|
PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 90632
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$136.51 |
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Aetna Medicare |
$76.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.88
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$73.79
|
| Rate for Payer: BCN Medicare Advantage |
$73.79
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$106.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.79
|
| Rate for Payer: Healthscope Commercial |
$136.51
|
| Rate for Payer: Healthscope Commercial |
$118.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.50
|
| Rate for Payer: Nomi Health Commercial |
$88.55
|
| Rate for Payer: PACE SWMI |
$73.79
|
| Rate for Payer: PHP Medicare Advantage |
$73.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$73.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.79
|
| Rate for Payer: UHC Medicare Advantage |
$73.79
|
|
|
PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 90743
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$139.03 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Medicare |
$78.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.22
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$75.15
|
| Rate for Payer: BCN Medicare Advantage |
$75.15
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$100.70
|
| Rate for Payer: Cofinity Commercial |
$108.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.15
|
| Rate for Payer: Healthscope Commercial |
$120.24
|
| Rate for Payer: Healthscope Commercial |
$139.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Nomi Health Commercial |
$90.18
|
| Rate for Payer: PACE SWMI |
$75.15
|
| Rate for Payer: PHP Medicare Advantage |
$75.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$75.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.15
|
| Rate for Payer: UHC Medicare Advantage |
$75.15
|
|
|
PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 90739
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$328.49 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Aetna Medicare |
$184.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.93
|
| Rate for Payer: BCBS Complete |
$130.40
|
| Rate for Payer: BCBS MAPPO |
$177.56
|
| Rate for Payer: BCN Medicare Advantage |
$177.56
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cofinity Commercial |
$255.69
|
| Rate for Payer: Cofinity Commercial |
$237.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.56
|
| Rate for Payer: Healthscope Commercial |
$328.49
|
| Rate for Payer: Healthscope Commercial |
$284.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.90
|
| Rate for Payer: Nomi Health Commercial |
$213.07
|
| Rate for Payer: PACE SWMI |
$177.56
|
| Rate for Payer: PHP Medicare Advantage |
$177.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.90
|
| Rate for Payer: Priority Health Medicare |
$177.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.56
|
| Rate for Payer: UHC Medicare Advantage |
$177.56
|
|
|
PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 90746
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$94.31
|
| Rate for Payer: Aetna Medicare |
$73.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.35
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$70.38
|
| Rate for Payer: BCN Medicare Advantage |
$70.38
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Cofinity Commercial |
$101.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.38
|
| Rate for Payer: Healthscope Commercial |
$112.61
|
| Rate for Payer: Healthscope Commercial |
$130.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.95
|
| Rate for Payer: Nomi Health Commercial |
$84.46
|
| Rate for Payer: PACE SWMI |
$70.38
|
| Rate for Payer: PHP Medicare Advantage |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health Medicare |
$70.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.38
|
| Rate for Payer: UHC Medicare Advantage |
$70.38
|
|
|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90744
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: Aetna Commercial |
$42.44
|
| Rate for Payer: Aetna Medicare |
$32.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.44
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$31.67
|
| Rate for Payer: BCN Medicare Advantage |
$31.67
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.67
|
| Rate for Payer: Healthscope Commercial |
$58.59
|
| Rate for Payer: Healthscope Commercial |
$50.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Nomi Health Commercial |
$38.00
|
| Rate for Payer: PACE SWMI |
$31.67
|
| Rate for Payer: PHP Medicare Advantage |
$31.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$31.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.67
|
| Rate for Payer: UHC Medicare Advantage |
$31.67
|
|
|
PR HFO FLEXION GLOVE PRE OTS
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS L3912
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$213.73 |
| Rate for Payer: Aetna Commercial |
$154.81
|
| Rate for Payer: Aetna Medicare |
$120.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.81
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS MAPPO |
$115.53
|
| Rate for Payer: BCN Medicare Advantage |
$115.53
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$166.36
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.53
|
| Rate for Payer: Healthscope Commercial |
$184.85
|
| Rate for Payer: Healthscope Commercial |
$213.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.35
|
| Rate for Payer: Nomi Health Commercial |
$138.64
|
| Rate for Payer: PACE SWMI |
$115.53
|
| Rate for Payer: PHP Medicare Advantage |
$115.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$115.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.53
|
| Rate for Payer: UHC Medicare Advantage |
$115.53
|
|
|
PR HFO NONTORSION JNTS PRE CST
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS L3929
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Aetna Commercial |
$134.21
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.21
|
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCBS MAPPO |
$100.16
|
| Rate for Payer: BCN Medicare Advantage |
$100.16
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$144.23
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.16
|
| Rate for Payer: Healthscope Commercial |
$185.30
|
| Rate for Payer: Healthscope Commercial |
$160.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.90
|
| Rate for Payer: Nomi Health Commercial |
$120.19
|
| Rate for Payer: PACE SWMI |
$100.16
|
| Rate for Payer: PHP Medicare Advantage |
$100.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
