|
PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 90633
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Aetna Commercial |
$38.42
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.42
|
| Rate for Payer: BCBS Trust/PPO |
$39.13
|
| Rate for Payer: BCN Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.56
|
| Rate for Payer: UHC Core |
$39.56
|
| Rate for Payer: UHC Exchange |
$39.56
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 90632
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$106.17 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Medicare |
$76.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$73.73
|
| Rate for Payer: BCBS Trust/PPO |
$83.73
|
| Rate for Payer: BCN Commercial |
$84.64
|
| Rate for Payer: BCN Medicare Advantage |
$73.73
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$106.17
|
| Rate for Payer: Cofinity Commercial |
$98.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.10
|
| Rate for Payer: Nomi Health Commercial |
$88.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.75
|
| Rate for Payer: PACE SWMI |
$73.73
|
| Rate for Payer: PHP Commercial |
$103.22
|
| Rate for Payer: PHP Medicare Advantage |
$73.73
|
| Rate for Payer: Priority Health Medicare |
$73.73
|
| Rate for Payer: Railroad Medicare Medicare |
$73.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.94
|
| Rate for Payer: UHC Core |
$84.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.73
|
| Rate for Payer: UHC Exchange |
$84.94
|
| Rate for Payer: UMR Bronson Commercial |
$42.78
|
|
|
PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 90743
|
| Min. Negotiated Rate |
$48.76 |
| Max. Negotiated Rate |
$108.22 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Medicare |
$78.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.22
|
| Rate for Payer: BCBS MAPPO |
$75.15
|
| Rate for Payer: BCBS Trust/PPO |
$72.21
|
| Rate for Payer: BCN Commercial |
$67.58
|
| Rate for Payer: BCN Medicare Advantage |
$75.15
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$100.70
|
| Rate for Payer: Cofinity Commercial |
$108.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.67
|
| Rate for Payer: Nomi Health Commercial |
$90.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.50
|
| Rate for Payer: PACE SWMI |
$75.15
|
| Rate for Payer: PHP Commercial |
$105.21
|
| Rate for Payer: PHP Medicare Advantage |
$75.15
|
| Rate for Payer: Priority Health Medicare |
$75.15
|
| Rate for Payer: Railroad Medicare Medicare |
$75.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.21
|
| Rate for Payer: UHC Core |
$72.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$75.15
|
| Rate for Payer: UHC Exchange |
$72.21
|
| Rate for Payer: UMR Bronson Commercial |
$48.76
|
|
|
PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 90739
|
| Min. Negotiated Rate |
$153.25 |
| Max. Negotiated Rate |
$255.69 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Aetna Medicare |
$184.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.69
|
| Rate for Payer: BCBS MAPPO |
$177.56
|
| Rate for Payer: BCBS Trust/PPO |
$155.75
|
| Rate for Payer: BCN Commercial |
$153.25
|
| Rate for Payer: BCN Medicare Advantage |
$177.56
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$255.69
|
| Rate for Payer: Cofinity Commercial |
$237.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.32
|
| Rate for Payer: Nomi Health Commercial |
$213.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.00
|
| Rate for Payer: PACE SWMI |
$177.56
|
| Rate for Payer: PHP Commercial |
$248.58
|
| Rate for Payer: PHP Medicare Advantage |
$177.56
|
| Rate for Payer: Priority Health Medicare |
$177.56
|
| Rate for Payer: Railroad Medicare Medicare |
$177.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.75
|
| Rate for Payer: UHC Core |
$155.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$177.56
|
| Rate for Payer: UHC Exchange |
$155.75
|
| Rate for Payer: UMR Bronson Commercial |
$154.56
|
|
|
PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 90746
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$108.22 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Medicare |
$78.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.22
|
| Rate for Payer: BCBS MAPPO |
$75.15
|
| Rate for Payer: BCBS Trust/PPO |
$72.21
|
| Rate for Payer: BCN Commercial |
$70.96
|
| Rate for Payer: BCN Medicare Advantage |
$75.15
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$100.70
|
| Rate for Payer: Cofinity Commercial |
$108.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.67
|
| Rate for Payer: Nomi Health Commercial |
$90.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.75
|
| Rate for Payer: PACE SWMI |
$75.15
|
| Rate for Payer: PHP Commercial |
$105.21
|
| Rate for Payer: PHP Medicare Advantage |
$75.15
|
| Rate for Payer: Priority Health Medicare |
$75.15
|
| Rate for Payer: Railroad Medicare Medicare |
$75.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.23
|
| Rate for Payer: UHC Core |
$72.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$75.15
|
| Rate for Payer: UHC Exchange |
$72.23
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
|
