|
PR INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 20551
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$52.78
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS Trust/PPO |
$24.96
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.52
|
| Rate for Payer: Priority Health Narrow Network |
$58.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.68
|
| Rate for Payer: UHC Exchange |
$49.68
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
|
|
PR INJECTION SINUS TRACT DIAGNOSTIC
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 20501
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$211.59 |
| Rate for Payer: Aetna Commercial |
$49.72
|
| Rate for Payer: Aetna Medicare |
$141.50
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$211.59
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.45
|
| Rate for Payer: Priority Health Narrow Network |
$54.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.94
|
| Rate for Payer: UHC Exchange |
$47.94
|
| Rate for Payer: UHCCP Medicaid |
$22.79
|
|
|
PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 20500
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna Commercial |
$115.24
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$61.28
|
| Rate for Payer: BCBS Trust/PPO |
$556.70
|
| Rate for Payer: BCN Commercial |
$181.79
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Meridian Medicaid |
$61.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.88
|
| Rate for Payer: Priority Health Narrow Network |
$136.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.80
|
| Rate for Payer: UHC Exchange |
$104.80
|
| Rate for Payer: UHCCP Medicaid |
$58.36
|
|
|
PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Professional
|
Both
|
$156.00
|
|
|
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: Aetna Medicare |
$78.00
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| 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 |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Meridian Medicaid |
$98.27
|
| Rate for Payer: Meridian Medicaid |
$98.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.75
|
| Rate for Payer: Priority Health Narrow Network |
$80.75
|
| Rate for Payer: Priority Health Narrow Network |
$80.75
|
| Rate for Payer: UHCCP Medicaid |
$93.59
|
| Rate for Payer: UHCCP Medicaid |
$93.59
|
|
|
PR INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 20526
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$106.97 |
| Rate for Payer: Aetna Commercial |
$76.12
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.51
|
| Rate for Payer: Priority Health Narrow Network |
$86.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.40
|
| Rate for Payer: UHC Exchange |
$66.40
|
| Rate for Payer: UHCCP Medicaid |
$36.42
|
|
|
PR INJECTION THRU KIDNEY TUBE FOR XRAY
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 50394
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Medicare |
$119.50
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
|
|
PR INJECTION TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 30200
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$504.53 |
| Rate for Payer: Aetna Commercial |
$73.33
|
| Rate for Payer: Aetna Medicare |
$108.50
|
| Rate for Payer: BCBS Complete |
$40.93
|
| Rate for Payer: BCBS Trust/PPO |
$504.53
|
| Rate for Payer: BCN Commercial |
$131.93
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Meridian Medicaid |
$40.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.43
|
| Rate for Payer: Priority Health Narrow Network |
$83.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.67
|
| Rate for Payer: UHC Exchange |
$65.67
|
| Rate for Payer: UHCCP Medicaid |
$38.98
|
|
|
PR INJECTION WRIST ARTHROGRAPHY
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 25246
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$2,365.73 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Medicare |
$143.00
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,365.73
|
| Rate for Payer: BCN Commercial |
$290.27
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.91
|
| Rate for Payer: Priority Health Narrow Network |
$109.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.93
|
| Rate for Payer: UHC Exchange |
$91.93
|
| Rate for Payer: UHCCP Medicaid |
$46.01
|
|
|
PR INJECT NERV BLCK,CERV PLEXUS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 64413
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 27096
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$638.71 |
| Rate for Payer: Aetna Commercial |
$110.93
|
| Rate for Payer: Aetna Medicare |
$323.00
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$638.71
|
| Rate for Payer: BCN Commercial |
$237.98
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.69
|
| Rate for Payer: Priority Health Narrow Network |
$125.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.71
|
| Rate for Payer: UHC Exchange |
$83.71
|
| Rate for Payer: UHCCP Medicaid |
$53.25
|
|
|
PR INJECT THRU CHOLANGIO CATHETER
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 47505
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR INJ ENOXAPARIN SODIUM
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1650
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$0.70
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.27
|
| Rate for Payer: BCN Commercial |
$0.42
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,275.10
