|
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: Aetna New Business (MI Preferred) |
$14.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.74
|
| 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 |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$15.74
|
| 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 Commercial |
$15.30
|
| Rate for Payer: PHP Medicare Advantage |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$10.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.93
|
| Rate for Payer: UHC Medicare Advantage |
$10.93
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
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: Aetna New Business (MI Preferred) |
$29.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.48
|
| 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 |
$29.29
|
| Rate for Payer: Cofinity Commercial |
$31.48
|
| 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 Commercial |
$30.60
|
| Rate for Payer: PHP Medicare Advantage |
$21.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$21.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.86
|
| Rate for Payer: UHC Medicare Advantage |
$21.86
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
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: Aetna New Business (MI Preferred) |
$29.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.18
|
| 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 |
$29.95
|
| Rate for Payer: Cofinity Commercial |
$32.18
|
| 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 Commercial |
$31.29
|
| Rate for Payer: PHP Medicare Advantage |
$22.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$22.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.35
|
| Rate for Payer: UHC Medicare Advantage |
$22.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
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: Aetna New Business (MI Preferred) |
$16.30
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
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: Aetna New Business (MI Preferred) |
$22.35
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
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: Aetna New Business (MI Preferred) |
$19.36
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
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: Aetna New Business (MI Preferred) |
$10.44
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
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: Aetna New Business (MI Preferred) |
$20.88
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
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: Aetna New Business (MI Preferred) |
$111.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.23
|
| 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 |
$111.88
|
| Rate for Payer: Cofinity Commercial |
$120.23
|
| 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 Commercial |
$116.89
|
| Rate for Payer: PHP Medicare Advantage |
$83.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health Medicare |
$83.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.49
|
| Rate for Payer: UHC Medicare Advantage |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
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: Aetna New Business (MI Preferred) |
$111.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.23
|
| 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 |
$111.88
|
| Rate for Payer: Cofinity Commercial |
$120.23
|
| 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 Commercial |
$116.89
|
| Rate for Payer: PHP Medicare Advantage |
$83.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$83.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.49
|
| Rate for Payer: UHC Medicare Advantage |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$51.06
|
|
|
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: Aetna New Business (MI Preferred) |
$114.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.37
|
| 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 |
$106.37
|
| Rate for Payer: Cofinity Commercial |
$114.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.38
|
| 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 Commercial |
$111.13
|
| 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/Tiered Network |
$150.33
|
| Rate for Payer: Priority Health Medicare |
$79.38
|
| Rate for Payer: Priority Health Narrow Network |
$150.33
|
| Rate for Payer: Priority Health SBD |
$150.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.38
|
| Rate for Payer: UHC Medicare Advantage |
$79.38
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
| Rate for Payer: UMR Bronson Commercial |
$108.10
|
|
|
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: Aetna New Business (MI Preferred) |
$100.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| 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 |
$100.45
|
| Rate for Payer: Cofinity Commercial |
$93.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.76
|
| 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 Commercial |
$97.66
|
| 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/Tiered Network |
$131.25
|
| Rate for Payer: Priority Health Medicare |
$69.76
|
| Rate for Payer: Priority Health Narrow Network |
$131.25
|
| Rate for Payer: Priority Health SBD |
$131.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.76
|
| Rate for Payer: UHC Medicare Advantage |
$69.76
|
| Rate for Payer: UHCCP Medicaid |
$47.07
|
| Rate for Payer: UMR Bronson Commercial |
$431.02
|
|
|
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: Aetna New Business (MI Preferred) |
$194.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.73
|
| 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 |
$194.23
|
| Rate for Payer: Cofinity Commercial |
$208.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.95
|
| 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 Commercial |
$202.93
|
| 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/Tiered Network |
$268.46
|
| Rate for Payer: Priority Health Medicare |
$144.95
|
| Rate for Payer: Priority Health Narrow Network |
$268.46
|
| Rate for Payer: Priority Health SBD |
$268.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.95
|
| Rate for Payer: UHC Medicare Advantage |
$144.95
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
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: Aetna New Business (MI Preferred) |
$73.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.48
|
| 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 |
$73.03
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.50
|
| 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 Commercial |
$76.30
|
| 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/Tiered Network |
$102.01
|
| Rate for Payer: Priority Health Medicare |
$54.50
|
| Rate for Payer: Priority Health Narrow Network |
$102.01
|
| Rate for Payer: Priority Health SBD |
$102.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.50
|
| Rate for Payer: UHC Medicare Advantage |
$54.50
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
| Rate for Payer: UMR Bronson Commercial |
$385.48
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$500.02
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$1,855.41 |
| Rate for Payer: Aetna Commercial |
$1,344.90
|
| Rate for Payer: Aetna Medicare |
$1,043.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,445.27
|
| Rate for Payer: BCBS Complete |
$699.13
|
| Rate for Payer: BCBS MAPPO |
$1,003.66
|
| Rate for Payer: BCBS Trust/PPO |
$81.93
|
| Rate for Payer: BCN Commercial |
$1,512.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.66
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cofinity Commercial |
$1,445.27
