|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$2,378.41 |
| Rate for Payer: Aetna Commercial |
$127.29
|
| Rate for Payer: Aetna Medicare |
$98.79
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS MAPPO |
$94.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.41
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Medicare Advantage |
$94.99
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$136.79
|
| Rate for Payer: Cofinity Commercial |
$127.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.99
|
| Rate for Payer: Mclaren Medicaid |
$63.05
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.74
|
| Rate for Payer: PACE SWMI |
$94.99
|
| Rate for Payer: PHP Medicare Advantage |
$94.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.78
|
| Rate for Payer: Priority Health Medicare |
$94.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.99
|
| Rate for Payer: UHC Medicare Advantage |
$97.84
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$1,575.39 |
| Rate for Payer: Aetna Commercial |
$170.65
|
| Rate for Payer: Aetna Medicare |
$132.44
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS MAPPO |
$127.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.39
|
| Rate for Payer: BCN Commercial |
$284.41
|
| Rate for Payer: BCN Medicare Advantage |
$127.35
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$183.38
|
| Rate for Payer: Cofinity Commercial |
$170.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.35
|
| Rate for Payer: Mclaren Medicaid |
$84.56
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.72
|
| Rate for Payer: PACE SWMI |
$127.35
|
| Rate for Payer: PHP Medicare Advantage |
$127.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.20
|
| Rate for Payer: Priority Health Medicare |
$127.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.35
|
| Rate for Payer: UHC Medicare Advantage |
$131.17
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$963.62 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Medicare |
$164.90
|
| Rate for Payer: BCBS Complete |
$112.05
|
| Rate for Payer: BCBS MAPPO |
$158.56
|
| Rate for Payer: BCBS Trust/PPO |
$963.62
|
| Rate for Payer: BCN Commercial |
$380.68
|
| Rate for Payer: BCN Medicare Advantage |
$158.56
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cofinity Commercial |
$228.33
|
| Rate for Payer: Cofinity Commercial |
$212.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.56
|
| Rate for Payer: Mclaren Medicaid |
$106.71
|
| Rate for Payer: Meridian Medicaid |
$112.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$166.49
|
| Rate for Payer: PACE SWMI |
$158.56
|
| Rate for Payer: PHP Medicare Advantage |
$158.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.81
|
| Rate for Payer: Priority Health Medicare |
$158.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.56
|
| Rate for Payer: UHC Medicare Advantage |
$163.32
|
|
|
PR DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
HCPCS 17276
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$263.55
|
| Rate for Payer: Aetna Medicare |
$204.55
|
| Rate for Payer: BCBS Complete |
$134.86
|
| Rate for Payer: BCBS MAPPO |
$196.68
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$334.54
|
| Rate for Payer: BCN Medicare Advantage |
$196.68
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Cofinity Commercial |
$263.55
|
| Rate for Payer: Cofinity Commercial |
$283.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.68
|
| Rate for Payer: Mclaren Medicaid |
$128.44
|
| Rate for Payer: Meridian Medicaid |
$134.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$206.51
|
| Rate for Payer: PACE SWMI |
$196.68
|
| Rate for Payer: PHP Medicare Advantage |
$196.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.21
|
| Rate for Payer: Priority Health Medicare |
$196.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.68
|
| Rate for Payer: UHC Medicare Advantage |
$202.58
|
|
|
PR DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 64610
|
| Min. Negotiated Rate |
$309.49 |
| Max. Negotiated Rate |
$1,151.81 |
| Rate for Payer: Aetna Commercial |
$646.08
|
| Rate for Payer: Aetna Medicare |
$501.44
|
| Rate for Payer: BCBS Complete |
$324.96
|
| Rate for Payer: BCBS MAPPO |
$482.15
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: BCN Commercial |
$1,151.81
|
| Rate for Payer: BCN Medicare Advantage |
$482.15
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cofinity Commercial |
$646.08
|
| Rate for Payer: Cofinity Commercial |
$694.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.15
|
| Rate for Payer: Mclaren Medicaid |
$309.49
|
| Rate for Payer: Meridian Medicaid |
$324.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$506.26
|
| Rate for Payer: PACE SWMI |
$482.15
|
| Rate for Payer: PHP Medicare Advantage |
$482.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$819.90
|
| Rate for Payer: Priority Health Medicare |
$482.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$819.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.15
|
| Rate for Payer: UHC Medicare Advantage |
$496.61
|
|
|
PR DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 64620
|
| Min. Negotiated Rate |
$113.32 |
| Max. Negotiated Rate |
$1,271.09 |
| Rate for Payer: Aetna Commercial |
$231.82
|
| Rate for Payer: Aetna Medicare |
$179.92
|
| Rate for Payer: BCBS Complete |
$118.99
|
| Rate for Payer: BCBS MAPPO |
$173.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$304.45
|
| Rate for Payer: BCN Medicare Advantage |
$173.00
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cofinity Commercial |
$249.12
|
| Rate for Payer: Cofinity Commercial |
$231.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.00
|
| Rate for Payer: Mclaren Medicaid |
$113.32
|
| Rate for Payer: Meridian Medicaid |
