|
PR INJECTION SINUS TRACT DIAGNOSTIC
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 20501
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$211.59 |
| Rate for Payer: Aetna Commercial |
$48.27
|
| Rate for Payer: Aetna Medicare |
$36.02
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS MAPPO |
$36.02
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$211.59
|
| Rate for Payer: BCN Medicare Advantage |
$36.02
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$51.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.02
|
| Rate for Payer: Healthscope Commercial |
$43.22
|
| Rate for Payer: Healthscope Whirlpool |
$43.22
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.82
|
| Rate for Payer: PACE SWMI |
$36.02
|
| Rate for Payer: PHP Medicare Advantage |
$36.02
|
| 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 Medicare |
$36.02
|
| Rate for Payer: Priority Health Narrow Network |
$55.15
|
| Rate for Payer: UHC Medicare Advantage |
$37.10
|
|
|
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 |
$116.49
|
| Rate for Payer: Aetna Medicare |
$86.93
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS MAPPO |
$86.93
|
| Rate for Payer: BCBS Trust/PPO |
$556.70
|
| Rate for Payer: BCN Commercial |
$181.79
|
| Rate for Payer: BCN Medicare Advantage |
$86.93
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$125.18
|
| Rate for Payer: Cofinity Commercial |
$116.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.93
|
| Rate for Payer: Healthscope Commercial |
$104.32
|
| Rate for Payer: Healthscope Whirlpool |
$104.32
|
| Rate for Payer: Meridian Medicaid |
$60.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.28
|
| Rate for Payer: PACE SWMI |
$86.93
|
| Rate for Payer: PHP Medicare Advantage |
$86.93
|
| 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 Medicare |
$86.93
|
| Rate for Payer: Priority Health Narrow Network |
$135.83
|
| Rate for Payer: UHC Medicare Advantage |
$89.54
|
|
|
PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Professional
|
Both
|
$153.00
|
|
|
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: BCN Commercial |
$345.09
|
| Rate for Payer: BCN Commercial |
$345.09
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$122.40
|
| 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
|
|
|
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 |
$75.47
|
| Rate for Payer: Aetna Medicare |
$56.32
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCBS MAPPO |
$56.32
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: BCN Medicare Advantage |
$56.32
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$81.10
|
| Rate for Payer: Cofinity Commercial |
$75.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.32
|
| Rate for Payer: Healthscope Commercial |
$67.58
|
| Rate for Payer: Healthscope Whirlpool |
$67.58
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.14
|
| Rate for Payer: PACE SWMI |
$56.32
|
| Rate for Payer: PHP Medicare Advantage |
$56.32
|
| 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 Medicare |
$56.32
|
| Rate for Payer: Priority Health Narrow Network |
$86.81
|
| Rate for Payer: UHC Medicare Advantage |
$58.01
|
|
|
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
|
|
|
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 |
$77.61
|
| Rate for Payer: Aetna Medicare |
$57.92
|
| Rate for Payer: BCBS Complete |
$40.26
|
| Rate for Payer: BCBS MAPPO |
$57.92
|
| Rate for Payer: BCBS Trust/PPO |
$504.53
|
| Rate for Payer: BCN Commercial |
$131.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.92
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Cofinity Commercial |
$83.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.92
|
| Rate for Payer: Healthscope Commercial |
$69.50
|
| Rate for Payer: Healthscope Whirlpool |
$69.50
|
| Rate for Payer: Meridian Medicaid |
$40.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.82
|
| Rate for Payer: PACE SWMI |
$57.92
|
| Rate for Payer: PHP Medicare Advantage |
$57.92
|
| 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 Medicare |
$57.92
|
| Rate for Payer: Priority Health Narrow Network |
$82.42
|
| Rate for Payer: UHC Medicare Advantage |
$59.66
|
|
|
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 |
$95.85
|
| Rate for Payer: Aetna Medicare |
$71.53
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,365.73
|
| Rate for Payer: BCN Commercial |
$290.27
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$103.00
|
| Rate for Payer: Cofinity Commercial |
$95.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$85.84
|
| Rate for Payer: Healthscope Whirlpool |
$85.84
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.11
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| 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 Medicare |
$71.53
|
| Rate for Payer: Priority Health Narrow Network |
$109.79
|
| Rate for Payer: UHC Medicare Advantage |
$73.68
|
|
|
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
|
|
|
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 |
$108.38
|
| Rate for Payer: Aetna Medicare |
$80.88
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS MAPPO |
