|
PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 90657
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$14.78
|
| Rate for Payer: Aetna Medicare |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$11.03
|
| Rate for Payer: BCBS Trust/PPO |
$9.74
|
| Rate for Payer: BCN Commercial |
$9.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.03
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$14.78
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.03
|
| Rate for Payer: Healthscope Commercial |
$20.41
|
| Rate for Payer: Healthscope Commercial |
$17.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.06
|
| Rate for Payer: Nomi Health Commercial |
$13.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE SWMI |
$11.03
|
| Rate for Payer: PHP Medicare Advantage |
$11.03
|
| Rate for Payer: Priority Health Medicare |
$11.03
|
| Rate for Payer: Railroad Medicare Medicare |
$11.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.06
|
| Rate for Payer: UHC Core |
$10.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.03
|
| Rate for Payer: UHC Exchange |
$10.06
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 90658
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$40.83 |
| Rate for Payer: Aetna Commercial |
$29.57
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.78
|
| Rate for Payer: BCBS MAPPO |
$22.07
|
| Rate for Payer: BCBS Trust/PPO |
$19.48
|
| Rate for Payer: BCN Commercial |
$19.51
|
| Rate for Payer: BCN Medicare Advantage |
$22.07
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$29.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.07
|
| Rate for Payer: Healthscope Commercial |
$35.31
|
| Rate for Payer: Healthscope Commercial |
$40.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.06
|
| Rate for Payer: Nomi Health Commercial |
$26.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE SWMI |
$22.07
|
| Rate for Payer: PHP Medicare Advantage |
$22.07
|
| Rate for Payer: Priority Health Medicare |
$22.07
|
| Rate for Payer: Railroad Medicare Medicare |
$22.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.11
|
| Rate for Payer: UHC Core |
$20.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.07
|
| Rate for Payer: UHC Exchange |
$20.11
|
|
|
PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 90656
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Aetna Commercial |
$31.11
|
| Rate for Payer: Aetna Medicare |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.44
|
| Rate for Payer: BCBS MAPPO |
$23.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.49
|
| Rate for Payer: BCN Commercial |
$21.12
|
| Rate for Payer: BCN Medicare Advantage |
$23.22
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$31.11
|
| Rate for Payer: Cofinity Commercial |
$33.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.22
|
| Rate for Payer: Healthscope Commercial |
$37.15
|
| Rate for Payer: Healthscope Commercial |
$42.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Nomi Health Commercial |
$27.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE SWMI |
$23.22
|
| Rate for Payer: PHP Medicare Advantage |
$23.22
|
| Rate for Payer: Priority Health Medicare |
$23.22
|
| Rate for Payer: Railroad Medicare Medicare |
$23.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.07
|
| Rate for Payer: UHC Core |
$21.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.22
|
| Rate for Payer: UHC Exchange |
$21.07
|
|
|
PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 90655
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.30
|
| Rate for Payer: BCBS Trust/PPO |
$20.49
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$13.38
|
| Rate for Payer: UHC Exchange |
$13.38
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 90686
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.35
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.35
|
| Rate for Payer: UHC Core |
$22.35
|
| Rate for Payer: UHC Exchange |
$22.35
|
|
|
PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 90685
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$19.36
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.36
|
| Rate for Payer: BCBS Trust/PPO |
$22.05
|
| Rate for Payer: BCN Commercial |
$22.05
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.78
|
| Rate for Payer: UHC Core |
$22.78
|
| Rate for Payer: UHC Exchange |
$22.78
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 90687
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna Commercial |
$10.44
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.44
|
| Rate for Payer: BCBS Trust/PPO |
$9.22
|
| Rate for Payer: BCN Commercial |
$10.78
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.44
|
| Rate for Payer: UHC Core |
$10.44
|
| Rate for Payer: UHC Exchange |
$10.44
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 90688
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$21.56 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.44
