|
PR DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,052.00
|
|
|
Service Code
|
HCPCS 32220
|
| Min. Negotiated Rate |
$981.08 |
| Max. Negotiated Rate |
$2,811.60 |
| Rate for Payer: Aetna Commercial |
$2,045.87
|
| Rate for Payer: Aetna Medicare |
$1,587.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,045.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,198.55
|
| Rate for Payer: BCBS Complete |
$1,030.13
|
| Rate for Payer: BCBS MAPPO |
$1,526.77
|
| Rate for Payer: BCN Commercial |
$2,372.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,526.77
|
| Rate for Payer: Cash Price |
$2,441.60
|
| Rate for Payer: Cash Price |
$2,441.60
|
| Rate for Payer: Cofinity Commercial |
$2,045.87
|
| Rate for Payer: Cofinity Commercial |
$2,198.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,526.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,603.11
|
| Rate for Payer: Meridian Medicaid |
$1,030.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,679.45
|
| Rate for Payer: Nomi Health Commercial |
$1,832.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,289.00
|
| Rate for Payer: PACE SWMI |
$1,526.77
|
| Rate for Payer: PHP Commercial |
$2,137.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,526.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$981.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,234.08
|
| Rate for Payer: Priority Health Medicare |
$1,526.77
|
| Rate for Payer: Priority Health SBD |
$2,234.08
|
| Rate for Payer: Priority Health Tiered Network |
$2,234.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,526.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,811.60
|
| Rate for Payer: UHC Core |
$2,811.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,526.77
|
| Rate for Payer: UHC Exchange |
$2,811.60
|
| Rate for Payer: UHC Medicaid |
$981.08
|
| Rate for Payer: UHCCP Medicaid |
$981.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,403.92
|
|
|
PR DEGARELIX INJECTION
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J9155
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Aetna Commercial |
$5.98
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.44
|
| Rate for Payer: BCN Commercial |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Cofinity Commercial |
$6.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Nomi Health Commercial |
$5.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PHP Commercial |
$6.24
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.45
|
| Rate for Payer: UHC Core |
$4.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.46
|
| Rate for Payer: UHC Exchange |
$4.45
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
|
|
PR DELAYED CREATION EXIT SITE EMBEDDED CATHETER
|
Professional
|
Both
|
$1,329.00
|
|
|
Service Code
|
HCPCS 49436
|
| Min. Negotiated Rate |
$113.32 |
| Max. Negotiated Rate |
$996.75 |
| Rate for Payer: Aetna Commercial |
$234.29
|
| Rate for Payer: Aetna Medicare |
$181.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.29
|
| Rate for Payer: BCBS Complete |
$118.99
|
| Rate for Payer: BCBS MAPPO |
$174.84
|
| Rate for Payer: BCN Commercial |
$280.86
|
| Rate for Payer: BCN Medicare Advantage |
$174.84
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cofinity Commercial |
$251.77
|
| Rate for Payer: Cofinity Commercial |
$234.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.58
|
| Rate for Payer: Meridian Medicaid |
$118.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.32
|
| Rate for Payer: Nomi Health Commercial |
$209.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.75
|
| Rate for Payer: PACE SWMI |
$174.84
|
| Rate for Payer: PHP Commercial |
$244.78
|
| Rate for Payer: PHP Medicare Advantage |
$174.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.20
|
| Rate for Payer: Priority Health Medicare |
$174.84
|
| Rate for Payer: Priority Health SBD |
$342.20
|
| Rate for Payer: Priority Health Tiered Network |
$342.20
|
| Rate for Payer: Railroad Medicare Medicare |
$174.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.31
|
| Rate for Payer: UHC Core |
$329.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.84
|
| Rate for Payer: UHC Exchange |
$329.31
|
| Rate for Payer: UHC Medicaid |
$113.32
|
| Rate for Payer: UHCCP Medicaid |
$113.32
|
| Rate for Payer: UMR Bronson Commercial |
$611.34
|
|
|
PR DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Professional
|
Both
|
$933.00
|
|
|
Service Code
|
HCPCS 15630
