|
PR INJECTION THRU KIDNEY TUBE FOR XRAY
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 50394
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.50
|
|
|
PR INJECTION TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 30200
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Medicare |
$52.40
|
| Rate for Payer: BCBS Complete |
$36.24
|
| Rate for Payer: BCBS MAPPO |
$52.40
|
| Rate for Payer: BCN Commercial |
$71.86
|
| Rate for Payer: BCN Medicare Advantage |
$52.40
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$70.22
|
| Rate for Payer: Cofinity Commercial |
$75.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.40
|
| Rate for Payer: Healthscope Commercial |
$62.88
|
| Rate for Payer: Healthscope Whirlpool |
$62.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.02
|
| Rate for Payer: Meridian Medicaid |
$36.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.64
|
| Rate for Payer: Nomi Health Commercial |
$62.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.00
|
| Rate for Payer: PACE SWMI |
$52.40
|
| Rate for Payer: PHP Medicare Advantage |
$52.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$85.81
|
| Rate for Payer: Priority Health Medicare |
$52.40
|
| Rate for Payer: Priority Health Narrow Network |
$85.81
|
| Rate for Payer: Railroad Medicare Medicare |
$52.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52.40
|
| Rate for Payer: UHC Exchange |
$100.12
|
| Rate for Payer: UHC Medicaid |
$34.51
|
| Rate for Payer: UHCCP DNSP |
$52.40
|
| Rate for Payer: UHCCP Medicaid |
$34.51
|
|
|
PR INJECTION WRIST ARTHROGRAPHY
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 25246
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$221.25 |
| Rate for Payer: Aetna Commercial |
$82.03
|
| Rate for Payer: Aetna Medicare |
$61.22
|
| Rate for Payer: BCBS Complete |
$41.15
|
| Rate for Payer: BCBS MAPPO |
$61.22
|
| Rate for Payer: BCN Commercial |
$107.56
|
| Rate for Payer: BCN Medicare Advantage |
$61.22
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Commercial |
$82.03
|
| Rate for Payer: Cofinity Commercial |
$88.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.22
|
| Rate for Payer: Healthscope Commercial |
$73.46
|
| Rate for Payer: Healthscope Whirlpool |
$73.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.28
|
| Rate for Payer: Meridian Medicaid |
$41.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.34
|
| Rate for Payer: Nomi Health Commercial |
$73.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.25
|
| Rate for Payer: PACE SWMI |
$61.22
|
| Rate for Payer: PHP Medicare Advantage |
$61.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$114.99
|
| Rate for Payer: Priority Health Medicare |
$61.22
|
| Rate for Payer: Priority Health Narrow Network |
$114.99
|
| Rate for Payer: Railroad Medicare Medicare |
$61.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$61.22
|
| Rate for Payer: UHC Exchange |
$131.34
|
| Rate for Payer: UHC Medicaid |
$39.19
|
| Rate for Payer: UHCCP DNSP |
$61.22
|
| Rate for Payer: UHCCP Medicaid |
$39.19
|
|
|
PR INJECT NERV BLCK,CERV PLEXUS
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 64413
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
|
|
PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 27096
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$97.27
|
| Rate for Payer: Aetna Medicare |
$72.59
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS MAPPO |
$72.59
|
| Rate for Payer: BCN Commercial |
$124.50
|
| Rate for Payer: BCN Medicare Advantage |
$72.59
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$104.53
|
| Rate for Payer: Cofinity Commercial |
$97.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.59
|
| Rate for Payer: Healthscope Commercial |
$87.11
|
| Rate for Payer: Healthscope Whirlpool |
$87.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.22
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.85
|
| Rate for Payer: Nomi Health Commercial |
$87.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.75
|
| Rate for Payer: PACE SWMI |
$72.59
|
| Rate for Payer: PHP Medicare Advantage |
$72.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.09
|
| Rate for Payer: Priority Health Medicare |
$72.59
|
| Rate for Payer: Priority Health Narrow Network |
$133.09
|
| Rate for Payer: Railroad Medicare Medicare |
$72.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$72.59
|
| Rate for Payer: UHC Exchange |
$145.92
|
| Rate for Payer: UHC Medicaid |
$47.07
|
| Rate for Payer: UHCCP DNSP |
$72.59
|
| Rate for Payer: UHCCP Medicaid |
$47.07
|
|
|
PR INJECT THRU CHOLANGIO CATHETER
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 47505
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
|
|
PR INJ ENOXAPARIN SODIUM
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1650
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.54
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$0.78
|
| Rate for Payer: Cofinity Commercial |