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.88
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: UHC Exchange |
$20.88
|
|
|
PR IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 90653
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Aetna Commercial |
$131.53
|
| Rate for Payer: Aetna Medicare |
$102.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.35
|
| Rate for Payer: BCBS MAPPO |
$98.16
|
| Rate for Payer: BCBS Trust/PPO |
$86.23
|
| Rate for Payer: BCN Commercial |
$72.06
|
| Rate for Payer: BCN Medicare Advantage |
$98.16
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$141.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.16
|
| Rate for Payer: Healthscope Commercial |
$181.60
|
| Rate for Payer: Healthscope Commercial |
$157.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.27
|
| Rate for Payer: Nomi Health Commercial |
$117.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
| Rate for Payer: PACE SWMI |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$98.16
|
| Rate for Payer: Priority Health Medicare |
$98.16
|
| Rate for Payer: Railroad Medicare Medicare |
$98.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.23
|
| Rate for Payer: UHC Core |
$86.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$98.16
|
| Rate for Payer: UHC Exchange |
$86.23
|
|
|
PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 90662
|
| Min. Negotiated Rate |
$65.67 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Aetna Commercial |
$131.53
|
| Rate for Payer: Aetna Medicare |
$102.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.35
|
| Rate for Payer: BCBS MAPPO |
$98.16
|
| Rate for Payer: BCBS Trust/PPO |
$86.23
|
| Rate for Payer: BCN Commercial |
$72.06
|
| Rate for Payer: BCN Medicare Advantage |
$98.16
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$141.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.16
|
| Rate for Payer: Healthscope Commercial |
$181.60
|
| Rate for Payer: Healthscope Commercial |
$157.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.67
|
| Rate for Payer: Nomi Health Commercial |
$117.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.50
|
| Rate for Payer: PACE SWMI |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$98.16
|
| Rate for Payer: Priority Health Medicare |
$98.16
|
| Rate for Payer: Railroad Medicare Medicare |
$98.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.23
|
| Rate for Payer: UHC Core |
$86.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$98.16
|
| Rate for Payer: UHC Exchange |
$86.23
|
|
|
PR ILEOSCOPY STOMA W/BALLOON DILATION
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 44381
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Aetna Commercial |
$101.71
|
| Rate for Payer: Aetna Medicare |
$78.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.30
|
| Rate for Payer: BCBS Complete |
$51.89
|
| Rate for Payer: BCBS MAPPO |
$75.90
|
| Rate for Payer: BCN Commercial |
$124.99
|
| Rate for Payer: BCN Medicare Advantage |
$75.90
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$109.30
|
| Rate for Payer: Cofinity Commercial |
$101.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.90
|
| Rate for Payer: Healthscope Commercial |
$140.41
|
| Rate for Payer: Healthscope Commercial |
$121.44
|
| Rate for Payer: Mclaren Medicaid |
$49.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.69
|
| Rate for Payer: Meridian Medicaid |
$51.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.32
|
| Rate for Payer: Nomi Health Commercial |
$91.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PACE SWMI |
$75.90
|
| Rate for Payer: PHP Medicare Advantage |
$75.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$152.30
|
| Rate for Payer: Priority Health Medicare |
$75.90
|
| Rate for Payer: Priority Health SBD |
$152.30
|
| Rate for Payer: Priority Health Tiered Network |
$152.30
|
| Rate for Payer: Railroad Medicare Medicare |
$75.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.11
|
| Rate for Payer: UHC Core |
$146.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$75.90
|
| Rate for Payer: UHC Exchange |
$146.11
|
| Rate for Payer: UHC Medicaid |
$49.42
|
| Rate for Payer: UHCCP Medicaid |
$49.42
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$965.00
|
|
|
Service Code
|
HCPCS 44382
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$723.75 |
| Rate for Payer: Aetna Commercial |
$88.65
|
| Rate for Payer: Aetna Medicare |
$68.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.27
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCBS MAPPO |
$66.16
|
| Rate for Payer: BCN Commercial |
$110.05
|
| Rate for Payer: BCN Medicare Advantage |
$66.16
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cofinity Commercial |
$95.27
|
| Rate for Payer: Cofinity Commercial |
$88.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.16
|
| Rate for Payer: Healthscope Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$105.86
|
| Rate for Payer: Mclaren Medicaid |