$80.88
|
| Rate for Payer: BCBS Trust/PPO |
$638.71
|
| Rate for Payer: BCN Commercial |
$237.98
|
| Rate for Payer: BCN Medicare Advantage |
$80.88
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Cofinity Commercial |
$116.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.88
|
| Rate for Payer: Healthscope Commercial |
$97.06
|
| Rate for Payer: Healthscope Whirlpool |
$97.06
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.92
|
| Rate for Payer: PACE SWMI |
$80.88
|
| Rate for Payer: PHP Medicare Advantage |
$80.88
|
| 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 Medicare |
$80.88
|
| Rate for Payer: Priority Health Narrow Network |
$125.10
|
| Rate for Payer: UHC Medicare Advantage |
$83.31
|
|
|
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
|
|
|
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 |
$0.91
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.27
|
| Rate for Payer: BCN Commercial |
$0.42
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$0.97
|
| Rate for Payer: Cofinity Commercial |
$0.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$0.81
|
| Rate for Payer: Healthscope Whirlpool |
$0.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.70
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
IP
|
$1,250.10
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$875.07 |
| Max. Negotiated Rate |
$1,250.10 |
| Rate for Payer: Aetna Commercial |
$1,125.09
|
| Rate for Payer: ASR ASR |
$1,212.60
|
| Rate for Payer: BCBS Trust/PPO |
$969.20
|
| Rate for Payer: BCN Commercial |
$969.20
|
| Rate for Payer: Cash Price |
$1,000.08
|
| Rate for Payer: Cofinity Commercial |
$1,175.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.08
|
| Rate for Payer: Healthscope Commercial |
$1,250.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,212.60
|
| Rate for Payer: Mclaren Commercial |
$1,125.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,062.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$875.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,100.09
|
|
|
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 |
$1,250.10 |
| Rate for Payer: Aetna Commercial |
$1,125.09
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: ASR ASR |
$1,212.60
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$969.20
|
| Rate for Payer: BCN Commercial |
$969.20
|
| 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 |
$1,175.09
|
| 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 |
$1,250.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,212.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Commercial |
$1,125.09
|
| 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 |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| 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 |
$1,137.59
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$887.57
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,100.09
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
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 |
$0.35
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Cofinity Commercial |
$0.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.32
|
| Rate for Payer: Healthscope Whirlpool |
$0.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.27
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Aetna Medicare |
$17.18
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$17.18
|
| Rate for Payer: BCBS Trust/PPO |
$17.65
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$24.73
|
| Rate for Payer: Cofinity Commercial |
$23.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Healthscope Whirlpool |
$20.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.03
|
| Rate for Payer: PACE SWMI |
$17.18
|
| Rate for Payer: PHP Medicare Advantage |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Medicare |
$17.18
|
| Rate for Payer: UHC Medicare Advantage |
$17.69
|
|
|
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 |
$1.30
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Healthscope Commercial |
$1.16
|
| Rate for Payer: Healthscope Whirlpool |
$1.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$0.97
|
| Rate for Payer: UHC Medicare Advantage |
$1.00
|
|
|
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 |
$42.93
|
| Rate for Payer: Aetna Medicare |
$32.04
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$32.04
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.70
|
| Rate for Payer: BCN Medicare Advantage |
$32.04
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$46.14
|
| Rate for Payer: Cofinity Commercial |
$42.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Whirlpool |
$38.45
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.64
|
| Rate for Payer: PACE SWMI |
$32.04
|
| Rate for Payer: PHP Medicare Advantage |
$32.04
|
| 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 Medicare |
$32.04
|
| Rate for Payer: Priority Health Narrow Network |
$69.53
|
| Rate for Payer: UHC Medicare Advantage |
$33.00
|
|
|
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 |
$200.54 |
| Max. Negotiated Rate |