$0.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.54
|
| Rate for Payer: Healthscope Commercial |
$0.65
|
| Rate for Payer: Healthscope Whirlpool |
$0.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.59
|
| Rate for Payer: Nomi Health Commercial |
$0.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PACE SWMI |
$0.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.54
|
| Rate for Payer: Priority Health Medicare |
$0.54
|
| Rate for Payer: Railroad Medicare Medicare |
$0.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.54
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHCCP DNSP |
$0.54
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS G0260
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$45.89
|
| Rate for Payer: BCBS Complete |
$525.20
|
| Rate for Payer: BCN Commercial |
$647.51
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$984.75
|
|
|
PR INJ, FUROSEMIDE, 1 MG
|
Professional
|
Both
|
$3.12
|
|
|
Service Code
|
HCPCS J1938
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$0.02
|
| Rate for Payer: BCBS MAPPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.02
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Healthscope Whirlpool |
$0.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.02
|
| Rate for Payer: Nomi Health Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
| Rate for Payer: PACE SWMI |
$0.02
|
| Rate for Payer: PHP Medicare Advantage |
$0.02
|
| Rate for Payer: Priority Health Medicare |
$0.02
|
| Rate for Payer: Railroad Medicare Medicare |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHCCP DNSP |
$0.02
|
|
|
PR INJ HEPARIN SODIUM PER 1000U
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1644
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.29
|
| Rate for Payer: Aetna Medicare |
$0.22
|
| Rate for Payer: BCBS MAPPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.22
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.32
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.26
|
| Rate for Payer: Healthscope Whirlpool |
$0.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.24
|
| Rate for Payer: Nomi Health Commercial |
$0.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.22
|
| Rate for Payer: PHP Medicare Advantage |
$0.22
|
| Rate for Payer: Priority Health Medicare |
$0.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.22
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHCCP DNSP |
$0.22
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$18.42
|
| Rate for Payer: BCN Commercial |
$17.55
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$26.08
|
| Rate for Payer: Cofinity Commercial |
$24.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$21.73
|
| Rate for Payer: Healthscope Whirlpool |
$21.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.92
|
| Rate for Payer: Nomi Health Commercial |
$21.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: Railroad Medicare Medicare |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.11
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHCCP DNSP |
$18.11
|
|
|
PR INJ, METHYLPRED ACETATE 1 MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1010
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.15
|
| Rate for Payer: Aetna Medicare |
$0.11
|
| Rate for Payer: BCBS MAPPO |
$0.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Medicare Advantage |
$0.11
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.16
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.11
|
| Rate for Payer: Healthscope Commercial |
$0.13
|
| Rate for Payer: Healthscope Whirlpool |
$0.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.12
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.11
|
| Rate for Payer: Priority Health Medicare |
$0.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.11
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHCCP DNSP |
$0.11
|
|
|
PR INJ, METHYLPRED SOD SUCC 5MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2919
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$0.32
|
| Rate for Payer: Aetna Medicare |
$0.24
|
| Rate for Payer: BCBS MAPPO |
$0.24
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Cofinity Commercial |
$0.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.24
|
| Rate for Payer: Healthscope Commercial |
$0.29
|
| Rate for Payer: Healthscope Whirlpool |
$0.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.26
|
| Rate for Payer: Nomi Health Commercial |
$0.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PACE SWMI |
$0.24
|
| Rate for Payer: PHP Medicare Advantage |
$0.24
|
| Rate for Payer: Priority Health Medicare |
$0.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.24
|
| Rate for Payer: UHC Exchange |
$0.26
|
| Rate for Payer: UHCCP DNSP |
$0.24
|
|
|
PR INJ PROGESTERONE PER 50 MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J2675
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.47
|
| Rate for Payer: BCN Commercial |
$0.42
|
| Rate for Payer: BCN Medicare Advantage |
