|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,483.00
|
|
|
Service Code
|
HCPCS 26990
|
| Min. Negotiated Rate |
$433.21 |
| Max. Negotiated Rate |
$1,049.90 |
| Rate for Payer: Aetna Commercial |
$895.01
|
| Rate for Payer: Aetna Medicare |
$694.64
|
| Rate for Payer: BCBS Complete |
$462.50
|
| Rate for Payer: BCBS MAPPO |
$667.92
|
| Rate for Payer: BCBS Trust/PPO |
$433.21
|
| Rate for Payer: BCN Commercial |
$1,004.72
|
| Rate for Payer: BCN Medicare Advantage |
$667.92
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$895.01
|
| Rate for Payer: Cofinity Commercial |
$961.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$667.92
|
| Rate for Payer: Mclaren Medicaid |
$440.48
|
| Rate for Payer: Meridian Medicaid |
$462.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$701.32
|
| Rate for Payer: PACE SWMI |
$667.92
|
| Rate for Payer: PHP Medicare Advantage |
$667.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,038.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,049.90
|
| Rate for Payer: Priority Health Medicare |
$667.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,049.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$667.92
|
| Rate for Payer: UHC Medicare Advantage |
$687.96
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,483.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
26990
|
| Min. Negotiated Rate |
$433.21 |
| Max. Negotiated Rate |
$1,049.90 |
| Rate for Payer: Aetna Commercial |
$895.01
|
| Rate for Payer: Aetna Medicare |
$694.64
|
| Rate for Payer: BCBS Complete |
$462.50
|
| Rate for Payer: BCBS MAPPO |
$667.92
|
| Rate for Payer: BCBS Trust/PPO |
$433.21
|
| Rate for Payer: BCN Commercial |
$1,004.72
|
| Rate for Payer: BCN Medicare Advantage |
$667.92
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$895.01
|
| Rate for Payer: Cofinity Commercial |
$961.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$667.92
|
| Rate for Payer: Mclaren Medicaid |
$440.48
|
| Rate for Payer: Meridian Medicaid |
$462.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$701.32
|
| Rate for Payer: PACE SWMI |
$667.92
|
| Rate for Payer: PHP Medicare Advantage |
$667.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,038.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,049.90
|
| Rate for Payer: Priority Health Medicare |
$667.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,049.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$667.92
|
| Rate for Payer: UHC Medicare Advantage |
$687.96
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 26990
|
| Hospital Charge Code |
26990
|
| Min. Negotiated Rate |
$352.21 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: Aetna Commercial |
$1,260.55
|
| Rate for Payer: Aetna Medicare |
$385.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$463.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$463.44
|
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: BCBS MAPPO |
$370.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,153.03
|
| Rate for Payer: BCN Commercial |
$1,153.03
|
| Rate for Payer: BCN Medicare Advantage |
$370.75
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$1,275.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.75
|
| Rate for Payer: Healthscope Commercial |
$1,334.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,112.25
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$389.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,260.55
|
| Rate for Payer: PACE Senior Care Partners |
$352.21
|
| Rate for Payer: PACE SWMI |
$370.75
|
| Rate for Payer: PHP Commercial |
$1,260.55
|
| Rate for Payer: PHP Medicare Advantage |
$370.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,038.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,290.21
|
| Rate for Payer: Priority Health Medicare |
$370.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$904.48
|
| Rate for Payer: Railroad Medicare Medicare |
$370.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,305.04
|
| Rate for Payer: UHC Core |
$1,238.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.75
|
| Rate for Payer: UHC Medicare Advantage |
$381.87
|
| Rate for Payer: VA VA |
$370.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,112.25
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 26990
|
| Hospital Charge Code |
26990
|
| Min. Negotiated Rate |
$904.48 |
| Max. Negotiated Rate |
$1,334.70 |
| Rate for Payer: Aetna Commercial |
$1,260.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,146.06
|
| Rate for Payer: BCN Commercial |
$1,146.06
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$1,275.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.40
|
| Rate for Payer: Healthscope Commercial |
$1,334.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,112.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,260.55
|
| Rate for Payer: PHP Commercial |
$1,260.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,038.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,290.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$904.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,305.04
|
| Rate for Payer: UHC Core |
$1,238.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,112.25
|
|
|
PR I&D PENIS DEEP