$773.00 |
| Rate for Payer: Aetna Commercial |
$695.70
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$749.81
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$599.31
|
| Rate for Payer: BCN Commercial |
$599.31
|
| 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 |
$726.62
|
| 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 |
$773.00
|
| Rate for Payer: Healthscope Whirlpool |
$749.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$695.70
|
| 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 |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| 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 |
$703.43
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$548.83
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$680.24
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
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 |
$541.10 |
| Max. Negotiated Rate |
$773.00 |
| Rate for Payer: Aetna Commercial |
$695.70
|
| Rate for Payer: ASR ASR |
$749.81
|
| Rate for Payer: BCBS Trust/PPO |
$599.31
|
| Rate for Payer: BCN Commercial |
$599.31
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$726.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.40
|
| Rate for Payer: Healthscope Commercial |
$773.00
|
| Rate for Payer: Healthscope Whirlpool |
$749.81
|
| Rate for Payer: Mclaren Commercial |
$695.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$680.24
|
|
|
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 |
$42.93
|
| Rate for Payer: Aetna Medicare |
$32.04
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$32.04
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.70
|
| Rate for Payer: BCN Medicare Advantage |
$32.04
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$46.14
|
| Rate for Payer: Cofinity Commercial |
$42.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Whirlpool |
$38.45
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.64
|
| Rate for Payer: PACE SWMI |
$32.04
|
| Rate for Payer: PHP Medicare Advantage |
$32.04
|
| 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 Medicare |
$32.04
|
| Rate for Payer: Priority Health Narrow Network |
$69.53
|
| Rate for Payer: UHC Medicare Advantage |
$33.00
|
|
|
PR INJ, RIMABOTULINUMTOXINB
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J0587
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Medicare |
$12.72
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$12.72
|
| Rate for Payer: BCBS Trust/PPO |
$13.27
|
| Rate for Payer: BCN Commercial |
$12.93
|
| Rate for Payer: BCN Medicare Advantage |
$12.72
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$18.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.72
|
| Rate for Payer: Healthscope Commercial |
$15.27
|
| Rate for Payer: Healthscope Whirlpool |
$15.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.36
|
| Rate for Payer: PACE SWMI |
$12.72
|
| Rate for Payer: PHP Medicare Advantage |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health Medicare |
$12.72
|
| Rate for Payer: UHC Medicare Advantage |
$13.10
|
|
|
PR INJ RISPERDAL CONSTA, 0.5 MG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2794
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$17.31 |
| Rate for Payer: Aetna Commercial |
$16.11
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$12.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.80
|
| Rate for Payer: BCN Medicare Advantage |
$12.02
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.02
|
| Rate for Payer: Healthscope Commercial |
$14.43
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.62
|
| Rate for Payer: PACE SWMI |
$12.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health Medicare |
$12.02
|
| Rate for Payer: UHC Medicare Advantage |
$12.38
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J3111
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna Commercial |
$13.89
|
| Rate for Payer: Aetna Medicare |
$10.37
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$10.92
|
| Rate for Payer: BCN Commercial |
$10.08
|
| Rate for Payer: BCN Medicare Advantage |
$10.37
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$13.89
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$12.44
|
| Rate for Payer: Healthscope Whirlpool |
$12.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.89
|
| Rate for Payer: PACE SWMI |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.70
|
| Rate for Payer: Priority Health Medicare |
$10.37
|
| Rate for Payer: UHC Medicare Advantage |
$10.68
|
|
|
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 |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS MAPPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.03
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.03
|
| Rate for Payer: Healthscope Commercial |
$0.03
|
| Rate for Payer: Healthscope Whirlpool |
$0.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: PACE SWMI |
$0.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.11
|
| Rate for Payer: Priority Health Medicare |
$0.03
|
| Rate for Payer: UHC Medicare Advantage |
$0.03
|
|
|
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
|
|