$43.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.47
|
| Rate for Payer: Meridian Medicaid |
$45.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.76
|
| Rate for Payer: Nomi Health Commercial |
$79.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.75
|
| Rate for Payer: PACE SWMI |
$66.16
|
| Rate for Payer: PHP Medicare Advantage |
$66.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$134.10
|
| Rate for Payer: Priority Health Medicare |
$66.16
|
| Rate for Payer: Priority Health SBD |
$134.10
|
| Rate for Payer: Priority Health Tiered Network |
$134.10
|
| Rate for Payer: Railroad Medicare Medicare |
$66.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.59
|
| Rate for Payer: UHC Core |
$127.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$66.16
|
| Rate for Payer: UHC Exchange |
$127.59
|
| Rate for Payer: UHC Medicaid |
$43.24
|
| Rate for Payer: UHCCP Medicaid |
$43.24
|
|
|
PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 44384
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$275.46 |
| Rate for Payer: Aetna Commercial |
$179.40
|
| Rate for Payer: Aetna Medicare |
$139.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.79
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS MAPPO |
$133.88
|
| Rate for Payer: BCN Commercial |
$226.08
|
| Rate for Payer: BCN Medicare Advantage |
$133.88
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$192.79
|
| Rate for Payer: Cofinity Commercial |
$179.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.88
|
| Rate for Payer: Healthscope Commercial |
$247.68
|
| Rate for Payer: Healthscope Commercial |
$214.21
|
| Rate for Payer: Mclaren Medicaid |
$86.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.57
|
| Rate for Payer: Meridian Medicaid |
$90.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.93
|
| Rate for Payer: Nomi Health Commercial |
$160.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: PACE SWMI |
$133.88
|
| Rate for Payer: PHP Medicare Advantage |
$133.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$275.46
|
| Rate for Payer: Priority Health Medicare |
$133.88
|
| Rate for Payer: Priority Health SBD |
$275.46
|
| Rate for Payer: Priority Health Tiered Network |
$275.46
|
| Rate for Payer: Railroad Medicare Medicare |
$133.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.12
|
| Rate for Payer: UHC Core |
$272.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.88
|
| Rate for Payer: UHC Exchange |
$272.12
|
| Rate for Payer: UHC Medicaid |
$86.05
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$647.25 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna Medicare |
$53.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.32
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS MAPPO |
$51.61
|
| Rate for Payer: BCN Commercial |
$86.15
|
| Rate for Payer: BCN Medicare Advantage |
$51.61
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cofinity Commercial |
$74.32
|
| Rate for Payer: Cofinity Commercial |
$69.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.61
|
| Rate for Payer: Healthscope Commercial |
$95.48
|
| Rate for Payer: Healthscope Commercial |
$82.58
|
| Rate for Payer: Mclaren Medicaid |
$33.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.19
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.18
|
| Rate for Payer: Nomi Health Commercial |
$61.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.25
|
| Rate for Payer: PACE SWMI |
$51.61
|
| Rate for Payer: PHP Medicare Advantage |
$51.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$104.97
|
| Rate for Payer: Priority Health Medicare |
$51.61
|
| Rate for Payer: Priority Health SBD |
$104.97
|
| Rate for Payer: Priority Health Tiered Network |
$104.97
|
| Rate for Payer: Railroad Medicare Medicare |
$51.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.63
|
| Rate for Payer: UHC Core |
$97.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.61
|
| Rate for Payer: UHC Exchange |
$97.63
|
| Rate for Payer: UHC Medicaid |
$33.87
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
PR ILEOSCOPY,THRU STOMA,TRANSENDO STENT
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 44383
|
| Min. Negotiated Rate |
$448.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Medicare |
$560.00
|
| Rate for Payer: BCBS Complete |
$448.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$840.00
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$2,631.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$617.06 |
| Max. Negotiated Rate |
$1,973.25 |
| Rate for Payer: Aetna Commercial |
$1,287.81
|
| Rate for Payer: Aetna Medicare |
$999.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,287.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.91
|
| Rate for Payer: BCBS Complete |
$647.91
|
| Rate for Payer: BCBS MAPPO |
$961.05
|
| Rate for Payer: BCN Commercial |
$1,556.69
|
| Rate for Payer: BCN Medicare Advantage |
$961.05
|
| Rate for Payer: Cash Price |
