|
PR INJ IRON DEXTRAN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J1750
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| 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: Nomi Health Commercial |
$21.73
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.11
|
| Rate for Payer: UHC Medicare Advantage |
$18.11
|
| Rate for Payer: UHCCP DNSP |
$18.11
|
|
|
PR INJ, METHYLPRED ACETATE 1 MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1010
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.12
|
| Rate for Payer: Healthscope Commercial |
$0.14
|
| Rate for Payer: Healthscope Whirlpool |
$0.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.13
|
| Rate for Payer: Nomi Health Commercial |
$0.14
|
| Rate for Payer: PACE SWMI |
$0.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.12
|
| Rate for Payer: UHC Medicare Advantage |
$0.12
|
| Rate for Payer: UHCCP DNSP |
$0.12
|
|
|
PR INJ, METHYLPRED SOD SUCC 5MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2919
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$0.28
|
| Rate for Payer: Aetna Medicare |
$0.21
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.21
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Cofinity Commercial |
$0.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.21
|
| Rate for Payer: Healthscope Commercial |
$0.25
|
| Rate for Payer: Healthscope Whirlpool |
$0.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.22
|
| Rate for Payer: Nomi Health Commercial |
$0.25
|
| Rate for Payer: PACE SWMI |
$0.21
|
| Rate for Payer: PHP Medicare Advantage |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health Medicare |
$0.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.21
|
| Rate for Payer: UHC Medicare Advantage |
$0.21
|
| Rate for Payer: UHCCP DNSP |
$0.21
|
|
|
PR INJ PROGESTERONE PER 50 MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J2675
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.70
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.01
|
| Rate for Payer: Cofinity Commercial |
$0.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.70
|
| Rate for Payer: Healthscope Commercial |
$0.84
|
| Rate for Payer: Healthscope Whirlpool |
$0.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: PACE SWMI |
$0.70
|
| Rate for Payer: PHP Medicare Advantage |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$0.70
|
| Rate for Payer: UHCCP DNSP |
$0.70
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$512.20 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$30.46
|
| Rate for Payer: BCBS Complete |
$315.20
|
| Rate for Payer: BCBS MAPPO |
$30.46
|
| Rate for Payer: BCN Medicare Advantage |
$30.46
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$40.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$36.55
|
| Rate for Payer: Healthscope Whirlpool |
$36.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.98
|
| Rate for Payer: Nomi Health Commercial |
$36.55
|
| Rate for Payer: PACE SWMI |
$30.46
|
| Rate for Payer: PHP Medicare Advantage |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health Medicare |
$30.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.46
|
| Rate for Payer: UHC Medicare Advantage |
$30.46
|
| Rate for Payer: UHCCP DNSP |
$30.46
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$764.36
|
| Rate for Payer: ASR Commercial |
$764.36
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$645.29
|
| Rate for Payer: BCN Commercial |
$610.94
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$788.00
|
| Rate for Payer: Healthscope Whirlpool |
$764.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$709.20
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.80
|
| Rate for Payer: Nomi Health Commercial |
$646.16
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$552.39
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$512.20 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$30.46
|
| Rate for Payer: BCBS Complete |
$315.20
|
| Rate for Payer: BCBS MAPPO |
$30.46
|
| Rate for Payer: BCN Medicare Advantage |
$30.46
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$40.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$36.55
|
| Rate for Payer: Healthscope Whirlpool |
$36.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.98
|
| Rate for Payer: Nomi Health Commercial |
$36.55
|
| Rate for Payer: PACE SWMI |
$30.46
|
| Rate for Payer: PHP Medicare Advantage |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.20
|
| Rate for Payer: Priority Health Medicare |
$30.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.46
|
| Rate for Payer: UHC Medicare Advantage |
$30.46
|
| Rate for Payer: UHCCP DNSP |
$30.46
|
|
|
PR INJ, REMDESIVIR, 1 MG
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J0248
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$9.69
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Healthscope Commercial |
$8.08
|
| Rate for Payer: Healthscope Whirlpool |
$8.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$8.08
