|
PR INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 20527
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$83.00
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS Trust/PPO |
$52.64
|
| Rate for Payer: BCN Commercial |
$128.52
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.25
|
| Rate for Payer: Priority Health Narrow Network |
$100.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.98
|
| Rate for Payer: UHC Exchange |
$76.98
|
| Rate for Payer: UHCCP Medicaid |
$42.39
|
|
|
PR INJECTION EPIDURAL BLOOD/CLOT PATCH
|
Professional
|
Both
|
$471.00
|
|
|
Service Code
|
HCPCS 62273
|
| Min. Negotiated Rate |
$72.21 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Aetna Commercial |
$145.25
|
| Rate for Payer: Aetna Medicare |
$235.50
|
| Rate for Payer: BCBS Complete |
$75.82
|
| Rate for Payer: BCBS Trust/PPO |
$645.05
|
| Rate for Payer: BCN Commercial |
$271.19
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Meridian Medicaid |
$75.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.66
|
| Rate for Payer: Priority Health Narrow Network |
$191.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.69
|
| Rate for Payer: UHC Exchange |
$131.69
|
| Rate for Payer: UHCCP Medicaid |
$72.21
|
|
|
PR INJECTION INTRALESIONAL >7 LESIONS
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 11901
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$185.19 |
| Rate for Payer: Aetna Commercial |
$50.17
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$30.20
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$82.07
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Meridian Medicaid |
$30.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.96
|
| Rate for Payer: Priority Health Narrow Network |
$60.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.75
|
| Rate for Payer: UHC Exchange |
$52.75
|
| Rate for Payer: UHCCP Medicaid |
$28.76
|
|
|
PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 11900
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$32.33
|
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: BCBS Complete |
$19.68
|
| Rate for Payer: BCBS Trust/PPO |
$206.51
|
| Rate for Payer: BCN Commercial |
$67.15
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Meridian Medicaid |
$19.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.19
|
| Rate for Payer: Priority Health Narrow Network |
$40.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.83
|
| Rate for Payer: UHC Exchange |
$33.83
|
| Rate for Payer: UHCCP Medicaid |
$18.74
|
|
|
PR INJECTION KNEE ARTHROGRAPHY
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 27370
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Medicare |
$143.00
|
| Rate for Payer: BCBS Complete |
$114.40
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.90
|
|
|
PR INJECTION,ONABOTULINUMTOXINA
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0585
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$6.52 |
| Rate for Payer: Aetna Commercial |
$6.52
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.27
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.38
|
| Rate for Payer: UHC Exchange |
$6.38
|
|
|
PR INJECTION, PLATELET RICH PLASMA, ANY SITE INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00671
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
PR INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 24220
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$281.97 |
| Rate for Payer: Aetna Commercial |
$90.48
|
| Rate for Payer: Aetna Medicare |
$143.50
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$70.79
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.73
|
| Rate for Payer: Priority Health Narrow Network |
$99.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.56
|
| Rate for Payer: UHC Exchange |
$83.56
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
|
|
PR INJECTION PROCEDURE FOR PEYRONIE DISEASE
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 54200
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$189.66 |
| Rate for Payer: Aetna Commercial |
$107.78
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: BCBS Trust/PPO |
$189.66
|
| Rate for Payer: BCN Commercial |
$169.08
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Meridian Medicaid |
$59.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.61
|
| Rate for Payer: Priority Health Narrow Network |
$140.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.23
|
| Rate for Payer: UHC Exchange |
$99.23
|
| Rate for Payer: UHCCP Medicaid |
$57.08
|
|
|
PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 62284
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$499.24 |
| Rate for Payer: Aetna Commercial |
$109.22
|
| Rate for Payer: Aetna Medicare |
$301.00
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$499.24
|
| Rate for Payer: BCN Commercial |
$308.31
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.91
|
| Rate for Payer: Priority Health Narrow Network |
$139.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.44
|
| Rate for Payer: UHC Exchange |
$105.44
|
| Rate for Payer: UHCCP Medicaid |
$52.61
|
|
|
PR INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 62290
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$210.47
|
| Rate for Payer: Aetna Medicare |
$720.00
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCBS Trust/PPO |
$675.17
|
| Rate for Payer: BCN Commercial |
$565.52
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$936.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.31
|
| Rate for Payer: Priority Health Narrow Network |
$263.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.33
|
| Rate for Payer: UHC Exchange |
$200.33
|
| Rate for Payer: UHCCP Medicaid |
$99.68
|
|
|
PR INJECTION PX ONLY MAMMARY DUCTOGRAM/GALACTOGRAM
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 19030
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$242.39 |
| Rate for Payer: Aetna Commercial |
$82.84
|
| Rate for Payer: Aetna Medicare |
$165.00
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS Trust/PPO |
$13.78
|
| Rate for Payer: BCN Commercial |
$242.39
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.69
|
| Rate for Payer: Priority Health Narrow Network |
$100.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.91
|
| Rate for Payer: UHC Exchange |
$87.91
|
| Rate for Payer: UHCCP Medicaid |
$47.71
|
|
|
PR INJECTION PX PEYRONIE DS W/SURG EXPOSURE PLAQUE
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 54205
|
| Min. Negotiated Rate |
$342.50 |
| Max. Negotiated Rate |
$851.63 |
| Rate for Payer: Aetna Commercial |
$681.56
|
| Rate for Payer: Aetna Medicare |
$545.50
|
| Rate for Payer: BCBS Complete |
$359.62
|
| Rate for Payer: BCBS Trust/PPO |
$414.72
|
| Rate for Payer: BCN Commercial |
$769.17
|
| Rate for Payer: Cash Price |
$872.80
|
| Rate for Payer: Cash Price |
$872.80
|
| Rate for Payer: Meridian Medicaid |
$359.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$851.63
|
| Rate for Payer: Priority Health Narrow Network |
$851.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$643.03
|
| Rate for Payer: UHC Exchange |
$643.03
|
