|
PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 57023
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$441.03 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Medicare |
$306.27
|
| Rate for Payer: BCBS Complete |
$210.40
|
| Rate for Payer: BCBS MAPPO |
$306.27
|
| Rate for Payer: BCN Medicare Advantage |
$306.27
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$441.03
|
| Rate for Payer: Cofinity Commercial |
$410.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.27
|
| Rate for Payer: Healthscope Commercial |
$367.52
|
| Rate for Payer: Healthscope Whirlpool |
$367.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.58
|
| Rate for Payer: Nomi Health Commercial |
$367.52
|
| Rate for Payer: PACE SWMI |
$306.27
|
| Rate for Payer: PHP Medicare Advantage |
$306.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health Medicare |
$306.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.27
|
| Rate for Payer: UHC Medicare Advantage |
$306.27
|
| Rate for Payer: UHCCP DNSP |
$306.27
|
|
|
PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 57022
|
| Min. Negotiated Rate |
$173.41 |
| Max. Negotiated Rate |
$297.70 |
| Rate for Payer: Aetna Commercial |
$232.37
|
| Rate for Payer: Aetna Medicare |
$173.41
|
| Rate for Payer: BCBS Complete |
$183.20
|
| Rate for Payer: BCBS MAPPO |
$173.41
|
| Rate for Payer: BCN Medicare Advantage |
$173.41
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$249.71
|
| Rate for Payer: Cofinity Commercial |
$232.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.41
|
| Rate for Payer: Healthscope Commercial |
$208.09
|
| Rate for Payer: Healthscope Whirlpool |
$208.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.08
|
| Rate for Payer: Nomi Health Commercial |
$208.09
|
| Rate for Payer: PACE SWMI |
$173.41
|
| Rate for Payer: PHP Medicare Advantage |
$173.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.70
|
| Rate for Payer: Priority Health Medicare |
$173.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.41
|
| Rate for Payer: UHC Medicare Advantage |
$173.41
|
| Rate for Payer: UHCCP DNSP |
$173.41
|
|
|
PR I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 56405
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Medicare |
$120.03
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$120.03
|
| Rate for Payer: BCN Medicare Advantage |
$120.03
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$172.84
|
| Rate for Payer: Cofinity Commercial |
$160.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.03
|
| Rate for Payer: Healthscope Commercial |
$144.04
|
| Rate for Payer: Healthscope Whirlpool |
$144.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.03
|
| Rate for Payer: Nomi Health Commercial |
$144.04
|
| Rate for Payer: PACE SWMI |
$120.03
|
| Rate for Payer: PHP Medicare Advantage |
$120.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$120.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.03
|
| Rate for Payer: UHC Medicare Advantage |
$120.03
|
| Rate for Payer: UHCCP DNSP |
$120.03
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90657
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$14.78
|
| Rate for Payer: Aetna Medicare |
$11.03
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$11.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.03
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$14.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.03
|
| Rate for Payer: Healthscope Commercial |
$13.24
|
| Rate for Payer: Healthscope Whirlpool |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.58
|
| Rate for Payer: Nomi Health Commercial |
$13.24
|
| Rate for Payer: PACE SWMI |
$11.03
|
| Rate for Payer: PHP Medicare Advantage |
$11.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$11.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.03
|
| Rate for Payer: UHC Medicare Advantage |
$11.03
|
| Rate for Payer: UHCCP DNSP |
$11.03
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90658
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$31.78 |
| Rate for Payer: Aetna Commercial |
$29.57
|
| Rate for Payer: Aetna Medicare |
$22.07
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$22.07
|
| Rate for Payer: BCN Medicare Advantage |
$22.07
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$29.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.07
|
| Rate for Payer: Healthscope Commercial |
$26.48
|
| Rate for Payer: Healthscope Whirlpool |
$26.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.17
|
| Rate for Payer: Nomi Health Commercial |
$26.48
|
| Rate for Payer: PACE SWMI |
$22.07
|
| Rate for Payer: PHP Medicare Advantage |
$22.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$22.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.07
|
| Rate for Payer: UHC Medicare Advantage |
$22.07
|
| Rate for Payer: UHCCP DNSP |
$22.07
|
|
|
PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90656
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$33.44 |
| Rate for Payer: Aetna Commercial |
$31.11
|
| Rate for Payer: Aetna Medicare |
$23.22
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$23.22
|
| Rate for Payer: BCN Medicare Advantage |
$23.22
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$33.44
|
| Rate for Payer: Cofinity Commercial |
$31.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.22
|
| Rate for Payer: Healthscope Commercial |
$27.86
|
| Rate for Payer: Healthscope Whirlpool |
$27.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.38
|
| Rate for Payer: Nomi Health Commercial |