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$6.73
|
|
|
PR INJ, RIMABOTULINUMTOXINB
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J0587
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna Medicare |
$13.29
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$13.29
|
| Rate for Payer: BCN Medicare Advantage |
$13.29
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.29
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Healthscope Whirlpool |
$15.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.95
|
| Rate for Payer: Nomi Health Commercial |
$15.95
|
| Rate for Payer: PACE SWMI |
$13.29
|
| Rate for Payer: PHP Medicare Advantage |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$13.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.29
|
| Rate for Payer: UHC Medicare Advantage |
$13.29
|
| Rate for Payer: UHCCP DNSP |
$13.29
|
|
|
PR INJ RISPERDAL CONSTA, 0.5 MG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2794
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$15.81 |
| Rate for Payer: Aetna Commercial |
$14.71
|
| Rate for Payer: Aetna Medicare |
$10.98
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$10.98
|
| Rate for Payer: BCN Medicare Advantage |
$10.98
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$13.18
|
| Rate for Payer: Healthscope Whirlpool |
$13.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.53
|
| Rate for Payer: Nomi Health Commercial |
$13.18
|
| Rate for Payer: PACE SWMI |
$10.98
|
| Rate for Payer: PHP Medicare Advantage |
$10.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$10.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.98
|
| Rate for Payer: UHC Medicare Advantage |
$10.98
|
| Rate for Payer: UHCCP DNSP |
$10.98
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J3111
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Aetna Medicare |
$12.07
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$12.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.07
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$17.38
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.07
|
| Rate for Payer: Healthscope Commercial |
$14.48
|
| Rate for Payer: Healthscope Whirlpool |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.67
|
| Rate for Payer: Nomi Health Commercial |
$14.48
|
| Rate for Payer: PACE SWMI |
$12.07
|
| Rate for Payer: PHP Medicare Advantage |
$12.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health Medicare |
$12.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.07
|
| Rate for Payer: UHC Medicare Advantage |
$12.07
|
| Rate for Payer: UHCCP DNSP |
$12.07
|
|
|
PR INJ TESTOSTERONE CYPIONATE
|
Professional
|
Both
|
$0.16
|
|
|
Service Code
|
HCPCS J1071
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| 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: 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 |
$0.04
|
| Rate for Payer: Healthscope Whirlpool |
$0.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: Nomi Health Commercial |
$0.04
|
| Rate for Payer: PACE SWMI |
$0.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.10
|
| Rate for Payer: Priority Health Medicare |
$0.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.03
|
| Rate for Payer: UHC Medicare Advantage |
$0.03
|
| Rate for Payer: UHCCP DNSP |
$0.03
|
|
|
PR INPT/ED TELECONSULT30
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS G0425
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$130.65 |
| Rate for Payer: Aetna Commercial |
$117.92
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: BCBS MAPPO |
$88.00
|
| Rate for Payer: BCN Medicare Advantage |
$88.00
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$126.72
|
| Rate for Payer: Cofinity Commercial |
$117.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$105.60
|
| Rate for Payer: Healthscope Whirlpool |
$105.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.40
|
| Rate for Payer: Nomi Health Commercial |
$105.60
|
| Rate for Payer: PACE SWMI |
$88.00
|
| Rate for Payer: PHP Medicare Advantage |
$88.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health Medicare |
$88.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.00
|
| Rate for Payer: UHC Medicare Advantage |
$88.00
|
| Rate for Payer: UHCCP DNSP |
$88.00
|
|
|
PR INPT/ED TELECONSULT50
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS G0426
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$178.57 |
| Rate for Payer: Aetna Commercial |
$166.17
|
| Rate for Payer: Aetna Medicare |
$124.01
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$124.01
|
| Rate for Payer: BCN Medicare Advantage |
$124.01
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$178.57
|
| Rate for Payer: Cofinity Commercial |
$166.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.01
|
| Rate for Payer: Healthscope Commercial |
$148.81
|
| Rate for Payer: Healthscope Whirlpool |
$148.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.21
|
| Rate for Payer: Nomi Health Commercial |
$148.81
|
| Rate for Payer: PACE SWMI |
