|
PR HEPATECTOMY RESCJ PARTIAL LOBECTOMY
|
Professional
|
Both
|
$4,633.00
|
|
|
Service Code
|
HCPCS 47120
|
| Min. Negotiated Rate |
$1,495.26 |
| Max. Negotiated Rate |
$4,170.79 |
| Rate for Payer: Aetna Commercial |
$3,030.91
|
| Rate for Payer: Aetna Medicare |
$2,352.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,030.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,257.09
|
| Rate for Payer: BCBS Complete |
$1,570.02
|
| Rate for Payer: BCBS MAPPO |
$2,261.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,491.46
|
| Rate for Payer: BCN Commercial |
$3,402.17
|
| Rate for Payer: BCN Medicare Advantage |
$2,261.87
|
| Rate for Payer: Cash Price |
$3,706.40
|
| Rate for Payer: Cash Price |
$3,706.40
|
| Rate for Payer: Cofinity Commercial |
$3,030.91
|
| Rate for Payer: Cofinity Commercial |
$3,257.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,261.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,374.96
|
| Rate for Payer: Meridian Medicaid |
$1,570.02
|
| Rate for Payer: Nomi Health Commercial |
$2,714.24
|
| Rate for Payer: PACE SWMI |
$2,261.87
|
| Rate for Payer: PHP Commercial |
$3,166.62
|
| Rate for Payer: PHP Medicare Advantage |
$2,261.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,495.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,011.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,170.79
|
| Rate for Payer: Priority Health Medicare |
$2,261.87
|
| Rate for Payer: Priority Health Narrow Network |
$4,170.79
|
| Rate for Payer: Priority Health SBD |
$4,170.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,261.87
|
| Rate for Payer: UHC Medicare Advantage |
$2,261.87
|
| Rate for Payer: UHCCP Medicaid |
$1,495.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,131.18
|
|
|
PR HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY
|
Professional
|
Both
|
$6,159.00
|
|
|
Service Code
|
HCPCS 47130
|
| Min. Negotiated Rate |
$2,109.13 |
| Max. Negotiated Rate |
$5,882.42 |
| Rate for Payer: Aetna Commercial |
$4,292.53
|
| Rate for Payer: Aetna Medicare |
$3,331.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,292.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,612.87
|
| Rate for Payer: BCBS Complete |
$2,214.59
|
| Rate for Payer: BCBS MAPPO |
$3,203.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,750.86
|
| Rate for Payer: BCN Commercial |
$4,804.19
|
| Rate for Payer: BCN Medicare Advantage |
$3,203.38
|
| Rate for Payer: Cash Price |
$4,927.20
|
| Rate for Payer: Cash Price |
$4,927.20
|
| Rate for Payer: Cofinity Commercial |
$4,292.53
|
| Rate for Payer: Cofinity Commercial |
$4,612.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,203.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,363.55
|
| Rate for Payer: Meridian Medicaid |
$2,214.59
|
| Rate for Payer: Nomi Health Commercial |
$3,844.06
|
| Rate for Payer: PACE SWMI |
$3,203.38
|
| Rate for Payer: PHP Commercial |
$4,484.73
|
| Rate for Payer: PHP Medicare Advantage |
$3,203.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,109.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,003.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,882.42
|
| Rate for Payer: Priority Health Medicare |
$3,203.38
|
| Rate for Payer: Priority Health Narrow Network |
$5,882.42
|
| Rate for Payer: Priority Health SBD |
$5,882.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,203.38
|
| Rate for Payer: UHC Medicare Advantage |
$3,203.38
|
| Rate for Payer: UHCCP Medicaid |
$2,109.13
|
| Rate for Payer: UMR Bronson Commercial |
$2,833.14
|
|
|
PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 90636
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$134.53 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.57
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$134.53
|
| Rate for Payer: BCN Commercial |
$134.53
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 90371
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$188.16 |
| Rate for Payer: Aetna Commercial |
$175.09
|
| Rate for Payer: Aetna Medicare |
$135.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.16
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS MAPPO |
$130.66
|
| Rate for Payer: BCBS Trust/PPO |
$151.61
|
| Rate for Payer: BCN Commercial |
$146.22
|
| Rate for Payer: BCN Medicare Advantage |
$130.66
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$175.09
|
| Rate for Payer: Cofinity Commercial |
$188.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.20
|
| Rate for Payer: Nomi Health Commercial |
$156.80
|
| Rate for Payer: PACE SWMI |
$130.66
|
| Rate for Payer: PHP Commercial |
$182.93
|
| Rate for Payer: PHP Medicare Advantage |
$130.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Medicare |
$130.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.66