$2,104.80
|
| Rate for Payer: Cash Price |
$2,104.80
|
| Rate for Payer: Cofinity Commercial |
$1,383.91
|
| Rate for Payer: Cofinity Commercial |
$1,287.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$961.05
|
| Rate for Payer: Healthscope Commercial |
$1,537.68
|
| Rate for Payer: Healthscope Commercial |
$1,777.94
|
| Rate for Payer: Mclaren Medicaid |
$617.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,009.10
|
| Rate for Payer: Meridian Medicaid |
$647.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,057.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,852.78
|
| Rate for Payer: Nomi Health Commercial |
$1,153.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,973.25
|
| Rate for Payer: PACE SWMI |
$961.05
|
| Rate for Payer: PHP Medicare Advantage |
$961.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$617.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,896.72
|
| Rate for Payer: Priority Health Medicare |
$961.05
|
| Rate for Payer: Priority Health SBD |
$1,896.72
|
| Rate for Payer: Priority Health Tiered Network |
$1,896.72
|
| Rate for Payer: Railroad Medicare Medicare |
$961.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,851.78
|
| Rate for Payer: UHC Core |
$1,851.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$961.05
|
| Rate for Payer: UHC Exchange |
$1,851.78
|
| Rate for Payer: UHC Medicaid |
$617.06
|
| Rate for Payer: UHCCP Medicaid |
$617.06
|
|
|
PR ILIAC ART ANGIO,CARDIAC CATH
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS G0278
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$15.81
|
| Rate for Payer: Aetna Medicare |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.99
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$11.80
|
| Rate for Payer: BCN Commercial |
$19.42
|
| Rate for Payer: BCN Medicare Advantage |
$11.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.80
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.16
|
| Rate for Payer: Nomi Health Commercial |
$14.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$11.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.58
|
| Rate for Payer: Priority Health Medicare |
$11.80
|
| Rate for Payer: Priority Health SBD |
$19.58
|
| Rate for Payer: Priority Health Tiered Network |
$19.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.08
|
| Rate for Payer: UHC Core |
$21.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.80
|
| Rate for Payer: UHC Exchange |
$21.08
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$30.38 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Medicare |
$17.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.64
|
| Rate for Payer: BCBS MAPPO |
$16.42
|
| Rate for Payer: BCN Commercial |
$19.64
|
| Rate for Payer: BCN Medicare Advantage |
$16.42
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$23.64
|
| Rate for Payer: Cofinity Commercial |
$22.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.42
|
| Rate for Payer: Healthscope Commercial |
$26.27
|
| Rate for Payer: Healthscope Commercial |
$30.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Nomi Health Commercial |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: PACE SWMI |
$16.42
|
| Rate for Payer: PHP Medicare Advantage |
$16.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$16.42
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: Priority Health Tiered Network |
$26.75
|
| Rate for Payer: Railroad Medicare Medicare |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.42
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$21.81 |
| Rate for Payer: Aetna Commercial |
$15.80
|
| Rate for Payer: Aetna Medicare |
$12.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.80
|
| Rate for Payer: BCBS MAPPO |
$11.79
|
| Rate for Payer: BCN Commercial |
$14.14
|
| Rate for Payer: BCN Medicare Advantage |
$11.79
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$15.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.79
|
| Rate for Payer: Healthscope Commercial |
$21.81
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$14.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PACE SWMI |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.53
|
| Rate for Payer: Priority Health Medicare |
$11.79
|
| Rate for Payer: Priority Health SBD |
$16.53
|
| Rate for Payer: Priority Health Tiered Network |
$16.53
|
| Rate for Payer: Railroad Medicare Medicare |
$11.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$12.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.79
|
| Rate for Payer: UHC Exchange |
$12.38
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 90471
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$38.28 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna Medicare |
$21.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.79
|
| Rate for Payer: BCBS MAPPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$27.07
|
| Rate for Payer: BCN Medicare Advantage |
$20.69