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 54015
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$2,212.52 |
| Rate for Payer: Aetna Commercial |
$398.84
|
| Rate for Payer: Aetna Medicare |
$309.55
|
| Rate for Payer: BCBS Complete |
$203.97
|
| Rate for Payer: BCBS MAPPO |
$297.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,212.52
|
| Rate for Payer: BCN Commercial |
$439.81
|
| Rate for Payer: BCN Medicare Advantage |
$297.64
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$428.60
|
| Rate for Payer: Cofinity Commercial |
$398.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.64
|
| Rate for Payer: Mclaren Medicaid |
$194.26
|
| Rate for Payer: Meridian Medicaid |
$203.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.52
|
| Rate for Payer: PACE SWMI |
$297.64
|
| Rate for Payer: PHP Medicare Advantage |
$297.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.31
|
| Rate for Payer: Priority Health Medicare |
$297.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.64
|
| Rate for Payer: UHC Medicare Advantage |
$306.57
|
|
|
PR I&D PERIANAL ABSCESS SUPERFICIAL
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 46050
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$1,360.90 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$102.95
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCBS MAPPO |
$98.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.90
|
| Rate for Payer: BCN Commercial |
$349.40
|
| Rate for Payer: BCN Medicare Advantage |
$98.99
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$142.55
|
| Rate for Payer: Cofinity Commercial |
$132.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.99
|
| Rate for Payer: Mclaren Medicaid |
$65.39
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$103.94
|
| Rate for Payer: PACE SWMI |
$98.99
|
| Rate for Payer: PHP Medicare Advantage |
$98.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.75
|
| Rate for Payer: Priority Health Medicare |
$98.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.99
|
| Rate for Payer: UHC Medicare Advantage |
$101.96
|
|
|
PR I&D SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 23030
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$648.96 |
| Rate for Payer: Aetna Commercial |
$335.66
|
| Rate for Payer: Aetna Medicare |
$260.51
|
| Rate for Payer: BCBS Complete |
$172.88
|
| Rate for Payer: BCBS MAPPO |
$250.49
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$648.96
|
| Rate for Payer: BCN Medicare Advantage |
$250.49
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$360.71
|
| Rate for Payer: Cofinity Commercial |
$335.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.49
|
| Rate for Payer: Mclaren Medicaid |
$164.65
|
| Rate for Payer: Meridian Medicaid |
$172.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.01
|
| Rate for Payer: PACE SWMI |
$250.49
|
| Rate for Payer: PHP Medicare Advantage |
$250.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.65
|
| Rate for Payer: Priority Health Medicare |
$250.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$390.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.49
|
| Rate for Payer: UHC Medicare Advantage |
$258.00
|
|
|
PR I&D SHOULDER INFECTED BURSA
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
HCPCS 23031
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$639.67 |
| Rate for Payer: Aetna Commercial |
$292.21
|
| Rate for Payer: Aetna Medicare |
$226.79
|
| Rate for Payer: BCBS Complete |
$151.41
|
| Rate for Payer: BCBS MAPPO |
$218.07
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$639.67
|
| Rate for Payer: BCN Medicare Advantage |
$218.07
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cofinity Commercial |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$314.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.07
|
| Rate for Payer: Mclaren Medicaid |
$144.20
|
| Rate for Payer: Meridian Medicaid |
$151.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.97
|
| Rate for Payer: PACE SWMI |
$218.07
|
| Rate for Payer: PHP Medicare Advantage |
$218.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$341.63
|
| Rate for Payer: Priority Health Medicare |
$218.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.07
|
| Rate for Payer: UHC Medicare Advantage |
$224.61
|
|
|
PR I&D SOFT TISSUE ABSCESS SUBFASCIAL
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 20005
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$353.50 |
| Rate for Payer: BCBS Complete |
$202.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.50
|
|
|
PR I&D SUBMUCOSAL ABSCESS RECTUM
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 45005
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$2,676.37 |
| Rate for Payer: Aetna Commercial |
$219.24
|
| Rate for Payer: Aetna Medicare |
$170.15
|
| Rate for Payer: BCBS Complete |
$111.82
|
| Rate for Payer: BCBS MAPPO |
$163.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,676.37
|
| Rate for Payer: BCN Commercial |
$468.15
|
| Rate for Payer: BCN Medicare Advantage |
$163.61
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$219.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.61
|
| Rate for Payer: Mclaren Medicaid |
$106.50
|