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Aetna Commercial |
$45.89
|
| Rate for Payer: Aetna Medicare |
$637.55
|
| Rate for Payer: BCBS Complete |
$510.04
|
| Rate for Payer: BCN Commercial |
$596.01
|
| Rate for Payer: Cash Price |
$1,020.08
|
| Rate for Payer: Cash Price |
$1,020.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.82
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$1,275.10
|
|
|
Service Code
|
HCPCS G0260
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Aetna Commercial |
$45.89
|
| Rate for Payer: Aetna Medicare |
$637.55
|
| Rate for Payer: BCBS Complete |
$510.04
|
| Rate for Payer: BCN Commercial |
$596.01
|
| Rate for Payer: Cash Price |
$1,020.08
|
| Rate for Payer: Cash Price |
$1,020.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.82
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$1,236.75
|
| Rate for Payer: ASR Commercial |
$1,236.75
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,044.10
|
| Rate for Payer: BCN Commercial |
$988.51
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$1,198.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,020.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$1,275.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,236.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$1,147.50
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,083.75
|
| Rate for Payer: Nomi Health Commercial |
$1,045.50
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.16
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$893.78
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,122.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| Min. Negotiated Rate |
$828.75 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: ASR ASR |
$1,236.75
|
| Rate for Payer: ASR Commercial |
$1,236.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,039.00
|
| Rate for Payer: BCN Commercial |
$988.51
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$1,198.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,020.00
|
| Rate for Payer: Healthscope Commercial |
$1,275.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,236.75
|
| Rate for Payer: Mclaren Commercial |
$1,147.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,083.75
|
| Rate for Payer: Nomi Health Commercial |
$1,045.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,122.00
|
|
|
PR INJ HEPARIN SODIUM PER 1000U
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1644
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.28
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.65
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.99
|
| Rate for Payer: UHC Exchange |
$17.99
|
|
|
PR INJ, METHYLPRED ACETATE 1 MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1010
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.14
|
| Rate for Payer: UHC Exchange |
$0.14
|
|
|
PR INJ, METHYLPRED SOD SUCC 5MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2919
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
|
|
PR INJ PROGESTERONE PER 50 MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J2675
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.73
|
| Rate for Payer: UHC Exchange |
$0.73
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$764.36
|
| Rate for Payer: ASR Commercial |
$764.36
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$645.29
|
| Rate for Payer: BCN Commercial |
$610.94
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$740.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$788.00
|
| Rate for Payer: Healthscope Whirlpool |
$764.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$709.20
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.80
|
| Rate for Payer: Nomi Health Commercial |
$646.16
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.45
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$552.39
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$672.53 |
| Rate for Payer: Aetna Commercial |
$41.33
|
| Rate for Payer: Aetna Medicare |
$394.00
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.70
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.24
|
| Rate for Payer: Priority Health Narrow Network |
$63.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.79
|
| Rate for Payer: UHC Exchange |
$44.79
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$672.53 |
| Rate for Payer: Aetna Commercial |
$41.33
|
| Rate for Payer: Aetna Medicare |
$394.00
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.70
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.24
|
| Rate for Payer: Priority Health Narrow Network |
$63.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.79
|
| Rate for Payer: UHC Exchange |
$44.79
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
38792
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$512.20 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: ASR ASR |
$764.36
|
| Rate for Payer: ASR Commercial |
$764.36
|
| Rate for Payer: BCBS Trust/PPO |
$642.14
|
| Rate for Payer: BCN Commercial |
$610.94
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$740.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.40
|
| Rate for Payer: Healthscope Commercial |
$788.00
|
| Rate for Payer: Healthscope Whirlpool |
$764.36
|
| Rate for Payer: Mclaren Commercial |
$709.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.80
|
| Rate for Payer: Nomi Health Commercial |
$646.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.44
|
|