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$29.79
|
| Rate for Payer: Cofinity Commercial |
$27.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$33.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.64
|
| Rate for Payer: Nomi Health Commercial |
$24.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: PACE SWMI |
$20.69
|
| Rate for Payer: PHP Medicare Advantage |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$20.69
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: Priority Health Tiered Network |
$26.75
|
| Rate for Payer: Railroad Medicare Medicare |
$20.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.69
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 90472
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$28.03 |
| Rate for Payer: Aetna Commercial |
$20.30
|
| Rate for Payer: Aetna Medicare |
$15.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.30
|
| Rate for Payer: BCBS MAPPO |
$15.15
|
| Rate for Payer: BCN Commercial |
$17.28
|
| Rate for Payer: BCN Medicare Advantage |
$15.15
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$21.82
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.15
|
| Rate for Payer: Healthscope Commercial |
$28.03
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.67
|
| Rate for Payer: Nomi Health Commercial |
$18.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PACE SWMI |
$15.15
|
| Rate for Payer: PHP Medicare Advantage |
$15.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.20
|
| Rate for Payer: Priority Health Medicare |
$15.15
|
| Rate for Payer: Priority Health SBD |
$20.20
|
| Rate for Payer: Priority Health Tiered Network |
$20.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$12.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.15
|
| Rate for Payer: UHC Exchange |
$12.38
|
|
|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna Commercial |
$29.69
|
| Rate for Payer: Aetna Medicare |
$23.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.91
|
| Rate for Payer: BCBS MAPPO |
$22.16
|
| Rate for Payer: BCN Commercial |
$25.96
|
| Rate for Payer: BCN Medicare Advantage |
$22.16
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$31.91
|
| Rate for Payer: Cofinity Commercial |
$29.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$41.00
|
| Rate for Payer: Healthscope Commercial |
$35.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.28
|
| Rate for Payer: Nomi Health Commercial |
$26.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$22.16
|
| Rate for Payer: PHP Medicare Advantage |
$22.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$22.16
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: Priority Health Tiered Network |
$26.75
|
| Rate for Payer: Railroad Medicare Medicare |
$22.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.16
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
|
PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 90461
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$11.42
|
| Rate for Payer: Aetna Medicare |
$8.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.42
|
| Rate for Payer: BCBS MAPPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$13.80
|
| Rate for Payer: BCN Medicare Advantage |
$8.52
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$12.27
|
| Rate for Payer: Cofinity Commercial |
$11.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.52
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$15.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Nomi Health Commercial |
$10.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PACE SWMI |
$8.52
|
| Rate for Payer: PHP Medicare Advantage |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.94
|
| Rate for Payer: Priority Health Medicare |
$8.52
|
| Rate for Payer: Priority Health SBD |
$11.94
|
| Rate for Payer: Priority Health Tiered Network |
$11.94
|
| Rate for Payer: Railroad Medicare Medicare |
$8.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$12.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.52
|
| Rate for Payer: UHC Exchange |
$12.38
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
IP
|
$597.12
|
|
|
Service Code
|
NDC 76385010201
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.19 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Advantage |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.84
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health SBD |
$376.19
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
OP
|
$597.12
|
|
|
Service Code
|
NDC 76385010201
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.67 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna Medicare |
$298.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Advantage |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.84
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health SBD |
$376.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.13
|
| Rate for Payer: UHC Core |
$311.10
|
| Rate for Payer: UHC Exchange |
$234.67
|
|