$124.01
|
| Rate for Payer: PHP Medicare Advantage |
$124.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$124.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.01
|
| Rate for Payer: UHC Medicare Advantage |
$124.01
|
| Rate for Payer: UHCCP DNSP |
$124.01
|
|
|
PR INPT/ED TELECONSULT70
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS G0427
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$262.60 |
| Rate for Payer: Aetna Commercial |
$236.43
|
| Rate for Payer: Aetna Medicare |
$176.44
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS MAPPO |
$176.44
|
| Rate for Payer: BCN Medicare Advantage |
$176.44
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$254.07
|
| Rate for Payer: Cofinity Commercial |
$236.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.44
|
| Rate for Payer: Healthscope Commercial |
$211.73
|
| Rate for Payer: Healthscope Whirlpool |
$211.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.26
|
| Rate for Payer: Nomi Health Commercial |
$211.73
|
| Rate for Payer: PACE SWMI |
$176.44
|
| Rate for Payer: PHP Medicare Advantage |
$176.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health Medicare |
$176.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.44
|
| Rate for Payer: UHC Medicare Advantage |
$176.44
|
| Rate for Payer: UHCCP DNSP |
$176.44
|
|
|
PR INPT/TELE FOLLOW UP 25
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS G0407
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$92.12
|
| Rate for Payer: Aetna Medicare |
$68.75
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$68.75
|
| Rate for Payer: BCN Medicare Advantage |
$68.75
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.75
|
| Rate for Payer: Healthscope Commercial |
$82.50
|
| Rate for Payer: Healthscope Whirlpool |
$82.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.19
|
| Rate for Payer: Nomi Health Commercial |
$82.50
|
| Rate for Payer: PACE SWMI |
$68.75
|
| Rate for Payer: PHP Medicare Advantage |
$68.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Medicare |
$68.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.75
|
| Rate for Payer: UHC Medicare Advantage |
$68.75
|
| Rate for Payer: UHCCP DNSP |
$68.75
|
|
|
PR INPT/TELE FOLLOW UP 35
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G0408
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$142.76 |
| Rate for Payer: Aetna Commercial |
$132.85
|
| Rate for Payer: Aetna Medicare |
$99.14
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$99.14
|
| Rate for Payer: BCN Medicare Advantage |
$99.14
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Cofinity Commercial |
$132.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.14
|
| Rate for Payer: Healthscope Commercial |
$118.97
|
| Rate for Payer: Healthscope Whirlpool |
$118.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.10
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE SWMI |
$99.14
|
| Rate for Payer: PHP Medicare Advantage |
$99.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$99.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.14
|
| Rate for Payer: UHC Medicare Advantage |
$99.14
|
| Rate for Payer: UHCCP DNSP |
$99.14
|
|
|
PR INSERT CANNULA PROLONG CP INSUFF
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 36822
|
| Min. Negotiated Rate |
$632.80 |
| Max. Negotiated Rate |
$1,028.30 |
| Rate for Payer: Aetna Medicare |
$791.00
|
| Rate for Payer: BCBS Complete |
$632.80
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.30
|
|
|
PR INSERT GASTROSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 49440
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$276.44 |
| Rate for Payer: Aetna Commercial |
$257.24
|
| Rate for Payer: Aetna Medicare |
$191.97
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$191.97
|
| Rate for Payer: BCN Medicare Advantage |
$191.97
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$276.44
|
| Rate for Payer: Cofinity Commercial |
$257.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.97
|
| Rate for Payer: Healthscope Commercial |
$230.36
|
| Rate for Payer: Healthscope Whirlpool |
$230.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.57
|
| Rate for Payer: Nomi Health Commercial |
$230.36
|
| Rate for Payer: PACE SWMI |
$191.97
|
| Rate for Payer: PHP Medicare Advantage |
$191.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$191.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.97
|
| Rate for Payer: UHC Medicare Advantage |
$191.97
|
| Rate for Payer: UHCCP DNSP |
$191.97
|
|
|
PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY
|
Professional
|
Both
|
$1,714.00
|
|
|
Service Code
|
HCPCS 19340
|
| Min. Negotiated Rate |
$685.60 |
| Max. Negotiated Rate |
$1,114.10 |
| Rate for Payer: Aetna Commercial |
$975.45
|
| Rate for Payer: Aetna Medicare |
$727.95
|
| Rate for Payer: BCBS Complete |
$685.60
|
| Rate for Payer: BCBS MAPPO |
$727.95
|
| Rate for Payer: BCN Medicare Advantage |
$727.95
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cofinity Commercial |
$975.45
