|
PR MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 97803
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$3,963.00 |
| Rate for Payer: Aetna Commercial |
$34.22
|
| Rate for Payer: Aetna Medicare |
$26.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.78
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$25.54
|
| Rate for Payer: BCBS Trust/PPO |
$561.58
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$25.54
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$36.78
|
| Rate for Payer: Cofinity Commercial |
$34.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.54
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Healthscope Commercial |
$47.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.00
|
| Rate for Payer: Nomi Health Commercial |
$30.65
|
| Rate for Payer: PACE SWMI |
$25.54
|
| Rate for Payer: PHP Medicare Advantage |
$25.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.82
|
| Rate for Payer: Priority Health Medicare |
$25.54
|
| Rate for Payer: Priority Health Narrow Network |
$29.82
|
| Rate for Payer: Priority Health SBD |
$29.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.54
|
| Rate for Payer: UHC Exchange |
$19.00
|
| Rate for Payer: UHC Medicare Advantage |
$25.54
|
|
|
PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 97804
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$2,252.00 |
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna Medicare |
$14.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.68
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$641.36
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: BCN Medicare Advantage |
$14.36
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$26.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,252.00
|
| Rate for Payer: Nomi Health Commercial |
$17.23
|
| Rate for Payer: PACE SWMI |
$14.36
|
| Rate for Payer: PHP Medicare Advantage |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.57
|
| Rate for Payer: Priority Health Medicare |
$14.36
|
| Rate for Payer: Priority Health Narrow Network |
$15.57
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.36
|
| Rate for Payer: UHC Exchange |
$7.92
|
| Rate for Payer: UHC Medicare Advantage |
$14.36
|
|
|
PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 93463
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$14,337.00 |
| Rate for Payer: Aetna Commercial |
$122.86
|
| Rate for Payer: Aetna Medicare |
$95.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.86
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCBS MAPPO |
$91.69
|
| Rate for Payer: BCBS Trust/PPO |
$735.92
|
| Rate for Payer: BCN Commercial |
$140.25
|
| Rate for Payer: BCN Medicare Advantage |
$91.69
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$132.03
|
| Rate for Payer: Cofinity Commercial |
$122.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.69
|
| Rate for Payer: Healthscope Commercial |
$169.63
|
| Rate for Payer: Healthscope Commercial |
$146.70
|
| Rate for Payer: Mclaren Medicaid |
$61.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.27
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,337.00
|
| Rate for Payer: Nomi Health Commercial |
$110.03
|
| Rate for Payer: PACE SWMI |
$91.69
|
| Rate for Payer: PHP Medicare Advantage |
$91.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.66
|
| Rate for Payer: Priority Health Medicare |
$91.69
|
| Rate for Payer: Priority Health Narrow Network |
$134.66
|
| Rate for Payer: Priority Health SBD |
$134.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.69
|
| Rate for Payer: UHC Medicare Advantage |
$91.69
|
| Rate for Payer: UHCCP Medicaid |
$61.13
|
|
|
PR MEDICATION THERAPY EACH ADDITIONAL 15 MIN
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 99607
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$370.34 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.29
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$370.34
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.45
|
|
|
PR MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 99606
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$62.87 |
| Rate for Payer: Aetna Commercial |
$33.89
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.89
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$62.87
|
| Rate for Payer: Cash Price |
$25.60
|
| 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 MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 99605
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$79.81 |
| Rate for Payer: Aetna Commercial |
$67.55
|
| Rate for Payer: Aetna Medicare |
$32.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.55
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS Trust/PPO |
$79.81
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
|
|
PR MEDROXYPROGESTERONE ACETATE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1050
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.52
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.52
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.14
|
| Rate for Payer: BCN Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
|
|
PR MEDROXYPROGESTERONE INJ
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J1051
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
PR MEDRXYPROGESTER ACETATE INJ
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS J1055
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 90734
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$15,133.00 |
| Rate for Payer: Aetna Commercial |
$151.33
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.33
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$147.22
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,133.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.79
|
| Rate for Payer: UHC Exchange |
$171.79
|
|
|
PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 90619
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$15,910.00 |
| Rate for Payer: Aetna Commercial |
$159.10
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.10
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS Trust/PPO |
$168.36
|
| Rate for Payer: BCN Commercial |
$168.36
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,910.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.78
|
| Rate for Payer: UHC Exchange |
$187.78
|
|
|
PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 90620