| Rate for Payer: Priority Health Medicare |
$100.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.16
|
| Rate for Payer: UHC Medicare Advantage |
$100.16
|
|
|
PR HFO W/JOINT(S) CF
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS L3921
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$651.64 |
| Rate for Payer: Aetna Commercial |
$472.00
|
| Rate for Payer: Aetna Medicare |
$366.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$352.24
|
| Rate for Payer: BCN Medicare Advantage |
$352.24
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$507.23
|
| Rate for Payer: Cofinity Commercial |
$472.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.24
|
| Rate for Payer: Healthscope Commercial |
$563.58
|
| Rate for Payer: Healthscope Commercial |
$651.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.00
|
| Rate for Payer: Nomi Health Commercial |
$422.69
|
| Rate for Payer: PACE SWMI |
$352.24
|
| Rate for Payer: PHP Medicare Advantage |
$352.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health Medicare |
$352.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.24
|
| Rate for Payer: UHC Medicare Advantage |
$352.24
|
|
|
PR HFO W/O JOINTS CF
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS L3913
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$549.38 |
| Rate for Payer: Aetna Commercial |
$397.93
|
| Rate for Payer: Aetna Medicare |
$308.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.93
|
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCBS MAPPO |
$296.96
|
| Rate for Payer: BCN Medicare Advantage |
$296.96
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cofinity Commercial |
$427.62
|
| Rate for Payer: Cofinity Commercial |
$397.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.96
|
| Rate for Payer: Healthscope Commercial |
$475.14
|
| Rate for Payer: Healthscope Commercial |
$549.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.45
|
| Rate for Payer: Nomi Health Commercial |
$356.35
|
| Rate for Payer: PACE SWMI |
$296.96
|
| Rate for Payer: PHP Medicare Advantage |
$296.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.45
|
| Rate for Payer: Priority Health Medicare |
$296.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.96
|
| Rate for Payer: UHC Medicare Advantage |
$296.96
|
|
|
PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 90748
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
|
|
PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90647
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
|
|
PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90648
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR HIB VACCINE, HBOC, IM
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90645
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
|
|
PR HIB VACCINE, PRP-D, IM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90646
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR HINGE EXTENSION/FLEX WRIST/F
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
HCPCS L3900
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$3,286.19 |
| Rate for Payer: Aetna Commercial |
$2,380.27
|
| Rate for Payer: Aetna Medicare |
$1,847.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,380.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,557.90
|
| Rate for Payer: BCBS Complete |
$604.80
|
| Rate for Payer: BCBS MAPPO |
$1,776.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,776.32
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cofinity Commercial |
$2,380.27
|
| Rate for Payer: Cofinity Commercial |
$2,557.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,776.32
|
| Rate for Payer: Healthscope Commercial |
$3,286.19
|
| Rate for Payer: Healthscope Commercial |
$2,842.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,865.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$982.80
|
| Rate for Payer: Nomi Health Commercial |
$2,131.58
|
| Rate for Payer: PACE SWMI |
$1,776.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,776.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$982.80
|
| Rate for Payer: Priority Health Medicare |
$1,776.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,776.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,776.32
|
|
|
PR HOME HEALTH CARE SUPERVISION
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G0181
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$183.52 |
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$103.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.93
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$99.20
|
| Rate for Payer: BCN Medicare Advantage |
$99.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$142.85
|
| Rate for Payer: Cofinity Commercial |
$132.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$183.52
|
| Rate for Payer: Healthscope Commercial |
$158.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.60
|
| Rate for Payer: Nomi Health Commercial |
$119.04
|
| Rate for Payer: PACE SWMI |
$99.20
|
| Rate for Payer: PHP Medicare Advantage |
$99.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$99.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.20
|
| Rate for Payer: UHC Medicare Advantage |
$99.20
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 99350
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$322.62 |
| Rate for Payer: Aetna Commercial |
$233.68
|
| Rate for Payer: Aetna Medicare |
$181.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.68
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$174.39
|
| Rate for Payer: BCN Medicare Advantage |
$174.39
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$251.12
|
| Rate for Payer: Cofinity Commercial |
$233.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.39
|
| Rate for Payer: Healthscope Commercial |
$279.02
|
| Rate for Payer: Healthscope Commercial |
$322.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Nomi Health Commercial |
$209.27
|
| Rate for Payer: PACE SWMI |
$174.39
|
| Rate for Payer: PHP Medicare Advantage |
$174.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$174.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.39
|
| Rate for Payer: UHC Medicare Advantage |
$174.39
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99348
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$134.09 |
| Rate for Payer: Aetna Commercial |
$97.12
|
| Rate for Payer: Aetna Medicare |
$75.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.37
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$72.48
|
| Rate for Payer: BCN Medicare Advantage |
$72.48
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.48
|