|
| Rate for Payer: UHC Medicare Advantage |
$130.66
|
| Rate for Payer: UMR Bronson Commercial |
$83.72
|
|
|
PR HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 47010
|
| Min. Negotiated Rate |
$241.96 |
| Max. Negotiated Rate |
$2,172.79 |
| Rate for Payer: Aetna Commercial |
$1,576.36
|
| Rate for Payer: Aetna Medicare |
$1,223.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,576.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,694.00
|
| Rate for Payer: BCBS Complete |
$819.45
|
| Rate for Payer: BCBS MAPPO |
$1,176.39
|
| Rate for Payer: BCBS Trust/PPO |
$241.96
|
| Rate for Payer: BCN Commercial |
$1,771.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,176.39
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Cofinity Commercial |
$1,694.00
|
| Rate for Payer: Cofinity Commercial |
$1,576.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,176.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,235.21
|
| Rate for Payer: Meridian Medicaid |
$819.45
|
| Rate for Payer: Nomi Health Commercial |
$1,411.67
|
| Rate for Payer: PACE SWMI |
$1,176.39
|
| Rate for Payer: PHP Commercial |
$1,646.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,176.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$780.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,172.79
|
| Rate for Payer: Priority Health Medicare |
$1,176.39
|
| Rate for Payer: Priority Health Narrow Network |
$2,172.79
|
| Rate for Payer: Priority Health SBD |
$2,172.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,176.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,176.39
|
| Rate for Payer: UHCCP Medicaid |
$780.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.78
|
|
|
PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 90633
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$38.42
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.42
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$31.32
|
| Rate for Payer: BCN Commercial |
$31.32
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 90632
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$104.66 |
| Rate for Payer: Aetna Commercial |
$97.40
|
| Rate for Payer: Aetna Medicare |
$75.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.40
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$72.68
|
| Rate for Payer: BCBS Trust/PPO |
$72.34
|
| Rate for Payer: BCN Commercial |
$73.37
|
| Rate for Payer: BCN Medicare Advantage |
$72.68
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$104.66
|
| Rate for Payer: Cofinity Commercial |
$97.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.32
|
| Rate for Payer: Nomi Health Commercial |
$87.22
|
| Rate for Payer: PACE SWMI |
$72.68
|
| Rate for Payer: PHP Commercial |
$101.76
|
| Rate for Payer: PHP Medicare Advantage |
$72.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$72.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.68
|
| Rate for Payer: UHC Medicare Advantage |
$72.68
|
| Rate for Payer: UMR Bronson Commercial |
$41.40
|
|
|
PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 90743
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$108.21 |
| Rate for Payer: Aetna Commercial |
$100.69
|
| Rate for Payer: Aetna Medicare |
$78.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.21
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$75.14
|
| Rate for Payer: BCBS Trust/PPO |
$76.66
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: BCN Medicare Advantage |
$75.14
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$100.69
|
| Rate for Payer: Cofinity Commercial |
$108.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.90
|
| Rate for Payer: Nomi Health Commercial |
$90.17
|
| Rate for Payer: PACE SWMI |
$75.14
|
| Rate for Payer: PHP Commercial |
$105.20
|
| Rate for Payer: PHP Medicare Advantage |
$75.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$75.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.14
|
| Rate for Payer: UHC Medicare Advantage |
$75.14
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 90739
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$255.68 |
| Rate for Payer: Aetna Commercial |
$237.92
|
| Rate for Payer: Aetna Medicare |
$184.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.68
|
| Rate for Payer: BCBS Complete |
$130.40
|
| Rate for Payer: BCBS MAPPO |
$177.56
|
| Rate for Payer: BCBS Trust/PPO |
$166.39
|
| Rate for Payer: BCN Commercial |
$132.46
|
| Rate for Payer: BCN Medicare Advantage |
$177.56
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cofinity Commercial |
$237.92
|
| Rate for Payer: Cofinity Commercial |
$255.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.43
|
| Rate for Payer: Nomi Health Commercial |
$213.07
|
| 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 Cigna Priority Health |