$118.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.65
|
| Rate for Payer: PACE SWMI |
$173.00
|
| Rate for Payer: PHP Medicare Advantage |
$173.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.84
|
| Rate for Payer: Priority Health Medicare |
$173.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.00
|
| Rate for Payer: UHC Medicare Advantage |
$178.19
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 64640
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$154.21
|
| Rate for Payer: Aetna Medicare |
$119.68
|
| Rate for Payer: BCBS Complete |
$79.62
|
| Rate for Payer: BCBS MAPPO |
$115.08
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$360.16
|
| Rate for Payer: BCN Medicare Advantage |
$115.08
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Cofinity Commercial |
$154.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.08
|
| Rate for Payer: Mclaren Medicaid |
$75.83
|
| Rate for Payer: Meridian Medicaid |
$79.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.83
|
| Rate for Payer: PACE SWMI |
$115.08
|
| Rate for Payer: PHP Medicare Advantage |
$115.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.19
|
| Rate for Payer: Priority Health Medicare |
$115.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.08
|
| Rate for Payer: UHC Medicare Advantage |
$118.53
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$363.50 |
| Max. Negotiated Rate |
$536.40 |
| Rate for Payer: Aetna Commercial |
$506.60
|
| Rate for Payer: BCBS Trust/PPO |
$460.59
|
| Rate for Payer: BCN Commercial |
$460.59
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$512.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.80
|
| Rate for Payer: Healthscope Commercial |
$536.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.60
|
| Rate for Payer: PHP Commercial |
$506.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.48
|
| Rate for Payer: UHC Core |
$497.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.00
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$141.55 |
| Max. Negotiated Rate |
$627.82 |
| Rate for Payer: Aetna Commercial |
$506.60
|
| Rate for Payer: Aetna Medicare |
$154.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.25
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$149.00
|
| Rate for Payer: BCBS Trust/PPO |
$463.39
|
| Rate for Payer: BCN Commercial |
$463.39
|
| Rate for Payer: BCN Medicare Advantage |
$149.00
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$512.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.00
|
| Rate for Payer: Healthscope Commercial |
$536.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.00
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.60
|
| Rate for Payer: PACE Senior Care Partners |
$141.55
|
| Rate for Payer: PACE SWMI |
$149.00
|
| Rate for Payer: PHP Commercial |
$506.60
|
| Rate for Payer: PHP Medicare Advantage |
$149.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.52
|
| Rate for Payer: Priority Health Medicare |
$149.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.50
|
| Rate for Payer: Railroad Medicare Medicare |
$149.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.48
|
| Rate for Payer: UHC Core |
$497.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.00
|
| Rate for Payer: UHC Medicare Advantage |
$153.47
|
| Rate for Payer: VA VA |
$149.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.00
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$154.21
|
| Rate for Payer: Aetna Medicare |
$119.68
|
| Rate for Payer: BCBS Complete |
$79.62
|
| Rate for Payer: BCBS MAPPO |
$115.08
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$360.16
|
| Rate for Payer: BCN Medicare Advantage |
$115.08
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Cofinity Commercial |
$154.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.08
|
| Rate for Payer: Mclaren Medicaid |
$75.83
|
| Rate for Payer: Meridian Medicaid |
$79.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.83
|
| Rate for Payer: PACE SWMI |
$115.08
|
| Rate for Payer: PHP Medicare Advantage |
$115.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.19
|
| Rate for Payer: Priority Health Medicare |
$115.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.08
|
| Rate for Payer: UHC Medicare Advantage |
$118.53
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$1,009.58 |
| Rate for Payer: Aetna Commercial |
$210.89
|
| Rate for Payer: Aetna Medicare |
$163.68
|
| Rate for Payer: BCBS Complete |
$107.13
|
| Rate for Payer: BCBS MAPPO |
$157.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$157.38
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$226.63
|
| Rate for Payer: Cofinity Commercial |
$210.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.38
|
| Rate for Payer: Mclaren Medicaid |
$102.03
|
| Rate for Payer: Meridian Medicaid |
$107.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.25
|
| Rate for Payer: PACE SWMI |
$157.38
|
| Rate for Payer: PHP Medicare Advantage |
$157.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.22
|
| Rate for Payer: Priority Health Medicare |
$157.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.38
|
| Rate for Payer: UHC Medicare Advantage |
$162.10
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$138.88 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$290.74
|
| Rate for Payer: Aetna Medicare |
$225.65
|
| Rate for Payer: BCBS Complete |
$145.82
|
| Rate for Payer: BCBS MAPPO |
$216.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: BCN Medicare Advantage |
$216.97
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$290.74
|
| Rate for Payer: Cofinity Commercial |
$312.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.97
|
| Rate for Payer: Mclaren Medicaid |
$138.88
|
| Rate for Payer: Meridian Medicaid |
$145.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.82