$0.66
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Cofinity Commercial |
$0.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.66
|
| Rate for Payer: Healthscope Commercial |
$0.79
|
| Rate for Payer: Healthscope Whirlpool |
$0.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.73
|
| Rate for Payer: Nomi Health Commercial |
$0.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
| Rate for Payer: PACE SWMI |
$0.66
|
| Rate for Payer: PHP Medicare Advantage |
$0.66
|
| Rate for Payer: Priority Health Medicare |
$0.66
|
| Rate for Payer: Railroad Medicare Medicare |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.72
|
| Rate for Payer: UHCCP DNSP |
$0.66
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Aetna Commercial |
$36.64
|
| Rate for Payer: Aetna Medicare |
$27.34
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$27.34
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: BCN Medicare Advantage |
$27.34
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$36.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$32.81
|
| Rate for Payer: Healthscope Whirlpool |
$32.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.71
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$32.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: PACE SWMI |
$27.34
|
| Rate for Payer: PHP Medicare Advantage |
$27.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.95
|
| Rate for Payer: Priority Health Medicare |
$27.34
|
| Rate for Payer: Priority Health Narrow Network |
$62.95
|
| Rate for Payer: Railroad Medicare Medicare |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.34
|
| Rate for Payer: UHC Exchange |
$59.68
|
| Rate for Payer: UHC Medicaid |
$17.47
|
| Rate for Payer: UHCCP DNSP |
$27.34
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$812.00 |
| Rate for Payer: Aetna Commercial |
$730.80
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$787.64
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$669.49
|
| Rate for Payer: BCN Commercial |
$669.49
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$763.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$787.64
|
| Rate for Payer: Healthscope Whirlpool |
$812.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$730.80
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.20
|
| Rate for Payer: Nomi Health Commercial |
$665.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$711.47
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$569.21
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Aetna Commercial |
$36.64
|
| Rate for Payer: Aetna Medicare |
$27.34
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$27.34
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: BCN Medicare Advantage |
$27.34
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$36.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$32.81
|
| Rate for Payer: Healthscope Whirlpool |
$32.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.71
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$32.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
| Rate for Payer: PACE SWMI |
$27.34
|
| Rate for Payer: PHP Medicare Advantage |
$27.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.95
|
| Rate for Payer: Priority Health Medicare |
$27.34
|
| Rate for Payer: Priority Health Narrow Network |
$62.95
|
| Rate for Payer: Railroad Medicare Medicare |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.34
|
| Rate for Payer: UHC Exchange |
$59.68
|
| Rate for Payer: UHC Medicaid |
$17.47
|
| Rate for Payer: UHCCP DNSP |
$27.34
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$609.00 |
| Max. Negotiated Rate |
$812.00 |
| Rate for Payer: Aetna Commercial |
$730.80
|
| Rate for Payer: ASR ASR |
$787.64
|
| Rate for Payer: BCBS Trust/PPO |
$666.81
|
| Rate for Payer: BCN Commercial |
$666.81
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$763.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.60
|
| Rate for Payer: Healthscope Commercial |
$787.64
|
| Rate for Payer: Healthscope Whirlpool |
$812.00
|
| Rate for Payer: Mclaren Commercial |
$730.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.20
|
| Rate for Payer: Nomi Health Commercial |
$665.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.00
|
|
|
PR INJ, REMDESIVIR, 1 MG
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS J0248
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$9.25
|
| Rate for Payer: Aetna Medicare |
$6.90
|
| Rate for Payer: BCBS MAPPO |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$7.02
|
| Rate for Payer: BCN Commercial |
$6.47
|
| Rate for Payer: BCN Medicare Advantage |
$6.90
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$9.94
|
| Rate for Payer: Cofinity Commercial |
$9.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Healthscope Whirlpool |
$8.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.59
|
| Rate for Payer: Nomi Health Commercial |
$8.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.50
