial |
$67.15
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$42.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$35.26
|
| Rate for Payer: Healthscope Whirlpool |
$35.26
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.58
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health Narrow Network |
$36.58
|
| Rate for Payer: UHC Medicare Advantage |
$30.26
|
|
|
PR INJECTION KNEE ARTHROGRAPHY
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 27370
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: BCBS Complete |
$112.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.00
|
|
|
PR INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 19030
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$242.39 |
| Rate for Payer: Aetna Commercial |
$100.94
|
| Rate for Payer: Aetna Medicare |
$75.33
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS MAPPO |
$75.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.78
|
| Rate for Payer: BCN Commercial |
$242.39
|
| Rate for Payer: BCN Medicare Advantage |
$75.33
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$108.48
|
| Rate for Payer: Cofinity Commercial |
$100.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.33
|
| Rate for Payer: Healthscope Commercial |
$90.40
|
| Rate for Payer: Healthscope Whirlpool |
$90.40
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.10
|
| Rate for Payer: PACE SWMI |
$75.33
|
| Rate for Payer: PHP Medicare Advantage |
$75.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.90
|
| Rate for Payer: Priority Health Medicare |
$75.33
|
| Rate for Payer: Priority Health Narrow Network |
$92.90
|
| Rate for Payer: UHC Medicare Advantage |
$77.59
|
|
|
PR INJECTION,ONABOTULINUMTOXINA
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0585
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$6.39
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$6.39
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.27
|
| Rate for Payer: BCN Medicare Advantage |
$6.39
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.39
|
| Rate for Payer: Healthscope Commercial |
$7.67
|
| Rate for Payer: Healthscope Whirlpool |
$7.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.71
|
| Rate for Payer: PACE SWMI |
$6.39
|
| Rate for Payer: PHP Medicare Advantage |
$6.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health Medicare |
$6.39
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
|
|
PR INJECTION PEYRONIE DISEASE
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 54200
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$189.66 |
| Rate for Payer: Aetna Commercial |
$111.85
|
| Rate for Payer: Aetna Medicare |
$83.47
|
| Rate for Payer: BCBS Complete |
$59.04
|
| Rate for Payer: BCBS MAPPO |
$83.47
|
| Rate for Payer: BCBS Trust/PPO |
$189.66
|
| Rate for Payer: BCN Commercial |
$169.08
|
| Rate for Payer: BCN Medicare Advantage |
$83.47
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$120.20
|
| Rate for Payer: Cofinity Commercial |
$111.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.47
|
| Rate for Payer: Healthscope Commercial |
$100.16
|
| Rate for Payer: Healthscope Whirlpool |
$100.16
|
| Rate for Payer: Meridian Medicaid |
$59.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.64
|
| Rate for Payer: PACE SWMI |
$83.47
|
| Rate for Payer: PHP Medicare Advantage |
$83.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.87
|
| Rate for Payer: Priority Health Medicare |
$83.47
|
| Rate for Payer: Priority Health Narrow Network |
$138.87
|
| Rate for Payer: UHC Medicare Advantage |
$85.97
|
|
|
PR INJECTION, PLATELET RICH PLASMA, ANY SITE INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 00671
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
|
|
PR INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 24220
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$281.97 |
| Rate for Payer: Aetna Commercial |
$87.84
|
| Rate for Payer: Aetna Medicare |
$65.55
|
| Rate for Payer: BCBS Complete |
$43.84
|
| Rate for Payer: BCBS MAPPO |
$65.55
|
| Rate for Payer: BCBS Trust/PPO |
$70.79
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Medicare Advantage |
$65.55
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Cofinity Commercial |
$87.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$78.66
|
| Rate for Payer: Healthscope Whirlpool |
$78.66
|
| Rate for Payer: Meridian Medicaid |
$43.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.83
|
| Rate for Payer: PACE SWMI |
$65.55
|
| Rate for Payer: PHP Medicare Advantage |
$65.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.60
|
| Rate for Payer: Priority Health Medicare |
$65.55
|
| Rate for Payer: Priority Health Narrow Network |
$100.60
|
| Rate for Payer: UHC Medicare Advantage |
$67.52
|