|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90744
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$34.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.81
|
| Rate for Payer: BCBS MAPPO |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$29.25
|
| Rate for Payer: BCN Commercial |
$28.65
|
| Rate for Payer: BCN Medicare Advantage |
$33.20
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$47.81
|
| Rate for Payer: Cofinity Commercial |
$44.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.52
|
| Rate for Payer: Nomi Health Commercial |
$39.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$33.20
|
| Rate for Payer: PHP Commercial |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$33.20
|
| Rate for Payer: Priority Health Medicare |
$33.20
|
| Rate for Payer: Railroad Medicare Medicare |
$33.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.26
|
| Rate for Payer: UHC Core |
$29.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.20
|
| Rate for Payer: UHC Exchange |
$29.26
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR HFO FLEXION GLOVE PRE OTS
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS L3912
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$169.69 |
| Rate for Payer: Aetna Commercial |
$157.91
|
| Rate for Payer: Aetna Medicare |
$122.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.69
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$117.84
|
| Rate for Payer: BCN Commercial |
$112.82
|
| Rate for Payer: BCN Medicare Advantage |
$117.84
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$169.69
|
| Rate for Payer: Cofinity Commercial |
$157.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.62
|
| Rate for Payer: Nomi Health Commercial |
$141.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.50
|
| Rate for Payer: PACE SWMI |
$117.84
|
| Rate for Payer: PHP Commercial |
$164.98
|
| Rate for Payer: PHP Medicare Advantage |
$117.84
|
| Rate for Payer: Priority Health Medicare |
$117.84
|
| Rate for Payer: Railroad Medicare Medicare |
$117.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.42
|
| Rate for Payer: UHC Core |
$38.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$117.84
|
| Rate for Payer: UHC Exchange |
$38.42
|
| Rate for Payer: UMR Bronson Commercial |
$46.92
|
|
|
PR HFO NONTORSION JNTS PRE CST
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS L3929
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$147.11 |
| Rate for Payer: Aetna Commercial |
$136.89
|
| Rate for Payer: Aetna Medicare |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.11
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS MAPPO |
$102.16
|
| Rate for Payer: BCN Commercial |
$97.81
|
| Rate for Payer: BCN Medicare Advantage |
$102.16
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$136.89
|
| Rate for Payer: Cofinity Commercial |
$147.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$112.38
|
| Rate for Payer: Nomi Health Commercial |
$122.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.75
|
| Rate for Payer: PACE SWMI |
$102.16
|
| Rate for Payer: PHP Commercial |
$143.02
|
| Rate for Payer: PHP Medicare Advantage |
$102.16
|
| Rate for Payer: Priority Health Medicare |
$102.16
|
| Rate for Payer: Railroad Medicare Medicare |
$102.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.31
|
| Rate for Payer: UHC Core |
$33.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$102.16
|
| Rate for Payer: UHC Exchange |
$33.31
|
| Rate for Payer: UMR Bronson Commercial |
$40.94
|
|
|
PR HFO W/JOINT(S) CF
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS L3921
|
| Min. Negotiated Rate |
$117.15 |
| Max. Negotiated Rate |
$517.36 |
| Rate for Payer: Aetna Commercial |
$481.44
|
| Rate for Payer: Aetna Medicare |
$373.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.36
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: BCBS MAPPO |
$359.28
|
| Rate for Payer: BCN Commercial |
$343.98
|
| Rate for Payer: BCN Medicare Advantage |
$359.28
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$517.36
|
| Rate for Payer: Cofinity Commercial |
$481.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$395.21
|
| Rate for Payer: Nomi Health Commercial |
$431.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.75
|
| Rate for Payer: PACE SWMI |
$359.28
|
| Rate for Payer: PHP Commercial |
$502.99
|
| Rate for Payer: PHP Medicare Advantage |
$359.28
|
| Rate for Payer: Priority Health Medicare |
$359.28
|
| Rate for Payer: Railroad Medicare Medicare |
$359.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.15
|
| Rate for Payer: UHC Core |
$117.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$359.28
|
| Rate for Payer: UHC Exchange |
$117.15
|
| Rate for Payer: UMR Bronson Commercial |
$142.14
|
|
|
PR HFO W/O JOINTS CF
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS L3913
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$436.18 |
| Rate for Payer: Aetna Commercial |
$405.89
|
| Rate for Payer: Aetna Medicare |
$315.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.18
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: BCBS MAPPO |
$302.90
|
| Rate for Payer: BCN Commercial |
