|
PR I&D PENIS DEEP
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
HCPCS 54015
|
| Min. Negotiated Rate |
$195.11 |
| Max. Negotiated Rate |
$2,212.52 |
| Rate for Payer: Aetna Commercial |
$389.65
|
| Rate for Payer: Aetna Medicare |
$302.41
|
| Rate for Payer: BCBS Complete |
$204.87
|
| Rate for Payer: BCBS MAPPO |
$290.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,212.52
|
| Rate for Payer: BCN Commercial |
$439.81
|
| Rate for Payer: BCN Medicare Advantage |
$290.78
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Cofinity Commercial |
$418.72
|
| Rate for Payer: Cofinity Commercial |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.78
|
| Rate for Payer: Mclaren Medicaid |
$195.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.32
|
| Rate for Payer: Meridian Medicaid |
$204.87
|
| Rate for Payer: Nomi Health Commercial |
$348.94
|
| Rate for Payer: PACE SWMI |
$290.78
|
| Rate for Payer: PHP Medicare Advantage |
$290.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.90
|
| Rate for Payer: Priority Health HMO/PPO |
$485.73
|
| Rate for Payer: Priority Health Medicare |
$293.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$485.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.78
|
| Rate for Payer: UHC Exchange |
$290.78
|
| Rate for Payer: UHC Medicare Advantage |
$290.78
|
| Rate for Payer: UHCCP Medicaid |
$195.11
|
|
|
PR I&D PERIANAL ABSCESS SUPERFICIAL
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 46050
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$1,360.90 |
| Rate for Payer: Aetna Commercial |
$129.91
|
| Rate for Payer: Aetna Medicare |
$100.83
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS MAPPO |
$96.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.90
|
| Rate for Payer: BCN Commercial |
$349.40
|
| Rate for Payer: BCN Medicare Advantage |
$96.95
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$139.61
|
| Rate for Payer: Cofinity Commercial |
$129.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.95
|
| Rate for Payer: Mclaren Medicaid |
$66.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.80
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Nomi Health Commercial |
$116.34
|
| Rate for Payer: PACE SWMI |
$96.95
|
| Rate for Payer: PHP Medicare Advantage |
$96.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO |
$183.15
|
| Rate for Payer: Priority Health Medicare |
$97.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.95
|
| Rate for Payer: UHC Exchange |
$96.95
|
| Rate for Payer: UHC Medicare Advantage |
$96.95
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
|
|
PR I&D SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 23030
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$648.96 |
| Rate for Payer: Aetna Commercial |
$329.21
|
| Rate for Payer: Aetna Medicare |
$255.51
|
| Rate for Payer: BCBS Complete |
$174.45
|
| Rate for Payer: BCBS MAPPO |
$245.68
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$648.96
|
| Rate for Payer: BCN Medicare Advantage |
$245.68
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$353.78
|
| Rate for Payer: Cofinity Commercial |
$329.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.68
|
| Rate for Payer: Mclaren Medicaid |
$166.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.96
|
| Rate for Payer: Meridian Medicaid |
$174.45
|
| Rate for Payer: Nomi Health Commercial |
$294.82
|
| Rate for Payer: PACE SWMI |
$245.68
|
| Rate for Payer: PHP Medicare Advantage |
$245.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO |
$393.35
|
| Rate for Payer: Priority Health Medicare |
$248.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$393.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$245.68
|
| Rate for Payer: UHC Exchange |
$245.68
|
| Rate for Payer: UHC Medicare Advantage |
$245.68
|
| Rate for Payer: UHCCP Medicaid |
$166.14
|
|
|
PR I&D SHOULDER INFECTED BURSA
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 23031
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$639.67 |
| Rate for Payer: Aetna Commercial |
$287.83
|
| Rate for Payer: Aetna Medicare |
$223.39
|
| Rate for Payer: BCBS Complete |
$153.21
|
| Rate for Payer: BCBS MAPPO |
$214.80
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$639.67
|
| Rate for Payer: BCN Medicare Advantage |
$214.80
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$309.31
|
| Rate for Payer: Cofinity Commercial |
$287.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.80
|
| Rate for Payer: Mclaren Medicaid |
$145.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.54
|
| Rate for Payer: Meridian Medicaid |
$153.21
|
| Rate for Payer: Nomi Health Commercial |
$257.76
|
| Rate for Payer: PACE SWMI |
$214.80
|
| Rate for Payer: PHP Medicare Advantage |
$214.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.00
|
| Rate for Payer: Priority Health HMO/PPO |
$344.50
|
| Rate for Payer: Priority Health Medicare |
$216.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.80
|
| Rate for Payer: UHC Exchange |
$214.80
|
| Rate for Payer: UHC Medicare Advantage |
$214.80
|
| Rate for Payer: UHCCP Medicaid |
$145.91
|
|
|
PR I&D SOFT TISSUE ABSCESS SUBFASCIAL
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 20005
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$334.75 |
| Rate for Payer: Aetna Medicare |
$257.50
|
| Rate for Payer: BCBS Complete |
$206.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.75