| Rate for Payer: Meridian Medicaid |
$111.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.79
|
| Rate for Payer: PACE SWMI |
$163.61
|
| Rate for Payer: PHP Medicare Advantage |
$163.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.57
|
| Rate for Payer: Priority Health Medicare |
$163.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.61
|
| Rate for Payer: UHC Medicare Advantage |
$168.52
|
|
|
PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 23930
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$531.68 |
| Rate for Payer: Aetna Commercial |
$284.94
|
| Rate for Payer: Aetna Medicare |
$221.15
|
| Rate for Payer: BCBS Complete |
$146.04
|
| Rate for Payer: BCBS MAPPO |
$212.64
|
| Rate for Payer: BCBS Trust/PPO |
$18.25
|
| Rate for Payer: BCN Commercial |
$531.68
|
| Rate for Payer: BCN Medicare Advantage |
$212.64
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$306.20
|
| Rate for Payer: Cofinity Commercial |
$284.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.64
|
| Rate for Payer: Mclaren Medicaid |
$139.09
|
| Rate for Payer: Meridian Medicaid |
$146.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$223.27
|
| Rate for Payer: PACE SWMI |
$212.64
|
| Rate for Payer: PHP Medicare Advantage |
$212.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.90
|
| Rate for Payer: Priority Health Medicare |
$212.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.64
|
| Rate for Payer: UHC Medicare Advantage |
$219.02
|
|
|
PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 57023
|
| Min. Negotiated Rate |
$205.97 |
| Max. Negotiated Rate |
$2,321.35 |
| Rate for Payer: Aetna Commercial |
$424.85
|
| Rate for Payer: Aetna Medicare |
$329.73
|
| Rate for Payer: BCBS Complete |
$216.27
|
| Rate for Payer: BCBS MAPPO |
$317.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,321.35
|
| Rate for Payer: BCN Commercial |
$469.62
|
| Rate for Payer: BCN Medicare Advantage |
$317.05
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$456.55
|
| Rate for Payer: Cofinity Commercial |
$424.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.05
|
| Rate for Payer: Mclaren Medicaid |
$205.97
|
| Rate for Payer: Meridian Medicaid |
$216.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$332.90
|
| Rate for Payer: PACE SWMI |
$317.05
|
| Rate for Payer: PHP Medicare Advantage |
$317.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$454.97
|
| Rate for Payer: Priority Health Medicare |
$317.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$454.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.05
|
| Rate for Payer: UHC Medicare Advantage |
$326.56
|
|
|
PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 57022
|
| Min. Negotiated Rate |
$116.72 |
| Max. Negotiated Rate |
$3,001.80 |
| Rate for Payer: Aetna Commercial |
$240.20
|
| Rate for Payer: Aetna Medicare |
$186.42
|
| Rate for Payer: BCBS Complete |
$122.56
|
| Rate for Payer: BCBS MAPPO |
$179.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,001.80
|
| Rate for Payer: BCN Commercial |
$266.82
|
| Rate for Payer: BCN Medicare Advantage |
$179.25
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$258.12
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.25
|
| Rate for Payer: Mclaren Medicaid |
$116.72
|
| Rate for Payer: Meridian Medicaid |
$122.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$188.21
|
| Rate for Payer: PACE SWMI |
$179.25
|
| Rate for Payer: PHP Medicare Advantage |
$179.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.48
|
| Rate for Payer: Priority Health Medicare |
$179.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.25
|
| Rate for Payer: UHC Medicare Advantage |
$184.63
|
|
|
PR I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 56405
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$1,505.13 |
| Rate for Payer: Aetna Commercial |
$166.33
|
| Rate for Payer: Aetna Medicare |
$129.10
|
| Rate for Payer: BCBS Complete |
$86.11
|
| Rate for Payer: BCBS MAPPO |
$124.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,505.13
|
| Rate for Payer: BCN Commercial |
$217.95
|
| Rate for Payer: BCN Medicare Advantage |
$124.13
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$178.75
|
| Rate for Payer: Cofinity Commercial |
$166.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.13
|
| Rate for Payer: Mclaren Medicaid |
$82.01
|
| Rate for Payer: Meridian Medicaid |
$86.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$130.34
|
| Rate for Payer: PACE SWMI |
$124.13
|
| Rate for Payer: PHP Medicare Advantage |
$124.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.32
|
| Rate for Payer: Priority Health Medicare |
$124.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.13
|
| Rate for Payer: UHC Medicare Advantage |
$127.85
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 90657
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 90658
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$16.32
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
|
PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 90656
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
|
|
PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90655
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 90686