|
| Rate for Payer: PACE SWMI |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$6.90
|
| Rate for Payer: Priority Health Medicare |
$6.90
|
| Rate for Payer: Railroad Medicare Medicare |
$6.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.90
|
| Rate for Payer: UHC Exchange |
$6.90
|
| Rate for Payer: UHCCP DNSP |
$6.90
|
|
|
PR INJ, RIMABOTULINUMTOXINB
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J0587
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$13.53
|
| Rate for Payer: BCN Commercial |
$13.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$15.94
|
| Rate for Payer: Healthscope Whirlpool |
$15.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.61
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.28
|
| Rate for Payer: UHC Exchange |
$13.29
|
| Rate for Payer: UHCCP DNSP |
$13.28
|
|
|
PR INJ RISPERDAL CONSTA, 0.5 MG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2794
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$10.97
|
| Rate for Payer: BCN Commercial |
$10.16
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.96
|
| Rate for Payer: Healthscope Whirlpool |
$12.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.88
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.00
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.80
|
| Rate for Payer: UHC Exchange |
$11.18
|
| Rate for Payer: UHCCP DNSP |
$10.80
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J3111
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Commercial |
$16.33
|
| Rate for Payer: Aetna Medicare |
$12.19
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.33
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$17.55
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Healthscope Commercial |
$14.63
|
| Rate for Payer: Healthscope Whirlpool |
$14.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.41
|
| Rate for Payer: Nomi Health Commercial |
$14.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.25
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.19
|
| Rate for Payer: UHC Exchange |
$12.11
|
| Rate for Payer: UHCCP DNSP |
$12.19
|
|
|
PR INJ TESTOSTERONE CYPIONATE
|
Professional
|
Both
|
$0.16
|
|
|
Service Code
|
HCPCS J1071
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$0.02
|
| Rate for Payer: BCBS MAPPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.02
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Healthscope Whirlpool |
$0.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.02
|
| Rate for Payer: Nomi Health Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.12
|
| Rate for Payer: PACE SWMI |
$0.02
|
| Rate for Payer: PHP Medicare Advantage |
$0.02
|
| Rate for Payer: Priority Health Medicare |
$0.02
|
| Rate for Payer: Railroad Medicare Medicare |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHCCP DNSP |
$0.02
|
|
|
PR INJ, TRIVISC 1 MG
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS J7329
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$18.17 |
| Rate for Payer: Aetna Commercial |
$4.38
|
| Rate for Payer: Aetna Medicare |
$3.27
|
| Rate for Payer: BCBS MAPPO |
$3.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Medicare Advantage |
$3.27
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Healthscope Whirlpool |
$3.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE SWMI |
$3.27
|
| Rate for Payer: PHP Medicare Advantage |
$3.27
|
| Rate for Payer: Priority Health Medicare |
$3.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.27
|
| Rate for Payer: UHC Exchange |
$3.61
|
| Rate for Payer: UHCCP DNSP |
$3.27
|
|
|
PR INPT/ED TELECONSULT30
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS G0425
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Aetna Commercial |
$112.29
|
| Rate for Payer: Aetna Medicare |
$83.80
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS MAPPO |
$83.80
|
| Rate for Payer: BCN Commercial |
$136.95
|
| Rate for Payer: BCN Medicare Advantage |
$83.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$120.67
|
| Rate for Payer: Cofinity Commercial |
$112.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.80
|
| Rate for Payer: Healthscope Commercial |
$100.56
|
| Rate for Payer: Healthscope Whirlpool |
$100.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.99
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.18
|
| Rate for Payer: Nomi Health Commercial |
$100.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.25
|
| Rate for Payer: PACE SWMI |
$83.80
|
| Rate for Payer: PHP Medicare Advantage |
$83.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123.18
|
| Rate for Payer: Priority Health Medicare |
$83.80
|
| Rate for Payer: Priority Health Narrow Network |
$123.18
|
| Rate for Payer: Railroad Medicare Medicare |
$83.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.80
|
| Rate for Payer: UHC Exchange |
$160.05
|
| Rate for Payer: UHC Medicaid |
$53.68
|
| Rate for Payer: UHCCP DNSP |
$83.80
|
| Rate for Payer: UHCCP Medicaid |
$53.68
|
|