|
|
|
PR I&D SUBMUCOSAL ABSCESS RECTUM
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 45005
|
| Min. Negotiated Rate |
$109.06 |
| Max. Negotiated Rate |
$2,676.37 |
| Rate for Payer: Aetna Commercial |
$215.75
|
| Rate for Payer: Aetna Medicare |
$167.45
|
| Rate for Payer: BCBS Complete |
$114.51
|
| Rate for Payer: BCBS MAPPO |
$161.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,676.37
|
| Rate for Payer: BCN Commercial |
$468.15
|
| Rate for Payer: BCN Medicare Advantage |
$161.01
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cofinity Commercial |
$231.85
|
| Rate for Payer: Cofinity Commercial |
$215.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.01
|
| Rate for Payer: Mclaren Medicaid |
$109.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.06
|
| Rate for Payer: Meridian Medicaid |
$114.51
|
| Rate for Payer: Nomi Health Commercial |
$193.21
|
| Rate for Payer: PACE SWMI |
$161.01
|
| Rate for Payer: PHP Medicare Advantage |
$161.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.55
|
| Rate for Payer: Priority Health HMO/PPO |
$298.30
|
| Rate for Payer: Priority Health Medicare |
$162.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.01
|
| Rate for Payer: UHC Exchange |
$161.01
|
| Rate for Payer: UHC Medicare Advantage |
$161.01
|
| Rate for Payer: UHCCP Medicaid |
$109.06
|
|
|
PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 23930
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$531.68 |
| Rate for Payer: Aetna Commercial |
$279.70
|
| Rate for Payer: Aetna Medicare |
$217.08
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS MAPPO |
$208.73
|
| Rate for Payer: BCBS Trust/PPO |
$18.25
|
| Rate for Payer: BCN Commercial |
$531.68
|
| Rate for Payer: BCN Medicare Advantage |
$208.73
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cofinity Commercial |
$300.57
|
| Rate for Payer: Cofinity Commercial |
$279.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.73
|
| Rate for Payer: Mclaren Medicaid |
$140.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.17
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Nomi Health Commercial |
$250.48
|
| Rate for Payer: PACE SWMI |
$208.73
|
| Rate for Payer: PHP Medicare Advantage |
$208.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.00
|
| Rate for Payer: Priority Health HMO/PPO |
$332.29
|
| Rate for Payer: Priority Health Medicare |
$210.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.73
|
| Rate for Payer: UHC Exchange |
$208.73
|
| Rate for Payer: UHC Medicare Advantage |
$208.73
|
| Rate for Payer: UHCCP Medicaid |
$140.79
|
|
|
PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 57023
|
| Min. Negotiated Rate |
$205.33 |
| Max. Negotiated Rate |
$2,321.35 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Medicare |
$318.52
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS MAPPO |
$306.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,321.35
|
| Rate for Payer: BCN Commercial |
$469.62
|
| Rate for Payer: BCN Medicare Advantage |
$306.27
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$441.03
|
| Rate for Payer: Cofinity Commercial |
$410.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.27
|
| Rate for Payer: Mclaren Medicaid |
$205.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.58
|
| Rate for Payer: Meridian Medicaid |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$367.52
|
| Rate for Payer: PACE SWMI |
$306.27
|
| Rate for Payer: PHP Medicare Advantage |
$306.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health HMO/PPO |
$479.68
|
| Rate for Payer: Priority Health Medicare |
$309.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.27
|
| Rate for Payer: UHC Exchange |
$306.27
|
| Rate for Payer: UHC Medicare Advantage |
$306.27
|
| Rate for Payer: UHCCP Medicaid |
$205.33
|
|
|
PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 57022
|
| Min. Negotiated Rate |
$116.72 |
| Max. Negotiated Rate |
$3,001.80 |
| Rate for Payer: Aetna Commercial |
$232.37
|
| Rate for Payer: Aetna Medicare |
$180.35
|
| Rate for Payer: BCBS Complete |
$122.56
|
| Rate for Payer: BCBS MAPPO |
$173.41
|
| Rate for Payer: BCBS Trust/PPO |
$3,001.80
|
| Rate for Payer: BCN Commercial |
$266.82
|
| Rate for Payer: BCN Medicare Advantage |
$173.41
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$249.71
|
| Rate for Payer: Cofinity Commercial |
$232.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.41
|
| Rate for Payer: Mclaren Medicaid |
$116.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.08
|
| Rate for Payer: Meridian Medicaid |
$122.56
|
| Rate for Payer: Nomi Health Commercial |
$208.09
|
| Rate for Payer: PACE SWMI |
$173.41
|
| Rate for Payer: PHP Medicare Advantage |
$173.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.70
|
| Rate for Payer: Priority Health HMO/PPO |
$271.84
|
| Rate for Payer: Priority Health Medicare |
$175.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.41
|
| Rate for Payer: UHC Exchange |
$173.41
|
| Rate for Payer: UHC Medicare Advantage |
$173.41
|
| Rate for Payer: UHCCP Medicaid |
$116.72
|
|
|
PR I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 56405
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$1,505.13 |
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Medicare |
$124.83
|
| Rate for Payer: BCBS Complete |
$86.11
|
| Rate for Payer: BCBS MAPPO |
$120.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,505.13