$27.86
|
| Rate for Payer: PACE SWMI |
$23.22
|
| Rate for Payer: PHP Medicare Advantage |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$23.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.22
|
| Rate for Payer: UHC Medicare Advantage |
$23.22
|
| Rate for Payer: UHCCP DNSP |
$23.22
|
|
|
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 |
$14.95 |
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90686
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90685
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90687
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90688
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 90653
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$141.35 |
| Rate for Payer: Aetna Commercial |
$131.53
|
| Rate for Payer: Aetna Medicare |
$98.16
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$98.16
|
| Rate for Payer: BCN Medicare Advantage |
$98.16
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$141.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.16
|
| Rate for Payer: Healthscope Commercial |
$117.79
|
| Rate for Payer: Healthscope Whirlpool |
$117.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.07
|
| Rate for Payer: Nomi Health Commercial |
$117.79
|
| Rate for Payer: PACE SWMI |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$98.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health Medicare |
$98.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.16
|
| Rate for Payer: UHC Medicare Advantage |
$98.16
|
| Rate for Payer: UHCCP DNSP |
$98.16
|
|
|
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 |
$141.35 |
| Rate for Payer: Aetna Commercial |
$131.53
|
| Rate for Payer: Aetna Medicare |
$98.16
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$98.16
|
| Rate for Payer: BCN Medicare Advantage |
$98.16
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$141.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.16
|
| Rate for Payer: Healthscope Commercial |
$117.79
|
| Rate for Payer: Healthscope Whirlpool |
$117.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.07
|
| Rate for Payer: Nomi Health Commercial |
$117.79
|
| Rate for Payer: PACE SWMI |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$98.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$98.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.16
|
| Rate for Payer: UHC Medicare Advantage |
$98.16
|
| Rate for Payer: UHCCP DNSP |
$98.16
|
|
|
PR ILEOSCOPY STOMA W/BALLOON DILATION
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 44381
|
| Min. Negotiated Rate |
$79.38 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$106.37
|
| Rate for Payer: Aetna Medicare |
$79.38
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$79.38
|
| Rate for Payer: BCN Medicare Advantage |
$79.38
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$114.31
|
| Rate for Payer: Cofinity Commercial |
$106.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.38
|
| Rate for Payer: Healthscope Commercial |
$95.26
|
| Rate for Payer: Healthscope Whirlpool |
$95.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.35
|
| Rate for Payer: Nomi Health Commercial |
$95.26
|
| Rate for Payer: PACE SWMI |
$79.38
|
| Rate for Payer: PHP Medicare Advantage |
$79.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health Medicare |
$79.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.38
|
| Rate for Payer: UHC Medicare Advantage |
$79.38
|
| Rate for Payer: UHCCP DNSP |
$79.38
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 44382
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$609.05 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Aetna Medicare |
$69.76
|
| Rate for Payer: BCBS Complete |
$374.80
|
| Rate for Payer: BCBS MAPPO |
$69.76
|
| Rate for Payer: BCN Medicare Advantage |
$69.76
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cofinity Commercial |
$93.48
|
| Rate for Payer: Cofinity Commercial |
$100.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.76
|
| Rate for Payer: Healthscope Commercial |
$83.71
|
| Rate for Payer: Healthscope Whirlpool |
$83.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.25
|
| Rate for Payer: Nomi Health Commercial |
$83.71
|
| Rate for Payer: PACE SWMI |
$69.76
|
| Rate for Payer: PHP Medicare Advantage |
$69.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.05
|
| Rate for Payer: Priority Health Medicare |
$69.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.76
|
| Rate for Payer: UHC Medicare Advantage |
$69.76
|
| Rate for Payer: UHCCP DNSP |
$69.76
|
|
|
PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 44384
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$208.73 |
| Rate for Payer: Aetna Commercial |
$194.23
|
| Rate for Payer: Aetna Medicare |
$144.95
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$144.95
|
| Rate for Payer: BCN Medicare Advantage |
$144.95
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$208.73
|
| Rate for Payer: Cofinity Commercial |
$194.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.95
|
| Rate for Payer: Healthscope Commercial |
$173.94
|
| Rate for Payer: Healthscope Whirlpool |
$173.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.20
|
| Rate for Payer: Nomi Health Commercial |
$173.94
|
| Rate for Payer: PACE SWMI |
$144.95
|
| Rate for Payer: PHP Medicare Advantage |
$144.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health Medicare |
$144.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.95
|
| Rate for Payer: UHC Medicare Advantage |
$144.95
|