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$21,542.00 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.42
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: BCBS Trust/PPO |
$198.55
|
| Rate for Payer: BCN Commercial |
$198.55
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,542.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.29
|
| Rate for Payer: UHC Exchange |
$244.29
|
|
|
PR MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 90621
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$18,317.00 |
| Rate for Payer: Aetna Commercial |
$183.17
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.17
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS Trust/PPO |
$165.84
|
| Rate for Payer: BCN Commercial |
$165.84
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,317.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.53
|
| Rate for Payer: UHC Exchange |
$225.53
|
|
|
PR MEPERIDINE HYDROCHL /100 MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J2175
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Medicare |
$16.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.03
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$15.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: BCN Medicare Advantage |
$15.69
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.69
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Healthscope Commercial |
$29.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.00
|
| Rate for Payer: Nomi Health Commercial |
$18.83
|
| Rate for Payer: PACE SWMI |
$15.69
|
| Rate for Payer: PHP Medicare Advantage |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$15.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.69
|
| Rate for Payer: UHC Exchange |
$7.38
|
| Rate for Payer: UHC Medicare Advantage |
$15.69
|
|
|
PR MEPERIDINE/PROMETHAZINE INJ
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J2180
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.58
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.02
|
| Rate for Payer: UHC Exchange |
$4.02
|
|
|
PR METATARSECTOMY
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 28140
|
| Min. Negotiated Rate |
$274.34 |
| Max. Negotiated Rate |
$75,530.00 |
| Rate for Payer: Aetna Commercial |
$546.13
|
| Rate for Payer: Aetna Medicare |
$423.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.89
|
| Rate for Payer: BCBS Complete |
$288.06
|
| Rate for Payer: BCBS MAPPO |
$407.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.26
|
| Rate for Payer: BCN Commercial |
$830.26
|
| Rate for Payer: BCN Medicare Advantage |
$407.56
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$546.13
|
| Rate for Payer: Cofinity Commercial |
$586.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.56
|
| Rate for Payer: Healthscope Commercial |
$652.10
|
| Rate for Payer: Healthscope Commercial |
$753.99
|
| Rate for Payer: Mclaren Medicaid |
$274.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.94
|
| Rate for Payer: Meridian Medicaid |
$288.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75,530.00
|
| Rate for Payer: Nomi Health Commercial |
$489.07
|
| Rate for Payer: PACE SWMI |
$407.56
|
| Rate for Payer: PHP Medicare Advantage |
$407.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.37
|
| Rate for Payer: Priority Health Medicare |
$407.56
|
| Rate for Payer: Priority Health Narrow Network |
$653.37
|
| Rate for Payer: Priority Health SBD |
$653.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$715.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.56
|
| Rate for Payer: UHC Exchange |
$715.10
|
| Rate for Payer: UHC Medicare Advantage |
$407.56
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
|
|
PR METHYLPREDNISOLONE 20 MG INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1020
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna Commercial |
$7.25
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.25
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$710.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR METHYLPREDNISOLONE 40 MG INJ
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1030
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.61
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
|
|
PR METHYLPREDNISOLONE 80 MG INJ
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J1040
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$5.37
|
| Rate for Payer: BCN Commercial |
$10.71
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,076.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR METHYLPREDNISOLONE INJECTION
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J2930
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$499.00 |
| Rate for Payer: Aetna Commercial |
$6.06
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR METHYLPREDNISOLONE INJECTION
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J2920
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna Commercial |
$4.31
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR MGMT LVR HEMRRG CPLX SUTR WND/INJ
|
Professional
|
Both
|
$3,454.00
|
|
|
Service Code
|
HCPCS 47360
|
| Min. Negotiated Rate |
$331.24 |
| Max. Negotiated Rate |
$335,570.00 |
| Rate for Payer: Aetna Commercial |
$2,436.71
|
| Rate for Payer: Aetna Medicare |
$1,891.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,436.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,618.55
|
| Rate for Payer: BCBS Complete |
$1,260.27
|
| Rate for Payer: BCBS MAPPO |
$1,818.44
|
| Rate for Payer: BCBS Trust/PPO |
$331.24
|
| Rate for Payer: BCN Commercial |
$2,732.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,818.44
|
| Rate for Payer: Cash Price |
$2,763.20
|
| Rate for Payer: Cash Price |
$2,763.20
|
| Rate for Payer: Cofinity Commercial |
$2,436.71
|
| Rate for Payer: Cofinity Commercial |
$2,618.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,818.44
|
| Rate for Payer: Healthscope Commercial |
$2,909.50
|
| Rate for Payer: Healthscope Commercial |
$3,364.11
|
| Rate for Payer: Mclaren Medicaid |
$1,200.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,909.36
|
| Rate for Payer: Meridian Medicaid |
$1,260.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335,570.00
|
| Rate for Payer: Nomi Health Commercial |
$2,182.13
|
| Rate for Payer: PACE SWMI |
$1,818.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,818.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,200.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,346.89