|
| Rate for Payer: BCN Commercial |
$217.95
|
| Rate for Payer: BCN Medicare Advantage |
$120.03
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$172.84
|
| Rate for Payer: Cofinity Commercial |
$160.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.03
|
| Rate for Payer: Mclaren Medicaid |
$82.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.03
|
| Rate for Payer: Meridian Medicaid |
$86.11
|
| Rate for Payer: Nomi Health Commercial |
$144.04
|
| Rate for Payer: PACE SWMI |
$120.03
|
| Rate for Payer: PHP Medicare Advantage |
$120.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO |
$190.98
|
| Rate for Payer: Priority Health Medicare |
$121.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.03
|
| Rate for Payer: UHC Exchange |
$120.03
|
| Rate for Payer: UHC Medicare Advantage |
$120.03
|
| Rate for Payer: UHCCP Medicaid |
$82.01
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90657
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$14.64
|
| Rate for Payer: Aetna Medicare |
$11.37
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$10.93
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Medicare Advantage |
$10.93
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.48
|
| Rate for Payer: Nomi Health Commercial |
$13.11
|
| Rate for Payer: PACE SWMI |
$10.93
|
| Rate for Payer: PHP Medicare Advantage |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$11.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.93
|
| Rate for Payer: UHC Exchange |
$10.93
|
| Rate for Payer: UHC Medicare Advantage |
$10.93
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90658
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$31.48 |
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Medicare |
$22.73
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$21.86
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Medicare Advantage |
$21.86
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$31.48
|
| Rate for Payer: Cofinity Commercial |
$29.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.95
|
| Rate for Payer: Nomi Health Commercial |
$26.23
|
| Rate for Payer: PACE SWMI |
$21.86
|
| Rate for Payer: PHP Medicare Advantage |
$21.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$22.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.86
|
| Rate for Payer: UHC Exchange |
$21.86
|
| Rate for Payer: UHC Medicare Advantage |
$21.86
|
|
|
PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90656
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Medicare |
$23.24
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$22.35
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Medicare Advantage |
$22.35
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$32.18
|
| Rate for Payer: Cofinity Commercial |
$29.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.47
|
| Rate for Payer: Nomi Health Commercial |
$26.82
|
| Rate for Payer: PACE SWMI |
$22.35
|
| Rate for Payer: PHP Medicare Advantage |
$22.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$22.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.35
|
| Rate for Payer: UHC Exchange |
$22.35
|
| Rate for Payer: UHC Medicare Advantage |
$22.35
|
|
|
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: Aetna Medicare |
$11.50
|
| 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 |
$14.95
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90686
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$22.65
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90685
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna Commercial |
$19.36
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$22.05
|
| Rate for Payer: BCN Commercial |
$22.05
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90687
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$10.44
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.78
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90688
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$21.56 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.56
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 90653
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$120.23 |
| Rate for Payer: Aetna Commercial |
$111.88
|
| Rate for Payer: Aetna Medicare |
$86.83
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$83.49
|
| Rate for Payer: BCBS Trust/PPO |
$60.56
|
| Rate for Payer: BCN Commercial |
$60.56
|
| Rate for Payer: BCN Medicare Advantage |
$83.49
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$120.23
|
| Rate for Payer: Cofinity Commercial |
$111.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.66
|
| Rate for Payer: Nomi Health Commercial |
$100.19
|
| Rate for Payer: PACE SWMI |
$83.49
|
| Rate for Payer: PHP Medicare Advantage |
$83.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health Medicare |
$84.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.49
|
| Rate for Payer: UHC Exchange |
$83.49
|
| Rate for Payer: UHC Medicare Advantage |
$83.49
|
|
|
PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 90662
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$120.23 |
| Rate for Payer: Aetna Commercial |
$111.88
|
| Rate for Payer: Aetna Medicare |
$86.83
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$83.49
|
| Rate for Payer: BCBS Trust/PPO |
$73.62
|
| Rate for Payer: BCN Commercial |
$73.62
|
| Rate for Payer: BCN Medicare Advantage |