| Rate for Payer: Healthscope Commercial |
$134.09
|
| Rate for Payer: Healthscope Commercial |
$115.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.50
|
| Rate for Payer: Nomi Health Commercial |
$86.98
|
| Rate for Payer: PACE SWMI |
$72.48
|
| Rate for Payer: PHP Medicare Advantage |
$72.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health Medicare |
$72.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.48
|
| Rate for Payer: UHC Medicare Advantage |
$72.48
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99349
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$222.11 |
| Rate for Payer: Aetna Commercial |
$160.88
|
| Rate for Payer: Aetna Medicare |
$124.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.88
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS MAPPO |
$120.06
|
| Rate for Payer: BCN Medicare Advantage |
$120.06
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$172.89
|
| Rate for Payer: Cofinity Commercial |
$160.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.06
|
| Rate for Payer: Healthscope Commercial |
$192.10
|
| Rate for Payer: Healthscope Commercial |
$222.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.00
|
| Rate for Payer: Nomi Health Commercial |
$144.07
|
| Rate for Payer: PACE SWMI |
$120.06
|
| Rate for Payer: PHP Medicare Advantage |
$120.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: Priority Health Medicare |
$120.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.06
|
| Rate for Payer: UHC Medicare Advantage |
$120.06
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 99347
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$79.01 |
| Rate for Payer: Aetna Commercial |
$57.23
|
| Rate for Payer: Aetna Medicare |
$44.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.23
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$42.71
|
| Rate for Payer: BCN Medicare Advantage |
$42.71
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$61.50
|
| Rate for Payer: Cofinity Commercial |
$57.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.71
|
| Rate for Payer: Healthscope Commercial |
$79.01
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.65
|
| Rate for Payer: Nomi Health Commercial |
$51.25
|
| Rate for Payer: PACE SWMI |
$42.71
|
| Rate for Payer: PHP Medicare Advantage |
$42.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health Medicare |
$42.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.71
|
| Rate for Payer: UHC Medicare Advantage |
$42.71
|
|
|
PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 99345
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$351.13 |
| Rate for Payer: Aetna Commercial |
$254.33
|
| Rate for Payer: Aetna Medicare |
$197.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.33
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS MAPPO |
$189.80
|
| Rate for Payer: BCN Medicare Advantage |
$189.80
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$273.31
|
| Rate for Payer: Cofinity Commercial |
$254.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.80
|
| Rate for Payer: Healthscope Commercial |
$303.68
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.60
|
| Rate for Payer: Nomi Health Commercial |
$227.76
|
| Rate for Payer: PACE SWMI |
$189.80
|
| Rate for Payer: PHP Medicare Advantage |
$189.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health Medicare |
$189.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.80
|
| Rate for Payer: UHC Medicare Advantage |
$189.80
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 99342
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$137.46 |
| Rate for Payer: Aetna Commercial |
$99.56
|
| Rate for Payer: Aetna Medicare |
$77.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.99
|
| Rate for Payer: BCBS Complete |
$64.80
|
| Rate for Payer: BCBS MAPPO |
$74.30
|
| Rate for Payer: BCN Medicare Advantage |
$74.30
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$99.56
|
| Rate for Payer: Cofinity Commercial |
$106.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.30
|
| Rate for Payer: Healthscope Commercial |
$137.46
|
| Rate for Payer: Healthscope Commercial |
$118.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.30
|
| Rate for Payer: Nomi Health Commercial |
$89.16
|
| Rate for Payer: PACE SWMI |
$74.30
|
| Rate for Payer: PHP Medicare Advantage |
$74.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health Medicare |
$74.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.30
|
| Rate for Payer: UHC Medicare Advantage |
$74.30
|
|
|
PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 99344
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$179.92
|
| Rate for Payer: Aetna Medicare |
$139.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.92
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: BCBS MAPPO |
$134.27
|
| Rate for Payer: BCN Medicare Advantage |
$134.27
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$193.35
|
| Rate for Payer: Cofinity Commercial |
$179.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.27
|
| Rate for Payer: Healthscope Commercial |
$214.83
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: Nomi Health Commercial |
$161.12
|
| Rate for Payer: PACE SWMI |
$134.27
|
| Rate for Payer: PHP Medicare Advantage |
$134.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| Rate for Payer: Priority Health Medicare |
$134.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.27
|
| Rate for Payer: UHC Medicare Advantage |
$134.27
|
|
|
PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99341
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: Aetna Commercial |
$62.36
|
| Rate for Payer: Aetna Medicare |
$48.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.36
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$46.54
|
| Rate for Payer: BCN Medicare Advantage |
$46.54
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$67.02
|
| Rate for Payer: Cofinity Commercial |
$62.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.54
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$86.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.50
|
| Rate for Payer: Nomi Health Commercial |
$55.85
|
| Rate for Payer: PACE SWMI |
$46.54
|
| Rate for Payer: PHP Medicare Advantage |
$46.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$46.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.54
|
| Rate for Payer: UHC Medicare Advantage |
$46.54
|
|
|
PR HOME SLEEP TEST/TYPE 3 PORTA
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS G0399
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$230.75 |
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
|