|
| Rate for Payer: PACE SWMI |
$216.97
|
| Rate for Payer: PHP Medicare Advantage |
$216.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.15
|
| Rate for Payer: Priority Health Medicare |
$216.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$373.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.97
|
| Rate for Payer: UHC Medicare Advantage |
$223.48
|
|
|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$881.00
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$3,486.25 |
| Rate for Payer: Aetna Commercial |
$305.35
|
| Rate for Payer: Aetna Medicare |
$236.98
|
| Rate for Payer: BCBS Complete |
$159.92
|
| Rate for Payer: BCBS MAPPO |
$227.87
|
| Rate for Payer: BCBS Trust/PPO |
$3,486.25
|
| Rate for Payer: BCN Commercial |
$682.69
|
| Rate for Payer: BCN Medicare Advantage |
$227.87
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cofinity Commercial |
$305.35
|
| Rate for Payer: Cofinity Commercial |
$328.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.87
|
| Rate for Payer: Mclaren Medicaid |
$152.30
|
| Rate for Payer: Meridian Medicaid |
$159.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$239.26
|
| Rate for Payer: PACE SWMI |
$227.87
|
| Rate for Payer: PHP Medicare Advantage |
$227.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.26
|
| Rate for Payer: Priority Health Medicare |
$227.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.87
|
| Rate for Payer: UHC Medicare Advantage |
$234.71
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$87.73
|
| Rate for Payer: Aetna Medicare |
$68.09
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS MAPPO |
$65.47
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: BCN Medicare Advantage |
$65.47
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$94.28
|
| Rate for Payer: Cofinity Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.47
|
| Rate for Payer: Mclaren Medicaid |
$42.39
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.74
|
| Rate for Payer: PACE SWMI |
$65.47
|
| Rate for Payer: PHP Medicare Advantage |
$65.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.55
|
| Rate for Payer: Priority Health Medicare |
$65.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.47
|
| Rate for Payer: UHC Medicare Advantage |
$67.43
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$654.04 |
| Rate for Payer: Aetna Commercial |
$77.49
|
| Rate for Payer: Aetna Medicare |
$60.14
|
| Rate for Payer: BCBS Complete |
$38.91
|
| Rate for Payer: BCBS MAPPO |
$57.83
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$57.83
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$77.49
|
| Rate for Payer: Cofinity Commercial |
$83.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.83
|
| Rate for Payer: Mclaren Medicaid |
$37.06
|
| Rate for Payer: Meridian Medicaid |
$38.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.72
|
| Rate for Payer: PACE SWMI |
$57.83
|
| Rate for Payer: PHP Medicare Advantage |
$57.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.52
|
| Rate for Payer: Priority Health Medicare |
$57.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.83
|
| Rate for Payer: UHC Medicare Advantage |
$59.56
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$249.39
|
| Rate for Payer: Aetna Medicare |
$193.55
|
| Rate for Payer: BCBS Complete |
$128.37
|
| Rate for Payer: BCBS MAPPO |
$186.11
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$186.11
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$249.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.11
|
| Rate for Payer: Mclaren Medicaid |
$122.26
|
| Rate for Payer: Meridian Medicaid |
$128.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.42
|
| Rate for Payer: PACE SWMI |
$186.11
|
| Rate for Payer: PHP Medicare Advantage |
$186.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.91
|
| Rate for Payer: Priority Health Medicare |
$186.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.11
|
| Rate for Payer: UHC Medicare Advantage |
$191.69
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$372.04 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna Commercial |
$518.50
|
| Rate for Payer: BCBS Trust/PPO |
$471.41
|
| Rate for Payer: BCN Commercial |
$471.41
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$524.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.00
|
| Rate for Payer: Healthscope Commercial |
$549.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$518.50
|
| Rate for Payer: PHP Commercial |
$518.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$536.80
|
| Rate for Payer: UHC Core |
$509.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.50
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,329.91 |
| Rate for Payer: Aetna Commercial |
$518.50
|
| Rate for Payer: Aetna Medicare |
$158.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.62
|
| Rate for Payer: BCBS Complete |
$1,329.91
|
| Rate for Payer: BCBS MAPPO |
$152.50
|
| Rate for Payer: BCBS Trust/PPO |
$474.28
|
| Rate for Payer: BCN Commercial |
$474.28
|
| Rate for Payer: BCN Medicare Advantage |
$152.50
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$524.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.50
|
| Rate for Payer: Healthscope Commercial |
$549.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.50
|
| Rate for Payer: Mclaren Medicaid |
$1,266.58
|
| Rate for Payer: Meridian Medicaid |
$1,329.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$160.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$518.50
|
| Rate for Payer: PACE Senior Care Partners |
$144.88
|
| Rate for Payer: PACE SWMI |
$152.50
|
| Rate for Payer: PHP Commercial |
$518.50
|
| Rate for Payer: PHP Medicare Advantage |
$152.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,266.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.70