$83.49
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$120.23
|
| Rate for Payer: Cofinity Commercial |
$111.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.67
|
| Rate for Payer: Nomi Health Commercial |
$100.19
|
| Rate for Payer: PACE SWMI |
$83.49
|
| Rate for Payer: PHP Medicare Advantage |
$83.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$84.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.49
|
| Rate for Payer: UHC Exchange |
$83.49
|
| Rate for Payer: UHC Medicare Advantage |
$83.49
|
|
|
PR ILEOSCOPY STOMA W/BALLOON DILATION
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 44381
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$1,457.24 |
| Rate for Payer: Aetna Commercial |
$106.37
|
| Rate for Payer: Aetna Medicare |
$82.56
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$79.38
|
| Rate for Payer: BCBS Trust/PPO |
$282.11
|
| Rate for Payer: BCN Commercial |
$1,457.24
|
| Rate for Payer: BCN Medicare Advantage |
$79.38
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$114.31
|
| Rate for Payer: Cofinity Commercial |
$106.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.38
|
| Rate for Payer: Mclaren Medicaid |
$53.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.35
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Nomi Health Commercial |
$95.26
|
| Rate for Payer: PACE SWMI |
$79.38
|
| Rate for Payer: PHP Medicare Advantage |
$79.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health HMO/PPO |
$150.33
|
| Rate for Payer: Priority Health Medicare |
$80.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.38
|
| Rate for Payer: UHC Exchange |
$79.38
|
| Rate for Payer: UHC Medicare Advantage |
$79.38
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 44382
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$609.05 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Aetna Medicare |
$72.55
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS MAPPO |
$69.76
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$440.79
|
| Rate for Payer: BCN Medicare Advantage |
$69.76
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cofinity Commercial |
$93.48
|
| Rate for Payer: Cofinity Commercial |
$100.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.76
|
| Rate for Payer: Mclaren Medicaid |
$47.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.25
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Nomi Health Commercial |
$83.71
|
| Rate for Payer: PACE SWMI |
$69.76
|
| Rate for Payer: PHP Medicare Advantage |
$69.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.05
|
| Rate for Payer: Priority Health HMO/PPO |
$131.25
|
| Rate for Payer: Priority Health Medicare |
$70.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.76
|
| Rate for Payer: UHC Exchange |
$69.76
|
| Rate for Payer: UHC Medicare Advantage |
$69.76
|
| Rate for Payer: UHCCP Medicaid |
$47.07
|
|
|
PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 44384
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$402.56 |
| Rate for Payer: Aetna Commercial |
$194.23
|
| Rate for Payer: Aetna Medicare |
$150.75
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$144.95
|
| Rate for Payer: BCBS Trust/PPO |
$402.56
|
| Rate for Payer: BCN Commercial |
$222.35
|
| Rate for Payer: BCN Medicare Advantage |
$144.95
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$208.73
|
| Rate for Payer: Cofinity Commercial |
$194.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.95
|
| Rate for Payer: Mclaren Medicaid |
$96.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.20
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Nomi Health Commercial |
$173.94
|
| Rate for Payer: PACE SWMI |
$144.95
|
| Rate for Payer: PHP Medicare Advantage |
$144.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health HMO/PPO |
$268.46
|
| Rate for Payer: Priority Health Medicare |
$146.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.95
|
| Rate for Payer: UHC Exchange |
$144.95
|
| Rate for Payer: UHC Medicare Advantage |
$144.95
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$544.70 |
| Rate for Payer: Aetna Commercial |
$73.03
|
| Rate for Payer: Aetna Medicare |
$56.68
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$54.50
|
| Rate for Payer: BCBS Trust/PPO |
$247.77
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$54.50
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Cofinity Commercial |
$73.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.50
|
| Rate for Payer: Mclaren Medicaid |
$36.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.22
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Nomi Health Commercial |
$65.40
|
| Rate for Payer: PACE SWMI |
$54.50
|
| Rate for Payer: PHP Medicare Advantage |
$54.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health HMO/PPO |
$102.01
|
| Rate for Payer: Priority Health Medicare |
$55.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.50
|
| Rate for Payer: UHC Exchange |
$54.50
|
| Rate for Payer: UHC Medicare Advantage |
$54.50
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
|
|
PR ILEOSCOPY,THRU STOMA,TRANSENDO STENT
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 44383
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$706.55 |
| Rate for Payer: Aetna Medicare |
$543.50
|
| Rate for Payer: BCBS Complete |
$434.80
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.55
|
|