$211.90
|
| Rate for Payer: Priority Health Medicare |
$177.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.56
|
| Rate for Payer: UHC Medicare Advantage |
$177.56
|
| Rate for Payer: UMR Bronson Commercial |
$149.96
|
|
|
PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 90746
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$101.34 |
| Rate for Payer: Aetna Commercial |
$94.30
|
| Rate for Payer: Aetna Medicare |
$73.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$70.38
|
| Rate for Payer: BCBS Trust/PPO |
$73.05
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: BCN Medicare Advantage |
$70.38
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$101.34
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.89
|
| Rate for Payer: Nomi Health Commercial |
$84.45
|
| Rate for Payer: PACE SWMI |
$70.38
|
| Rate for Payer: PHP Commercial |
$98.53
|
| Rate for Payer: PHP Medicare Advantage |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health Medicare |
$70.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.38
|
| Rate for Payer: UHC Medicare Advantage |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$38.18
|
|
|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90744
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$45.61 |
| Rate for Payer: Aetna Commercial |
$42.44
|
| Rate for Payer: Aetna Medicare |
$32.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.61
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$31.67
|
| Rate for Payer: BCBS Trust/PPO |
$31.03
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: BCN Medicare Advantage |
$31.67
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.25
|
| Rate for Payer: Nomi Health Commercial |
$38.01
|
| Rate for Payer: PACE SWMI |
$31.67
|
| Rate for Payer: PHP Commercial |
$44.34
|
| Rate for Payer: PHP Medicare Advantage |
$31.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$31.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.67
|
| Rate for Payer: UHC Medicare Advantage |
$31.67
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR HFO FLEXION GLOVE PRE OTS
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS L3912
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$91.04 |
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCN Commercial |
$91.04
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: UMR Bronson Commercial |
$45.54
|
|
|
PR HFO NONTORSION JNTS PRE CST
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS L3929
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$78.93 |
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCN Commercial |
$78.93
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
| Rate for Payer: UMR Bronson Commercial |
$39.56
|
|
|
PR HFO W/JOINT(S) CF
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS L3921
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$277.59 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCN Commercial |
$277.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: UMR Bronson Commercial |
$138.00
|
|
|
PR HFO W/O JOINTS CF
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS L3913
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$234.03 |
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCN Commercial |
$234.03
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.45
|
| Rate for Payer: UMR Bronson Commercial |
$116.38
|
|
|
PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 90748
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: Aetna Commercial |
$42.90
|
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.90
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.85
|
| Rate for Payer: BCN Commercial |
$42.06
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: UMR Bronson Commercial |
$121.90
|
|
|
PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90647
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Aetna Commercial |
$30.53
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.53
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$28.36
|
| Rate for Payer: BCN Commercial |
$28.36
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90648
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$18.57
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR HIB VACCINE, HBOC, IM
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90645
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR HIB VACCINE, PRP-D, IM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90646
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR HINGE EXTENSION/FLEX WRIST/F
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
HCPCS L3900
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$1,399.87 |
| Rate for Payer: BCBS Complete |
$604.80
|
| Rate for Payer: BCN Commercial |