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$30.99 |
| Rate for Payer: Aetna Commercial |
$28.83
|
| Rate for Payer: Aetna Medicare |
$22.38
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$21.52
|
| Rate for Payer: BCBS Trust/PPO |
$22.65
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Medicare Advantage |
$21.52
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$28.83
|
| Rate for Payer: Cofinity Commercial |
$30.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.59
|
| Rate for Payer: PACE SWMI |
$21.52
|
| Rate for Payer: PHP Medicare Advantage |
$21.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Medicare |
$21.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.52
|
| Rate for Payer: UHC Medicare Advantage |
$22.16
|
|
|
PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 90685
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$22.05
|
| Rate for Payer: BCN Commercial |
$22.05
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 90687
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$13.72
|
| Rate for Payer: Aetna Medicare |
$10.65
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$10.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.78
|
| Rate for Payer: BCN Medicare Advantage |
$10.24
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$13.72
|
| Rate for Payer: Cofinity Commercial |
$14.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.75
|
| Rate for Payer: PACE SWMI |
$10.24
|
| Rate for Payer: PHP Medicare Advantage |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Medicare |
$10.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.24
|
| Rate for Payer: UHC Medicare Advantage |
$10.55
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 90688
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$29.49 |
| Rate for Payer: Aetna Commercial |
$27.45
|
| Rate for Payer: Aetna Medicare |
$21.30
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$21.56
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: BCN Medicare Advantage |
$20.48
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$29.49
|
| Rate for Payer: Cofinity Commercial |
$27.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.51
|
| Rate for Payer: PACE SWMI |
$20.48
|
| Rate for Payer: PHP Medicare Advantage |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Medicare |
$20.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.48
|
| Rate for Payer: UHC Medicare Advantage |
$21.10
|
|
|
PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 90662
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$93.72
|
| Rate for Payer: Aetna Medicare |
$72.74
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$69.94
|
| Rate for Payer: BCBS Trust/PPO |
$73.62
|
| Rate for Payer: BCN Commercial |
$73.62
|
| Rate for Payer: BCN Medicare Advantage |
$69.94
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$100.72
|
| Rate for Payer: Cofinity Commercial |
$93.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.44
|
| Rate for Payer: PACE SWMI |
$69.94
|
| Rate for Payer: PHP Medicare Advantage |
$69.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health Medicare |
$69.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.94
|
| Rate for Payer: UHC Medicare Advantage |
$72.04
|
|
|
PR ILEOSCOPY STOMA W/BALLOON DILATION
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 44381
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$1,457.24 |
| Rate for Payer: Aetna Commercial |
$110.42
|
| Rate for Payer: Aetna Medicare |
$85.70
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS MAPPO |
$82.40
|
| Rate for Payer: BCBS Trust/PPO |
$282.11
|
| Rate for Payer: BCN Commercial |
$1,457.24
|
| Rate for Payer: BCN Medicare Advantage |
$82.40
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.40
|
| Rate for Payer: Mclaren Medicaid |
$53.68
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.52
|
| Rate for Payer: PACE SWMI |
$82.40
|
| Rate for Payer: PHP Medicare Advantage |
$82.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.00
|
| Rate for Payer: Priority Health Medicare |
$82.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.40
|
| Rate for Payer: UHC Medicare Advantage |
$84.87
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 44382
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$643.30 |
| Rate for Payer: Aetna Commercial |
$96.60
|
| Rate for Payer: Aetna Medicare |
$74.97
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$72.09
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$440.79
|
| Rate for Payer: BCN Medicare Advantage |
$72.09
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$96.60
|
| Rate for Payer: Cofinity Commercial |
$103.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.09
|
| Rate for Payer: Mclaren Medicaid |
$46.86
|
| Rate for Payer: Meridian Medicaid |
$49.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.69
|
| Rate for Payer: PACE SWMI |
$72.09
|
| Rate for Payer: PHP Medicare Advantage |
$72.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$643.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.76
|
| Rate for Payer: Priority Health Medicare |
$72.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.09
|
| Rate for Payer: UHC Medicare Advantage |
$74.25
|
|