|
|
PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 62284
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$499.24 |
| Rate for Payer: Aetna Commercial |
$110.58
|
| Rate for Payer: Aetna Medicare |
$82.52
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS MAPPO |
$82.52
|
| Rate for Payer: BCBS Trust/PPO |
$499.24
|
| Rate for Payer: BCN Commercial |
$308.31
|
| Rate for Payer: BCN Medicare Advantage |
$82.52
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cofinity Commercial |
$110.58
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.52
|
| Rate for Payer: Healthscope Commercial |
$99.02
|
| Rate for Payer: Healthscope Whirlpool |
$99.02
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.65
|
| Rate for Payer: PACE SWMI |
$82.52
|
| Rate for Payer: PHP Medicare Advantage |
$82.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.99
|
| Rate for Payer: Priority Health Medicare |
$82.52
|
| Rate for Payer: Priority Health Narrow Network |
$140.99
|
| Rate for Payer: UHC Medicare Advantage |
$85.00
|
|
|
PR INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
HCPCS 62290
|
| Min. Negotiated Rate |
$98.62 |
| Max. Negotiated Rate |
$988.40 |
| Rate for Payer: Aetna Commercial |
$206.51
|
| Rate for Payer: Aetna Medicare |
$154.11
|
| Rate for Payer: BCBS Complete |
$103.55
|
| Rate for Payer: BCBS MAPPO |
$154.11
|
| Rate for Payer: BCBS Trust/PPO |
$675.17
|
| Rate for Payer: BCN Commercial |
$565.52
|
| Rate for Payer: BCN Medicare Advantage |
$154.11
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Cofinity Commercial |
$221.92
|
| Rate for Payer: Cofinity Commercial |
$206.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.11
|
| Rate for Payer: Healthscope Commercial |
$184.93
|
| Rate for Payer: Healthscope Whirlpool |
$184.93
|
| Rate for Payer: Meridian Medicaid |
$103.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.82
|
| Rate for Payer: PACE SWMI |
$154.11
|
| Rate for Payer: PHP Medicare Advantage |
$154.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.30
|
| Rate for Payer: Priority Health Medicare |
$154.11
|
| Rate for Payer: Priority Health Narrow Network |
$263.30
|
| Rate for Payer: UHC Medicare Advantage |
$158.73
|
|
|
PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 36002
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$797.73 |
| Rate for Payer: Aetna Commercial |
$136.75
|
| Rate for Payer: Aetna Medicare |
$102.05
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$102.05
|
| Rate for Payer: BCBS Trust/PPO |
$797.73
|
| Rate for Payer: BCN Commercial |
$221.37
|
| Rate for Payer: BCN Medicare Advantage |
$102.05
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cofinity Commercial |
$146.95
|
| Rate for Payer: Cofinity Commercial |
$136.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.05
|
| Rate for Payer: Healthscope Commercial |
$122.46
|
| Rate for Payer: Healthscope Whirlpool |
$122.46
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.15
|
| Rate for Payer: PACE SWMI |
$102.05
|
| Rate for Payer: PHP Medicare Advantage |
$102.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.77
|
| Rate for Payer: Priority Health Medicare |
$102.05
|
| Rate for Payer: Priority Health Narrow Network |
$162.77
|
| Rate for Payer: UHC Medicare Advantage |
$105.11
|
|
|
PR INJECTION, REMDESIVIR, 1 MG
|
Professional
|
Both
|
$16.32
|
|
|
Service Code
|
HCPCS J0248
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna Medicare |
$6.06
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS MAPPO |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$5.61
|
| Rate for Payer: BCN Medicare Advantage |
$6.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$8.72
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.06
|
| Rate for Payer: Healthscope Commercial |
$7.27
|
| Rate for Payer: Healthscope Whirlpool |
$7.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.36
|
| Rate for Payer: PACE SWMI |
$6.06
|
| Rate for Payer: PHP Medicare Advantage |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 36471
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$751.77 |
| Rate for Payer: Aetna Commercial |
$100.49
|
| Rate for Payer: Aetna Medicare |
$74.99
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS MAPPO |
$74.99
|
| Rate for Payer: BCBS Trust/PPO |
$751.77
|
| Rate for Payer: BCN Commercial |
$234.81
|
| Rate for Payer: BCN Medicare Advantage |
$74.99
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$107.99
|
| Rate for Payer: Cofinity Commercial |
$100.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.99
|
| Rate for Payer: Healthscope Commercial |
$89.99
|
| Rate for Payer: Healthscope Whirlpool |
$89.99
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.74
|
| Rate for Payer: PACE SWMI |
$74.99