$1,399.87
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$982.80
|
| Rate for Payer: UMR Bronson Commercial |
$695.52
|
|
|
PR HOME HEALTH CARE SUPERVISION
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G0181
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$150.52 |
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$103.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.85
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$99.20
|
| Rate for Payer: BCBS Trust/PPO |
$90.87
|
| Rate for Payer: BCN Commercial |
$150.52
|
| Rate for Payer: BCN Medicare Advantage |
$99.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$142.85
|
| Rate for Payer: Cofinity Commercial |
$132.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.16
|
| Rate for Payer: Nomi Health Commercial |
$119.04
|
| Rate for Payer: PACE SWMI |
$99.20
|
| Rate for Payer: PHP Commercial |
$138.88
|
| Rate for Payer: PHP Medicare Advantage |
$99.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.02
|
| Rate for Payer: Priority Health Medicare |
$99.20
|
| Rate for Payer: Priority Health Narrow Network |
$142.02
|
| Rate for Payer: Priority Health SBD |
$142.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.20
|
| Rate for Payer: UHC Medicare Advantage |
$99.20
|
| Rate for Payer: UMR Bronson Commercial |
$84.64
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 99350
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$507.70 |
| Rate for Payer: Aetna Commercial |
$233.68
|
| Rate for Payer: Aetna Medicare |
$181.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.12
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$174.39
|
| Rate for Payer: BCBS Trust/PPO |
$507.70
|
| Rate for Payer: BCN Commercial |
$268.78
|
| Rate for Payer: BCN Medicare Advantage |
$174.39
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$233.68
|
| Rate for Payer: Cofinity Commercial |
$251.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.11
|
| Rate for Payer: Nomi Health Commercial |
$209.27
|
| Rate for Payer: PACE SWMI |
$174.39
|
| Rate for Payer: PHP Commercial |
$244.15
|
| Rate for Payer: PHP Medicare Advantage |
$174.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.70
|
| Rate for Payer: Priority Health Medicare |
$174.39
|
| Rate for Payer: Priority Health Narrow Network |
$247.70
|
| Rate for Payer: Priority Health SBD |
$247.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.39
|
| Rate for Payer: UHC Medicare Advantage |
$174.39
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99348
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$125.21 |
| Rate for Payer: Aetna Commercial |
$97.12
|
| Rate for Payer: Aetna Medicare |
$75.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.12
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$72.48
|
| Rate for Payer: BCBS Trust/PPO |
$125.21
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: BCN Medicare Advantage |
$72.48
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.10
|
| Rate for Payer: Nomi Health Commercial |
$86.98
|
| Rate for Payer: PACE SWMI |
$72.48
|
| Rate for Payer: PHP Commercial |
$101.47
|
| Rate for Payer: PHP Medicare Advantage |
$72.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.31
|
| Rate for Payer: Priority Health Medicare |
$72.48
|
| Rate for Payer: Priority Health Narrow Network |
$102.31
|
| Rate for Payer: Priority Health SBD |
$102.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.48
|
| Rate for Payer: UHC Medicare Advantage |
$72.48
|
| Rate for Payer: UMR Bronson Commercial |
$69.00
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99349
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$288.45 |
| Rate for Payer: Aetna Commercial |
$160.88
|
| Rate for Payer: Aetna Medicare |
$124.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.89
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS MAPPO |
$120.06
|
| Rate for Payer: BCBS Trust/PPO |
$288.45
|
| Rate for Payer: BCN Commercial |
$184.23
|
| Rate for Payer: BCN Medicare Advantage |
$120.06
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$160.88
|
| Rate for Payer: Cofinity Commercial |
$172.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.06
|
| Rate for Payer: Nomi Health Commercial |
$144.07
|
| Rate for Payer: PACE SWMI |
$120.06
|
| Rate for Payer: PHP Commercial |
$168.08
|
| Rate for Payer: PHP Medicare Advantage |
$120.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.06
|
| Rate for Payer: Priority Health Medicare |
$120.06
|
| Rate for Payer: Priority Health Narrow Network |
$170.06
|
| Rate for Payer: Priority Health SBD |
$170.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.06
|
| Rate for Payer: UHC Medicare Advantage |
$120.06
|
| Rate for Payer: UMR Bronson Commercial |
$101.20
|
|