|
| Rate for Payer: Priority Health Medicare |
$152.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.04
|
| Rate for Payer: Railroad Medicare Medicare |
$152.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$536.80
|
| Rate for Payer: UHC Core |
$509.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.50
|
| Rate for Payer: UHC Medicare Advantage |
$157.08
|
| Rate for Payer: VA VA |
$152.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.50
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$249.39
|
| Rate for Payer: Aetna Medicare |
$193.55
|
| Rate for Payer: BCBS Complete |
$128.37
|
| Rate for Payer: BCBS MAPPO |
$186.11
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$186.11
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cofinity Commercial |
$249.39
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.11
|
| Rate for Payer: Mclaren Medicaid |
$122.26
|
| Rate for Payer: Meridian Medicaid |
$128.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.42
|
| Rate for Payer: PACE SWMI |
$186.11
|
| Rate for Payer: PHP Medicare Advantage |
$186.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.91
|
| Rate for Payer: Priority Health Medicare |
$186.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.11
|
| Rate for Payer: UHC Medicare Advantage |
$191.69
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$1,329.91 |
| Rate for Payer: Aetna Commercial |
$512.55
|
| Rate for Payer: Aetna Medicare |
$156.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$188.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$188.44
|
| Rate for Payer: BCBS Complete |
$1,329.91
|
| Rate for Payer: BCBS MAPPO |
$150.75
|
| Rate for Payer: BCBS Trust/PPO |
$468.83
|
| Rate for Payer: BCN Commercial |
$468.83
|
| Rate for Payer: BCN Medicare Advantage |
$150.75
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$518.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.75
|
| Rate for Payer: Healthscope Commercial |
$542.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.25
|
| Rate for Payer: Mclaren Medicaid |
$1,266.58
|
| Rate for Payer: Meridian Medicaid |
$1,329.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$512.55
|
| Rate for Payer: PACE Senior Care Partners |
$143.21
|
| Rate for Payer: PACE SWMI |
$150.75
|
| Rate for Payer: PHP Commercial |
$512.55
|
| Rate for Payer: PHP Medicare Advantage |
$150.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,266.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$524.61
|
| Rate for Payer: Priority Health Medicare |
$150.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$367.77
|
| Rate for Payer: Railroad Medicare Medicare |
$150.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.64
|
| Rate for Payer: UHC Core |
$503.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.75
|
| Rate for Payer: UHC Medicare Advantage |
$155.27
|
| Rate for Payer: VA VA |
$150.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.25
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Aetna Commercial |
$512.55
|
| Rate for Payer: BCBS Trust/PPO |
$466.00
|
| Rate for Payer: BCN Commercial |
$466.00
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$518.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.40
|
| Rate for Payer: Healthscope Commercial |
$542.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$512.55
|
| Rate for Payer: PHP Commercial |
$512.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$524.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$367.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.64
|
| Rate for Payer: UHC Core |
$503.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.25
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 64635
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$249.80
|
| Rate for Payer: Aetna Medicare |
$193.88
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$186.42
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.42
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$268.44
|
| Rate for Payer: Cofinity Commercial |
$249.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.42
|
| Rate for Payer: Mclaren Medicaid |
$122.48
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.74
|
| Rate for Payer: PACE SWMI |
$186.42
|
| Rate for Payer: PHP Medicare Advantage |
$186.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$186.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.42
|
| Rate for Payer: UHC Medicare Advantage |
$192.01
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$249.80
|
| Rate for Payer: Aetna Medicare |
$193.88
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$186.42
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.42
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$268.44
|
| Rate for Payer: Cofinity Commercial |
$249.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.42
|
| Rate for Payer: Mclaren Medicaid |
$122.48
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.74
|
| Rate for Payer: PACE SWMI |
$186.42
|
| Rate for Payer: PHP Medicare Advantage |
$186.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$186.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.42
|
| Rate for Payer: UHC Medicare Advantage |
$192.01
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$95.50 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.92
|
| Rate for Payer: BCN Commercial |
$88.25
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
|
|
PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 90697
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$175.01 |
| Rate for Payer: Aetna Commercial |
$154.01
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$175.01
|
| Rate for Payer: BCN Commercial |
$175.01
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
|