|
| Rate for Payer: Cofinity Commercial |
$1,048.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$727.95
|
| Rate for Payer: Healthscope Commercial |
$873.54
|
| Rate for Payer: Healthscope Whirlpool |
$873.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.35
|
| Rate for Payer: Nomi Health Commercial |
$873.54
|
| Rate for Payer: PACE SWMI |
$727.95
|
| Rate for Payer: PHP Medicare Advantage |
$727.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,114.10
|
| Rate for Payer: Priority Health Medicare |
$727.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$727.95
|
| Rate for Payer: UHC Medicare Advantage |
$727.95
|
| Rate for Payer: UHCCP DNSP |
$727.95
|
|
|
PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 59200
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$102.70 |
| Rate for Payer: Aetna Commercial |
$88.37
|
| Rate for Payer: Aetna Medicare |
$65.95
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$65.95
|
| Rate for Payer: BCN Medicare Advantage |
$65.95
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$94.97
|
| Rate for Payer: Cofinity Commercial |
$88.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.95
|
| Rate for Payer: Healthscope Commercial |
$79.14
|
| Rate for Payer: Healthscope Whirlpool |
$79.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.25
|
| Rate for Payer: Nomi Health Commercial |
$79.14
|
| Rate for Payer: PACE SWMI |
$65.95
|
| Rate for Payer: PHP Medicare Advantage |
$65.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$65.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.95
|
| Rate for Payer: UHC Medicare Advantage |
$65.95
|
| Rate for Payer: UHCCP DNSP |
$65.95
|
|
|
PR INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 11981
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$147.55 |
| Rate for Payer: Aetna Commercial |
$81.42
|
| Rate for Payer: Aetna Medicare |
$60.76
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$60.76
|
| Rate for Payer: BCN Medicare Advantage |
$60.76
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$87.49
|
| Rate for Payer: Cofinity Commercial |
$81.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$72.91
|
| Rate for Payer: Healthscope Whirlpool |
$72.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.80
|
| Rate for Payer: Nomi Health Commercial |
$72.91
|
| Rate for Payer: PACE SWMI |
$60.76
|
| Rate for Payer: PHP Medicare Advantage |
$60.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health Medicare |
$60.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.76
|
| Rate for Payer: UHC Medicare Advantage |
$60.76
|
| Rate for Payer: UHCCP DNSP |
$60.76
|
|
|
PR INSERTION EPICARDIAL ELECTRODE OPEN
|
Professional
|
Both
|
$2,372.00
|
|
|
Service Code
|
HCPCS 33202
|
| Min. Negotiated Rate |
$738.87 |
| Max. Negotiated Rate |
$1,541.80 |
| Rate for Payer: Aetna Commercial |
$990.09
|
| Rate for Payer: Aetna Medicare |
$738.87
|
| Rate for Payer: BCBS Complete |
$948.80
|
| Rate for Payer: BCBS MAPPO |
$738.87
|
| Rate for Payer: BCN Medicare Advantage |
$738.87
|
| Rate for Payer: Cash Price |
$1,897.60
|
| Rate for Payer: Cash Price |
$1,897.60
|
| Rate for Payer: Cofinity Commercial |
$990.09
|
| Rate for Payer: Cofinity Commercial |
$1,063.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$738.87
|
| Rate for Payer: Healthscope Commercial |
$886.64
|
| Rate for Payer: Healthscope Whirlpool |
$886.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$775.81
|
| Rate for Payer: Nomi Health Commercial |
$886.64
|
| Rate for Payer: PACE SWMI |
$738.87
|
| Rate for Payer: PHP Medicare Advantage |
$738.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,541.80
|
| Rate for Payer: Priority Health Medicare |
$738.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$738.87
|
| Rate for Payer: UHC Medicare Advantage |
$738.87
|
| Rate for Payer: UHCCP DNSP |
$738.87
|
|
|
PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
HCPCS 93503
|
| Min. Negotiated Rate |
$83.22 |
| Max. Negotiated Rate |
$554.45 |
| Rate for Payer: Aetna Commercial |
$111.51
|
| Rate for Payer: Aetna Medicare |
$83.22
|
| Rate for Payer: BCBS Complete |
$341.20
|
| Rate for Payer: BCBS MAPPO |
$83.22
|
| Rate for Payer: BCN Medicare Advantage |
$83.22
|
| Rate for Payer: Cash Price |
$682.40
|
| Rate for Payer: Cash Price |
$682.40
|
| Rate for Payer: Cofinity Commercial |
$119.84
|
| Rate for Payer: Cofinity Commercial |
$111.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.22
|
| Rate for Payer: Healthscope Commercial |
$99.86
|
| Rate for Payer: Healthscope Whirlpool |
$99.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.38
|
| Rate for Payer: Nomi Health Commercial |
$99.86
|
| Rate for Payer: PACE SWMI |
$83.22
|
| Rate for Payer: PHP Medicare Advantage |
$83.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.45
|
| Rate for Payer: Priority Health Medicare |
$83.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.22
|
| Rate for Payer: UHC Medicare Advantage |
$83.22
|
| Rate for Payer: UHCCP DNSP |
$83.22
|
|