$290.00
|
| Rate for Payer: BCN Medicare Advantage |
$302.90
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$405.89
|
| Rate for Payer: Cofinity Commercial |
$436.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.19
|
| Rate for Payer: Nomi Health Commercial |
$363.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.75
|
| Rate for Payer: PACE SWMI |
$302.90
|
| Rate for Payer: PHP Commercial |
$424.06
|
| Rate for Payer: PHP Medicare Advantage |
$302.90
|
| Rate for Payer: Priority Health Medicare |
$302.90
|
| Rate for Payer: Railroad Medicare Medicare |
$302.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Core |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$302.90
|
| Rate for Payer: UHC Exchange |
$98.77
|
| Rate for Payer: UMR Bronson Commercial |
$120.06
|
|
|
PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 90748
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$42.90
|
| Rate for Payer: Aetna Medicare |
$136.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.90
|
| Rate for Payer: BCBS Complete |
$109.20
|
| Rate for Payer: BCBS Trust/PPO |
$42.85
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Core |
$50.47
|
| Rate for Payer: UHC Exchange |
$50.47
|
| Rate for Payer: UMR Bronson Commercial |
$125.58
|
|
|
PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 90647
|
| Min. Negotiated Rate |
$17.48 |
| Max. Negotiated Rate |
$31.47 |
| Rate for Payer: Aetna Commercial |
$30.53
|
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.53
|
| Rate for Payer: BCBS Trust/PPO |
$31.47
|
| Rate for Payer: BCN Commercial |
$29.96
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.47
|
| Rate for Payer: UHC Core |
$31.47
|
| Rate for Payer: UHC Exchange |
$31.47
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
|
PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 90648
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: BCBS Trust/PPO |
$13.17
|
| Rate for Payer: BCN Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.54
|
| Rate for Payer: UHC Core |
$13.54
|
| Rate for Payer: UHC Exchange |
$13.54
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR HIB VACCINE, HBOC, IM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90645
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR HIB VACCINE, PRP-D, IM
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 90646
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR HINGE EXTENSION/FLEX WRIST/F
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS L3900
|
| Min. Negotiated Rate |
$590.79 |
| Max. Negotiated Rate |
$2,609.06 |
| Rate for Payer: Aetna Commercial |
$2,427.88
|
| Rate for Payer: Aetna Medicare |
$1,884.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,427.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,609.06
|
| Rate for Payer: BCBS Complete |
$622.80
|
| Rate for Payer: BCBS MAPPO |
$1,811.85
|
| Rate for Payer: BCN Commercial |
$1,734.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,811.85
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$2,427.88
|
| Rate for Payer: Cofinity Commercial |
$2,609.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,811.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,902.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,993.04
|
| Rate for Payer: Nomi Health Commercial |
$2,174.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,167.75
|
| Rate for Payer: PACE SWMI |
$1,811.85
|
| Rate for Payer: PHP Commercial |
$2,536.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,811.85
|
| Rate for Payer: Priority Health Medicare |
$1,811.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,811.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$590.79
|
| Rate for Payer: UHC Core |
$590.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,811.85
|
| Rate for Payer: UHC Exchange |
$590.79
|
| Rate for Payer: UMR Bronson Commercial |
$716.22
|
|
|
PR HOME HEALTH CARE SUPERVISION
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS G0181
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$169.65 |
| Rate for Payer: Aetna Commercial |
$142.33
|
| Rate for Payer: Aetna Medicare |
$110.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.96
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: BCBS MAPPO |
$106.22
|
| Rate for Payer: BCN Commercial |
$157.36
|
| Rate for Payer: BCN Medicare Advantage |
$106.22
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$152.96
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.84
|
| Rate for Payer: Nomi Health Commercial |
$127.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: PACE SWMI |
$106.22
|
| Rate for Payer: PHP Commercial |
$148.71
|
| Rate for Payer: PHP Medicare Advantage |
$106.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$145.11
|
| Rate for Payer: Priority Health Medicare |
$106.22
|
| Rate for Payer: Priority Health SBD |
$145.11
|
| Rate for Payer: Priority Health Tiered Network |
$145.11
|
| Rate for Payer: Railroad Medicare Medicare |
$106.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.65
|
| Rate for Payer: UHC Core |
$169.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$106.22
|