|
| Rate for Payer: Priority Health Medicare |
$1,818.44
|
| Rate for Payer: Priority Health Narrow Network |
$3,346.89
|
| Rate for Payer: Priority Health SBD |
$3,346.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,608.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,818.44
|
| Rate for Payer: UHC Exchange |
$1,608.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,818.44
|
| Rate for Payer: UHCCP Medicaid |
$1,200.26
|
|
|
PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR
|
Professional
|
Both
|
$6,375.00
|
|
|
Service Code
|
HCPCS 47361
|
| Min. Negotiated Rate |
$1,921.90 |
| Max. Negotiated Rate |
$540,108.00 |
| Rate for Payer: Aetna Commercial |
$3,908.66
|
| Rate for Payer: Aetna Medicare |
$3,033.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,908.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,200.35
|
| Rate for Payer: BCBS Complete |
$2,018.00
|
| Rate for Payer: BCBS MAPPO |
$2,916.91
|
| Rate for Payer: BCN Commercial |
$4,387.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,916.91
|
| Rate for Payer: Cash Price |
$5,100.00
|
| Rate for Payer: Cash Price |
$5,100.00
|
| Rate for Payer: Cofinity Commercial |
$4,200.35
|
| Rate for Payer: Cofinity Commercial |
$3,908.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,916.91
|
| Rate for Payer: Healthscope Commercial |
$5,396.28
|
| Rate for Payer: Healthscope Commercial |
$4,667.06
|
| Rate for Payer: Mclaren Medicaid |
$1,921.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,062.76
|
| Rate for Payer: Meridian Medicaid |
$2,018.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$540,108.00
|
| Rate for Payer: Nomi Health Commercial |
$3,500.29
|
| Rate for Payer: PACE SWMI |
$2,916.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,916.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,921.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,143.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,352.04
|
| Rate for Payer: Priority Health Medicare |
$2,916.91
|
| Rate for Payer: Priority Health Narrow Network |
$5,352.04
|
| Rate for Payer: Priority Health SBD |
$5,352.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,748.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,916.91
|
| Rate for Payer: UHC Exchange |
$2,748.27
|
| Rate for Payer: UHC Medicare Advantage |
$2,916.91
|
| Rate for Payer: UHCCP Medicaid |
$1,921.90
|
|
|
PR MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING
|
Professional
|
Both
|
$2,999.00
|
|
|
Service Code
|
HCPCS 47362
|
| Min. Negotiated Rate |
$910.36 |
| Max. Negotiated Rate |
$256,162.00 |
| Rate for Payer: Aetna Commercial |
$1,839.79
|
| Rate for Payer: Aetna Medicare |
$1,427.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,839.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,977.09
|
| Rate for Payer: BCBS Complete |
$955.88
|
| Rate for Payer: BCBS MAPPO |
$1,372.98
|
| Rate for Payer: BCN Commercial |
$2,091.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,372.98
|
| Rate for Payer: Cash Price |
$2,399.20
|
| Rate for Payer: Cash Price |
$2,399.20
|
| Rate for Payer: Cofinity Commercial |
$1,977.09
|
| Rate for Payer: Cofinity Commercial |
$1,839.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,372.98
|
| Rate for Payer: Healthscope Commercial |
$2,540.01
|
| Rate for Payer: Healthscope Commercial |
$2,196.77
|
| Rate for Payer: Mclaren Medicaid |
$910.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,441.63
|
| Rate for Payer: Meridian Medicaid |
$955.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256,162.00
|
| Rate for Payer: Nomi Health Commercial |
$1,647.58
|
| Rate for Payer: PACE SWMI |
$1,372.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,372.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$910.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,949.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,594.58
|
| Rate for Payer: Priority Health Medicare |
$1,372.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,594.58
|
| Rate for Payer: Priority Health SBD |
$2,594.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,143.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,372.98
|
| Rate for Payer: UHC Exchange |
$1,143.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,372.98
|
| Rate for Payer: UHCCP Medicaid |
$910.36
|
|
|
PR MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ
|
Professional
|
Both
|
$2,903.00
|
|
|
Service Code
|
HCPCS 47350
|
| Min. Negotiated Rate |
$873.51 |
| Max. Negotiated Rate |
$244,382.00 |
| Rate for Payer: Aetna Commercial |
$1,765.73
|
| Rate for Payer: Aetna Medicare |
$1,370.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,765.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,897.50
|
| Rate for Payer: BCBS Complete |
$917.19
|
| Rate for Payer: BCBS MAPPO |
$1,317.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,888.67
|
| Rate for Payer: BCN Commercial |
$1,994.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,317.71
|
| Rate for Payer: Cash Price |
$2,322.40
|
| Rate for Payer: Cash Price |
$2,322.40
|
| Rate for Payer: Cofinity Commercial |
$1,897.50
|
| Rate for Payer: Cofinity Commercial |
$1,765.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,317.71
|
| Rate for Payer: Healthscope Commercial |
$2,437.76
|
| Rate for Payer: Healthscope Commercial |
$2,108.34
|
| Rate for Payer: Mclaren Medicaid |
$873.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,383.60
|
| Rate for Payer: Meridian Medicaid |
$917.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244,382.00
|
| Rate for Payer: Nomi Health Commercial |
$1,581.25
|
| Rate for Payer: PACE SWMI |
$1,317.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,317.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$873.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,886.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,437.69
|
| Rate for Payer: Priority Health Medicare |
$1,317.71
|
| Rate for Payer: Priority Health Narrow Network |
$2,437.69
|
| Rate for Payer: Priority Health SBD |
$2,437.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,186.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,317.71
|
| Rate for Payer: UHC Exchange |
$1,186.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,317.71
|
| Rate for Payer: UHCCP Medicaid |
$873.51
|
|