| Rate for Payer: UHCCP DNSP |
$144.95
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$544.70 |
| Rate for Payer: Aetna Commercial |
$73.03
|
| Rate for Payer: Aetna Medicare |
$54.50
|
| Rate for Payer: BCBS Complete |
$335.20
|
| Rate for Payer: BCBS MAPPO |
$54.50
|
| Rate for Payer: BCN Medicare Advantage |
$54.50
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Cofinity Commercial |
$73.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.50
|
| Rate for Payer: Healthscope Commercial |
$65.40
|
| Rate for Payer: Healthscope Whirlpool |
$65.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.23
|
| Rate for Payer: Nomi Health Commercial |
$65.40
|
| Rate for Payer: PACE SWMI |
$54.50
|
| Rate for Payer: PHP Medicare Advantage |
$54.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health Medicare |
$54.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.50
|
| Rate for Payer: UHC Medicare Advantage |
$54.50
|
| Rate for Payer: UHCCP DNSP |
$54.50
|
|
|
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
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$1,003.66 |
| Max. Negotiated Rate |
$1,660.10 |
| Rate for Payer: Aetna Commercial |
$1,344.90
|
| Rate for Payer: Aetna Medicare |
$1,003.66
|
| Rate for Payer: BCBS Complete |
$1,021.60
|
| Rate for Payer: BCBS MAPPO |
$1,003.66
|
| 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: Healthscope Commercial |
$1,204.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,204.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.84
|
| Rate for Payer: Nomi Health Commercial |
$1,204.39
|
| Rate for Payer: PACE SWMI |
$1,003.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health Medicare |
$1,003.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.66
|
| Rate for Payer: UHCCP DNSP |
$1,003.66
|
|
|
PR ILIAC ART ANGIO,CARDIAC CATH
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0278
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Medicare |
$12.64
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$12.64
|
| 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: Healthscope Commercial |
$15.17
|
| Rate for Payer: Healthscope Whirlpool |
$15.17
|
| 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 Medicare Advantage |
$12.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$12.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.64
|
| Rate for Payer: UHC Medicare Advantage |
$12.64
|
| Rate for Payer: UHCCP DNSP |
$12.64
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna Commercial |
$20.52
|
| Rate for Payer: Aetna Medicare |
$15.31
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$15.31
|
| 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 |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$18.37
|
| Rate for Payer: Healthscope Whirlpool |
$18.37
|
| 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 Medicare Advantage |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$15.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.31
|
| Rate for Payer: UHC Medicare Advantage |
$15.31
|
| Rate for Payer: UHCCP DNSP |
$15.31
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$11.12
|
| 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: Healthscope Commercial |
$13.34
|
| Rate for Payer: Healthscope Whirlpool |
$13.34
|
| 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 Medicare Advantage |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$11.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
| Rate for Payer: UHCCP DNSP |
$11.12
|
|
|
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 |
$27.13 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$18.84
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$18.84
|
| 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 |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$25.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$22.61
|
| Rate for Payer: Healthscope Whirlpool |
$22.61
|
| 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 Medicare Advantage |
$18.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$18.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.84
|
| Rate for Payer: UHC Medicare Advantage |
$18.84
|
| Rate for Payer: UHCCP DNSP |
$18.84
|
|
|
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 |
$19.41 |
| Rate for Payer: Aetna Commercial |
$18.06
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$13.48
|
| 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: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Whirlpool |
$16.18
|
| 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 Medicare Advantage |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$13.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.48
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
| Rate for Payer: UHCCP DNSP |
$13.48
|
|
|
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 |
$30.51 |
| Rate for Payer: Aetna Commercial |
$28.39
|
| Rate for Payer: Aetna Medicare |
$21.19
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$21.19
|
| 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 |
$30.51
|
| Rate for Payer: Cofinity Commercial |
$28.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.19
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Healthscope Whirlpool |
$25.43
|
| 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 Medicare Advantage |
$21.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$21.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.19
|
| Rate for Payer: UHC Medicare Advantage |
$21.19
|
| Rate for Payer: UHCCP DNSP |
$21.19
|
|