| Rate for Payer: UHC Exchange |
$169.65
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 99350
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$273.89 |
| Rate for Payer: Aetna Commercial |
$252.52
|
| Rate for Payer: Aetna Medicare |
$195.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.37
|
| Rate for Payer: BCBS MAPPO |
$188.45
|
| Rate for Payer: BCN Commercial |
$273.89
|
| Rate for Payer: BCN Medicare Advantage |
$188.45
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$252.52
|
| Rate for Payer: Cofinity Commercial |
$271.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$207.29
|
| Rate for Payer: Nomi Health Commercial |
$226.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PACE SWMI |
$188.45
|
| Rate for Payer: PHP Commercial |
$263.83
|
| Rate for Payer: PHP Medicare Advantage |
$188.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$246.37
|
| Rate for Payer: Priority Health Medicare |
$188.45
|
| Rate for Payer: Priority Health SBD |
$246.37
|
| Rate for Payer: Priority Health Tiered Network |
$246.37
|
| Rate for Payer: Railroad Medicare Medicare |
$188.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.50
|
| Rate for Payer: UHC Core |
$252.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.45
|
| Rate for Payer: UHC Exchange |
$252.50
|
| Rate for Payer: UMR Bronson Commercial |
$144.90
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99348
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$118.31 |
| Rate for Payer: Aetna Commercial |
$102.95
|
| Rate for Payer: Aetna Medicare |
$79.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.64
|
| Rate for Payer: BCBS MAPPO |
$76.83
|
| Rate for Payer: BCN Commercial |
$114.04
|
| Rate for Payer: BCN Medicare Advantage |
$76.83
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$102.95
|
| Rate for Payer: Cofinity Commercial |
$110.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.51
|
| Rate for Payer: Nomi Health Commercial |
$92.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.25
|
| Rate for Payer: PACE SWMI |
$76.83
|
| Rate for Payer: PHP Commercial |
$107.56
|
| Rate for Payer: PHP Medicare Advantage |
$76.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$102.57
|
| Rate for Payer: Priority Health Medicare |
$76.83
|
| Rate for Payer: Priority Health SBD |
$102.57
|
| Rate for Payer: Priority Health Tiered Network |
$102.57
|
| Rate for Payer: Railroad Medicare Medicare |
$76.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.31
|
| Rate for Payer: UHC Core |
$118.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.83
|
| Rate for Payer: UHC Exchange |
$118.31
|
| Rate for Payer: UMR Bronson Commercial |
$71.30
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 99349
|
| Min. Negotiated Rate |
$104.42 |
| Max. Negotiated Rate |
$188.74 |
| Rate for Payer: Aetna Commercial |
$172.86
|
| Rate for Payer: Aetna Medicare |
$134.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.76
|
| Rate for Payer: BCBS MAPPO |
$129.00
|
| Rate for Payer: BCN Commercial |
$188.74
|
| Rate for Payer: BCN Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.90
|
| Rate for Payer: Nomi Health Commercial |
$154.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.25
|
| Rate for Payer: PACE SWMI |
$129.00
|
| Rate for Payer: PHP Commercial |
$180.60
|
| Rate for Payer: PHP Medicare Advantage |
$129.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$169.76
|
| Rate for Payer: Priority Health Medicare |
$129.00
|
| Rate for Payer: Priority Health SBD |
$169.76
|
| Rate for Payer: Priority Health Tiered Network |
$169.76
|
| Rate for Payer: Railroad Medicare Medicare |
$129.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.92
|
| Rate for Payer: UHC Core |
$180.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$129.00
|
| Rate for Payer: UHC Exchange |
$180.92
|
| Rate for Payer: UMR Bronson Commercial |
$104.42
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 99347
|
| Min. Negotiated Rate |
$44.99 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$60.29
|
| Rate for Payer: Aetna Medicare |
$46.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: BCBS MAPPO |
$44.99
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: BCN Medicare Advantage |
$44.99
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$60.29
|
| Rate for Payer: Cofinity Commercial |
$64.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.49
|
| Rate for Payer: Nomi Health Commercial |
$53.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PACE SWMI |
$44.99
|
| Rate for Payer: PHP Commercial |
$62.99
|
| Rate for Payer: PHP Medicare Advantage |
$44.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$60.47
|
| Rate for Payer: Priority Health Medicare |
$44.99
|
| Rate for Payer: Priority Health SBD |
$60.47
|
| Rate for Payer: Priority Health Tiered Network |
$60.47
|
| Rate for Payer: Railroad Medicare Medicare |
$44.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.78
|
| Rate for Payer: UHC Core |
$76.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.99
|
| Rate for Payer: UHC Exchange |
$76.78
|
| Rate for Payer: UMR Bronson Commercial |
$47.84
|
|
|
PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 99345
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$313.02 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna Medicare |
$213.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.04
|
| Rate for Payer: BCBS MAPPO |
$204.89
|
| Rate for Payer: BCN Commercial |
$298.29
|
| Rate for Payer: BCN Medicare Advantage |
$204.89
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$295.04
|
| Rate for Payer: Cofinity Commercial |
$274.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.38
|
| Rate for Payer: Nomi Health Commercial |
$245.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.00
|
| Rate for Payer: PACE SWMI |
$204.89
|
| Rate for Payer: PHP Commercial |
$286.85
|
| Rate for Payer: PHP Medicare Advantage |
$204.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$268.32
|
| Rate for Payer: Priority Health Medicare |
$204.89
|
| Rate for Payer: Priority Health SBD |
$268.32
|
| Rate for Payer: Priority Health Tiered Network |
$268.32
|
| Rate for Payer: Railroad Medicare Medicare |
$204.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.02
|
| Rate for Payer: UHC Core |
$313.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$204.89
|
| Rate for Payer: UHC Exchange |
$313.02
|
| Rate for Payer: UMR Bronson Commercial |
$191.36
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 99342
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Aetna Commercial |
$103.54
|
| Rate for Payer: Aetna Medicare |
$80.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.27
|
| Rate for Payer: BCBS MAPPO |
$77.27
|
| Rate for Payer: BCN Commercial |
$116.53
|
| Rate for Payer: BCN Medicare Advantage |
$77.27
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$103.54
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.00
|
| Rate for Payer: Nomi Health Commercial |
$92.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.25
|
| Rate for Payer: PACE SWMI |
$77.27
|
| Rate for Payer: PHP Commercial |
$108.18
|
| Rate for Payer: PHP Medicare Advantage |
$77.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$104.81
|
| Rate for Payer: Priority Health Medicare |
$77.27
|
| Rate for Payer: Priority Health SBD |
$104.81
|
| Rate for Payer: Priority Health Tiered Network |
$104.81
|
| Rate for Payer: Railroad Medicare Medicare |
$77.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.59
|
| Rate for Payer: UHC Core |
$110.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$77.27
|
| Rate for Payer: UHC Exchange |
$110.59
|
| Rate for Payer: UMR Bronson Commercial |
$76.82
|
|
|
PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 99344
|
| Min. Negotiated Rate |
$143.37 |
| Max. Negotiated Rate |
$257.16 |
| Rate for Payer: Aetna Commercial |
$192.12
|
| Rate for Payer: Aetna Medicare |
$149.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.45
|
| Rate for Payer: BCBS MAPPO |
$143.37
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: BCN Medicare Advantage |
$143.37
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$206.45
|
| Rate for Payer: Cofinity Commercial |
$192.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.71
|
| Rate for Payer: Nomi Health Commercial |
$172.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.00
|
| Rate for Payer: PACE SWMI |
$143.37
|
| Rate for Payer: PHP Commercial |
$200.72
|
| Rate for Payer: PHP Medicare Advantage |
$143.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$189.48
|
| Rate for Payer: Priority Health Medicare |
$143.37
|
| Rate for Payer: Priority Health SBD |
$189.48
|
| Rate for Payer: Priority Health Tiered Network |
$189.48
|
| Rate for Payer: Railroad Medicare Medicare |
$143.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.16
|
| Rate for Payer: UHC Core |
$257.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$143.37
|
| Rate for Payer: UHC Exchange |
$257.16
|
| Rate for Payer: UMR Bronson Commercial |
$149.04
|
|
|
PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99341
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Aetna Commercial |
$64.35
|
| Rate for Payer: Aetna Medicare |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.15
|
| Rate for Payer: BCBS MAPPO |
$48.02
|
| Rate for Payer: BCN Commercial |
$73.20
|
| Rate for Payer: BCN Medicare Advantage |
$48.02
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Commercial |
$64.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.82
|
| Rate for Payer: Nomi Health Commercial |
$57.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.50
|
| Rate for Payer: PACE SWMI |
$48.02
|
| Rate for Payer: PHP Commercial |
$67.23
|
| Rate for Payer: PHP Medicare Advantage |
$48.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$65.85
|
| Rate for Payer: Priority Health Medicare |
$48.02
|
| Rate for Payer: Priority Health SBD |
$65.85
|
| Rate for Payer: Priority Health Tiered Network |
$65.85
|
| Rate for Payer: Railroad Medicare Medicare |
$48.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.82
|
| Rate for Payer: UHC Core |
$76.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.02
|
| Rate for Payer: UHC Exchange |
$76.82
|
| Rate for Payer: UMR Bronson Commercial |
$61.64
|
|