| Rate for Payer: UHCCP Medicaid |
$342.50
|
|
|
PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 36002
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$797.73 |
| Rate for Payer: Aetna Commercial |
$138.71
|
| Rate for Payer: Aetna Medicare |
$228.00
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCBS Trust/PPO |
$797.73
|
| Rate for Payer: BCN Commercial |
$221.37
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.74
|
| Rate for Payer: Priority Health Narrow Network |
$162.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.68
|
| Rate for Payer: UHC Exchange |
$141.68
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 36471
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$751.77 |
| Rate for Payer: Aetna Commercial |
$101.56
|
| Rate for Payer: Aetna Medicare |
$169.00
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Trust/PPO |
$751.77
|
| Rate for Payer: BCN Commercial |
$234.81
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.60
|
| Rate for Payer: Priority Health Narrow Network |
$118.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.49
|
| Rate for Payer: UHC Exchange |
$127.49
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$304.20
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$327.86
|
| Rate for Payer: ASR Commercial |
$327.86
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$276.79
|
| Rate for Payer: BCN Commercial |
$262.05
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$317.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$338.00
|
| Rate for Payer: Healthscope Whirlpool |
$327.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$304.20
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.30
|
| Rate for Payer: Nomi Health Commercial |
$277.16
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.16
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$236.94
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$751.77 |
| Rate for Payer: Aetna Commercial |
$101.56
|
| Rate for Payer: Aetna Medicare |
$169.00
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Trust/PPO |
$751.77
|
| Rate for Payer: BCN Commercial |
$234.81
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.60
|
| Rate for Payer: Priority Health Narrow Network |
$118.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.49
|
| Rate for Payer: UHC Exchange |
$127.49
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna Commercial |
$304.20
|
| Rate for Payer: ASR ASR |
$327.86
|
| Rate for Payer: ASR Commercial |
$327.86
|
| Rate for Payer: BCBS Trust/PPO |
$275.44
|
| Rate for Payer: BCN Commercial |
$262.05
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$317.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Healthscope Commercial |
$338.00
|
| Rate for Payer: Healthscope Whirlpool |
$327.86
|
| Rate for Payer: Mclaren Commercial |
$304.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.30
|
| Rate for Payer: Nomi Health Commercial |
$277.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.44
|
|
|
PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 36470
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$701.05 |
| Rate for Payer: Aetna Commercial |
$51.69
|
| Rate for Payer: Aetna Medicare |
$135.00
|
| Rate for Payer: BCBS Complete |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$701.05
|
| Rate for Payer: BCN Commercial |
$135.86
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Meridian Medicaid |
$25.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.56
|
| Rate for Payer: Priority Health Narrow Network |
$59.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.16
|
| Rate for Payer: UHC Exchange |
$90.16
|
| Rate for Payer: UHCCP Medicaid |
$24.28
|
|
|
PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 46500
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$3,628.89 |
| Rate for Payer: Aetna Commercial |
$245.44
|
| Rate for Payer: Aetna Medicare |
$174.50
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,628.89
|
| Rate for Payer: BCN Commercial |
$463.76
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Meridian Medicaid |
$125.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.51
|
| Rate for Payer: Priority Health Narrow Network |
$330.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.79
|
| Rate for Payer: UHC Exchange |
$147.79
|
| Rate for Payer: UHCCP Medicaid |
$119.07
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$116.40
|
| Rate for Payer: ASR Commercial |
$116.40
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$98.27
|
| Rate for Payer: BCN Commercial |
$93.04
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$112.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$120.00
|
| Rate for Payer: Healthscope Whirlpool |
$116.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$108.00
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.00
|
| Rate for Payer: Nomi Health Commercial |
$98.40
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.07
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$323.26
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: ASR ASR |
$116.40
|
| Rate for Payer: ASR Commercial |
$116.40
|
| Rate for Payer: BCBS Trust/PPO |
$97.79
|
| Rate for Payer: BCN Commercial |
$93.04
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$112.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.00
|
| Rate for Payer: Healthscope Commercial |
$120.00
|
| Rate for Payer: Healthscope Whirlpool |
$116.40
|
| Rate for Payer: Mclaren Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.00
|
| Rate for Payer: Nomi Health Commercial |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.60
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 20552
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: Aetna Medicare |
$60.00
|
| Rate for Payer: BCBS Complete |
$24.38
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Meridian Medicaid |
$24.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.98
|
| Rate for Payer: Priority Health Narrow Network |
$55.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.09
|
| Rate for Payer: UHC Exchange |
$43.09
|
| Rate for Payer: UHCCP Medicaid |
$23.22
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
20552
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: Aetna Medicare |
$60.00
|
| Rate for Payer: BCBS Complete |
$24.38
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Meridian Medicaid |
$24.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.98
|
| Rate for Payer: Priority Health Narrow Network |
$55.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.09
|
| Rate for Payer: UHC Exchange |
$43.09
|
| Rate for Payer: UHCCP Medicaid |
$23.22
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 20553
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$92.30 |
| Rate for Payer: Aetna Commercial |
$57.07
|
| Rate for Payer: Aetna Medicare |
$71.00
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.61
|
| Rate for Payer: Priority Health Narrow Network |
$63.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.93
|
| Rate for Payer: UHC Exchange |
$47.93
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