|
| Rate for Payer: PHP Medicare Advantage |
$74.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.63
|
| Rate for Payer: Priority Health Medicare |
$74.99
|
| Rate for Payer: Priority Health Narrow Network |
$118.63
|
| Rate for Payer: UHC Medicare Advantage |
$77.24
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$231.70 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: ASR ASR |
$321.07
|
| Rate for Payer: BCBS Trust/PPO |
$256.62
|
| Rate for Payer: BCN Commercial |
$256.62
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$311.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.80
|
| Rate for Payer: Healthscope Commercial |
$331.00
|
| Rate for Payer: Healthscope Whirlpool |
$321.07
|
| Rate for Payer: Mclaren Commercial |
$297.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.28
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$321.07
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$256.62
|
| Rate for Payer: BCN Commercial |
$256.62
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$311.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$331.00
|
| Rate for Payer: Healthscope Whirlpool |
$321.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$297.90
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.35
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.21
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$235.01
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.28
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$751.77 |
| Rate for Payer: Aetna Commercial |
$100.49
|
| Rate for Payer: Aetna Medicare |
$74.99
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS MAPPO |
$74.99
|
| Rate for Payer: BCBS Trust/PPO |
$751.77
|
| Rate for Payer: BCN Commercial |
$234.81
|
| Rate for Payer: BCN Medicare Advantage |
$74.99
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$100.49
|
| Rate for Payer: Cofinity Commercial |
$107.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.99
|
| Rate for Payer: Healthscope Commercial |
$89.99
|
| Rate for Payer: Healthscope Whirlpool |
$89.99
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.74
|
| Rate for Payer: PACE SWMI |
$74.99
|
| Rate for Payer: PHP Medicare Advantage |
$74.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.63
|
| Rate for Payer: Priority Health Medicare |
$74.99
|
| Rate for Payer: Priority Health Narrow Network |
$118.63
|
| Rate for Payer: UHC Medicare Advantage |
$77.24
|
|
|
PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 36470
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$701.05 |
| Rate for Payer: Aetna Commercial |
$51.47
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$38.41
|
| Rate for Payer: BCBS Trust/PPO |
$701.05
|
| Rate for Payer: BCN Commercial |
$135.86
|
| Rate for Payer: BCN Medicare Advantage |
$38.41
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$55.31
|
| Rate for Payer: Cofinity Commercial |
$51.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.41
|
| Rate for Payer: Healthscope Commercial |
$46.09
|
| Rate for Payer: Healthscope Whirlpool |
$46.09
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.33
|
| Rate for Payer: PACE SWMI |
$38.41
|
| Rate for Payer: PHP Medicare Advantage |
$38.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.64
|
| Rate for Payer: Priority Health Medicare |
$38.41
|
| Rate for Payer: Priority Health Narrow Network |
$60.64
|
| Rate for Payer: UHC Medicare Advantage |
$39.56
|
|
|
PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 46500
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$3,628.89 |
| Rate for Payer: Aetna Commercial |
$238.57
|
| Rate for Payer: Aetna Medicare |
$178.04
|
| Rate for Payer: BCBS Complete |
$123.90
|
| Rate for Payer: BCBS MAPPO |
$178.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,628.89
|
| Rate for Payer: BCN Commercial |
$463.76
|
| Rate for Payer: BCN Medicare Advantage |
$178.04
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Cofinity Commercial |
$256.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.04
|
| Rate for Payer: Healthscope Commercial |
$213.65
|
| Rate for Payer: Healthscope Whirlpool |
$213.65
|
| Rate for Payer: Meridian Medicaid |
$123.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.94
|
| Rate for Payer: PACE SWMI |
$178.04
|
| Rate for Payer: PHP Medicare Advantage |
$178.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.32
|
| Rate for Payer: Priority Health Medicare |
$178.04
|
| Rate for Payer: Priority Health Narrow Network |
$326.32
|
| Rate for Payer: UHC Medicare Advantage |
$183.38
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$377.64 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: ASR ASR |
$114.46
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$91.49
|