|
| Rate for Payer: Cofinity Commercial |
$1,344.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.84
|
| Rate for Payer: Meridian Medicaid |
$699.13
|
| Rate for Payer: Nomi Health Commercial |
$1,204.39
|
| Rate for Payer: PACE SWMI |
$1,003.66
|
| Rate for Payer: PHP Commercial |
$1,405.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$665.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,855.41
|
| Rate for Payer: Priority Health Medicare |
$1,003.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,855.41
|
| Rate for Payer: Priority Health SBD |
$1,855.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.66
|
| Rate for Payer: UHCCP Medicaid |
$665.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,174.84
|
|
|
PR ILIAC ART ANGIO,CARDIAC CATH
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0278
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Medicare |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.20
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$12.64
|
| Rate for Payer: BCBS Trust/PPO |
$152.15
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: BCN Medicare Advantage |
$12.64
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE SWMI |
$12.64
|
| Rate for Payer: PHP Commercial |
$17.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.54
|
| Rate for Payer: Priority Health Medicare |
$12.64
|
| Rate for Payer: Priority Health Narrow Network |
$20.54
|
| Rate for Payer: Priority Health SBD |
$20.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.64
|
| Rate for Payer: UHC Medicare Advantage |
$12.64
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$611.77 |
| Rate for Payer: Aetna Commercial |
$20.52
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.05
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$15.31
|
| Rate for Payer: BCBS Trust/PPO |
$611.77
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: BCN Medicare Advantage |
$15.31
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.08
|
| Rate for Payer: Nomi Health Commercial |
$18.37
|
| Rate for Payer: PACE SWMI |
$15.31
|
| Rate for Payer: PHP Commercial |
$21.43
|
| Rate for Payer: PHP Medicare Advantage |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$15.31
|
| Rate for Payer: Priority Health Narrow Network |
$26.75
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.31
|
| Rate for Payer: UHC Medicare Advantage |
$15.31
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$652.45 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.01
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$13.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.12
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.68
|
| Rate for Payer: Nomi Health Commercial |
$13.34
|
| Rate for Payer: PACE SWMI |
$11.12
|
| Rate for Payer: PHP Commercial |
$15.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.28
|
| Rate for Payer: Priority Health Medicare |
$11.12
|
| Rate for Payer: Priority Health Narrow Network |
$16.28
|
| Rate for Payer: Priority Health SBD |
$16.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90471
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$19.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.13
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$18.84
|
| Rate for Payer: BCBS Trust/PPO |
$593.28
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: BCN Medicare Advantage |
$18.84
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$25.25
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.78
|
| Rate for Payer: Nomi Health Commercial |
$22.61
|
| Rate for Payer: PACE SWMI |
$18.84
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Medicare Advantage |
$18.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$18.84
|
| Rate for Payer: Priority Health Narrow Network |
$26.75
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.84
|
| Rate for Payer: UHC Medicare Advantage |
$18.84
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90472
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$1,006.41 |
| Rate for Payer: Aetna Commercial |
$18.06
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.41
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$13.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.41
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$13.48
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$16.18
|
| Rate for Payer: PACE SWMI |
$13.48
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Medicare Advantage |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.91
|
| Rate for Payer: Priority Health Medicare |
$13.48
|
| Rate for Payer: Priority Health Narrow Network |
$19.91
|
| Rate for Payer: Priority Health SBD |
$19.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.48
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$519.85 |
| Rate for Payer: Aetna Commercial |
$28.39
|
| Rate for Payer: Aetna Medicare |
$22.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.51
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$21.19
|
| Rate for Payer: BCBS Trust/PPO |
$519.85
|
| Rate for Payer: BCN Commercial |
$25.68
|
| Rate for Payer: BCN Medicare Advantage |
$21.19
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$28.39
|
| Rate for Payer: Cofinity Commercial |
$30.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.25
|
| Rate for Payer: Nomi Health Commercial |
$25.43
|
| Rate for Payer: PACE SWMI |
$21.19
|
| Rate for Payer: PHP Commercial |
$29.67
|
| Rate for Payer: PHP Medicare Advantage |
$21.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$21.19
|
| Rate for Payer: Priority Health Narrow Network |
$26.75
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.19
|
| Rate for Payer: UHC Medicare Advantage |
$21.19
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90461
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$544.68 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$544.68
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Commercial |
$11.56
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: Priority Health Narrow Network |
$11.75
|
| Rate for Payer: Priority Health SBD |
$11.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
IP
|
$913.44
|
|
|
Service Code
|
NDC 00024159601
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.91 |
| Max. Negotiated Rate |
$822.10 |
| Rate for Payer: Aetna American Axle |
$593.74
|
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.74
|
| Rate for Payer: Cash Price |
$730.75
|
| Rate for Payer: Cofinity Commercial |
$639.41
|
| Rate for Payer: Cofinity Commercial |
$785.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.75
|
| Rate for Payer: Healthscope Commercial |
$822.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.74
|
| Rate for Payer: Priority Health SBD |
$575.47
|
| Rate for Payer: UMR Bronson Commercial |
$401.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.08
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
OP
|
$913.44
|
|
|
Service Code
|
NDC 00024159601
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.97 |
| Max. Negotiated Rate |
$822.10 |
| Rate for Payer: Aetna American Axle |
$593.74
|
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna Medicare |
$456.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.74
|
| Rate for Payer: BCBS Complete |
$365.38
|
| Rate for Payer: Cash Price |
$730.75
|
| Rate for Payer: Cofinity Commercial |
$639.41
|
| Rate for Payer: Cofinity Commercial |
$785.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.75
|
| Rate for Payer: Healthscope Commercial |
$822.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.74
|
| Rate for Payer: Priority Health SBD |
$575.47
|
| Rate for Payer: UMR Bronson Commercial |
$337.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.08
|
|