| Rate for Payer: BCN Commercial |
$91.49
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$110.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$118.00
|
| Rate for Payer: Healthscope Whirlpool |
$114.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$106.20
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.30
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.64
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$302.11
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.84
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 20552
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$82.60 |
| Rate for Payer: Aetna Commercial |
$48.78
|
| Rate for Payer: Aetna Medicare |
$36.40
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: BCBS MAPPO |
$36.40
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: BCN Medicare Advantage |
$36.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$52.42
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.40
|
| Rate for Payer: Healthscope Commercial |
$43.68
|
| Rate for Payer: Healthscope Whirlpool |
$43.68
|
| Rate for Payer: Meridian Medicaid |
$24.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.22
|
| Rate for Payer: PACE SWMI |
$36.40
|
| Rate for Payer: PHP Medicare Advantage |
$36.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.18
|
| Rate for Payer: Priority Health Medicare |
$36.40
|
| Rate for Payer: Priority Health Narrow Network |
$56.18
|
| Rate for Payer: UHC Medicare Advantage |
$37.49
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: ASR ASR |
$114.46
|
| Rate for Payer: BCBS Trust/PPO |
$91.49
|
| Rate for Payer: BCN Commercial |
$91.49
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$110.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Healthscope Commercial |
$118.00
|
| Rate for Payer: Healthscope Whirlpool |
$114.46
|
| Rate for Payer: Mclaren Commercial |
$106.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.84
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
20552
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$82.60 |
| Rate for Payer: Aetna Commercial |
$48.78
|
| Rate for Payer: Aetna Medicare |
$36.40
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: BCBS MAPPO |
$36.40
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: BCN Medicare Advantage |
$36.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Cofinity Commercial |
$52.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.40
|
| Rate for Payer: Healthscope Commercial |
$43.68
|
| Rate for Payer: Healthscope Whirlpool |
$43.68
|
| Rate for Payer: Meridian Medicaid |
$24.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.22
|
| Rate for Payer: PACE SWMI |
$36.40
|
| Rate for Payer: PHP Medicare Advantage |
$36.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.18
|
| Rate for Payer: Priority Health Medicare |
$36.40
|
| Rate for Payer: Priority Health Narrow Network |
$56.18
|
| Rate for Payer: UHC Medicare Advantage |
$37.49
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 20553
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$97.30 |
| Rate for Payer: Aetna Commercial |
$55.90
|
| Rate for Payer: Aetna Medicare |
$41.72
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$41.72
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: BCN Medicare Advantage |
$41.72
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$60.08
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.72
|
| Rate for Payer: Healthscope Commercial |
$50.06
|
| Rate for Payer: Healthscope Whirlpool |
$50.06
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.81
|
| Rate for Payer: PACE SWMI |
$41.72
|
| Rate for Payer: PHP Medicare Advantage |
$41.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$41.72
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: UHC Medicare Advantage |
$42.97
|
|
|
PR INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 20551
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$51.76
|
| Rate for Payer: Aetna Medicare |
$38.63
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS MAPPO |
$38.63
|
| Rate for Payer: BCBS Trust/PPO |
$24.96
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$38.63
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$55.63
|
| Rate for Payer: Cofinity Commercial |
$51.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.63
|
| Rate for Payer: Healthscope Commercial |
$46.36
|
| Rate for Payer: Healthscope Whirlpool |
$46.36
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.56
|
| Rate for Payer: PACE SWMI |
$38.63
|
| Rate for Payer: PHP Medicare Advantage |
$38.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.24
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow Network |
$59.24
|
| Rate for Payer: UHC Medicare Advantage |
$39.79
|
|