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$699.75 |
| Rate for Payer: Aetna Commercial |
$401.56
|
| Rate for Payer: Aetna Medicare |
$311.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.52
|
| Rate for Payer: BCBS Complete |
$208.45
|
| Rate for Payer: BCBS MAPPO |
$299.67
|
| Rate for Payer: BCN Commercial |
$521.38
|
| Rate for Payer: BCN Medicare Advantage |
$299.67
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cofinity Commercial |
$401.56
|
| Rate for Payer: Cofinity Commercial |
$431.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.65
|
| Rate for Payer: Meridian Medicaid |
$208.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$329.64
|
| Rate for Payer: Nomi Health Commercial |
$359.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$699.75
|
| Rate for Payer: PACE SWMI |
$299.67
|
| Rate for Payer: PHP Commercial |
$419.54
|
| Rate for Payer: PHP Medicare Advantage |
$299.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$477.21
|
| Rate for Payer: Priority Health Medicare |
$299.67
|
| Rate for Payer: Priority Health SBD |
$477.21
|
| Rate for Payer: Priority Health Tiered Network |
$477.21
|
| Rate for Payer: Railroad Medicare Medicare |
$299.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$585.95
|
| Rate for Payer: UHC Core |
$585.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$299.67
|
| Rate for Payer: UHC Exchange |
$585.95
|
| Rate for Payer: UHC Medicaid |
$198.52
|
| Rate for Payer: UHCCP Medicaid |
$198.52
|
| Rate for Payer: UMR Bronson Commercial |
$429.18
|
|
|
PR DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 15620
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Aetna Commercial |
$392.53
|
| Rate for Payer: Aetna Medicare |
$304.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.82
|
| Rate for Payer: BCBS Complete |
$203.97
|
| Rate for Payer: BCBS MAPPO |
$292.93
|
| Rate for Payer: BCN Commercial |
$496.49
|
| Rate for Payer: BCN Medicare Advantage |
$292.93
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cofinity Commercial |
$392.53
|
| Rate for Payer: Cofinity Commercial |
$421.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.58
|
| Rate for Payer: Meridian Medicaid |
$203.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$322.22
|
| Rate for Payer: Nomi Health Commercial |
$351.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.50
|
| Rate for Payer: PACE SWMI |
$292.93
|
| Rate for Payer: PHP Commercial |
$410.10
|
| Rate for Payer: PHP Medicare Advantage |
$292.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$454.41
|
| Rate for Payer: Priority Health Medicare |
$292.93
|
| Rate for Payer: Priority Health SBD |
$454.41
|
| Rate for Payer: Priority Health Tiered Network |
$454.41
|
| Rate for Payer: Railroad Medicare Medicare |
$292.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.03
|
| Rate for Payer: UHC Core |
$555.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$292.93
|
| Rate for Payer: UHC Exchange |
$555.03
|
| Rate for Payer: UHC Medicaid |
$194.26
|
| Rate for Payer: UHCCP Medicaid |
$194.26
|
| Rate for Payer: UMR Bronson Commercial |
$343.16
|
|
|
PR DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 15610
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$301.73
|
| Rate for Payer: Aetna Medicare |
$234.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.24
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$225.17
|
| Rate for Payer: BCN Commercial |
$372.99
|
| Rate for Payer: BCN Medicare Advantage |
$225.17
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$324.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.43
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$270.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: PACE SWMI |
$225.17
|
| Rate for Payer: PHP Commercial |
$315.24
|
| Rate for Payer: PHP Medicare Advantage |
$225.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$341.39
|
| Rate for Payer: Priority Health Medicare |
$225.17
|
| Rate for Payer: Priority Health SBD |
$341.39
|
| Rate for Payer: Priority Health Tiered Network |
$341.39
|
| Rate for Payer: Railroad Medicare Medicare |
$225.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.67
|
| Rate for Payer: UHC Core |
$411.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$225.17
|
| Rate for Payer: UHC Exchange |
$411.67
|
| Rate for Payer: UHC Medicaid |
$150.17
|
| Rate for Payer: UHCCP Medicaid |
$150.17
|
| Rate for Payer: UMR Bronson Commercial |
$289.80
|
|
|
PR DELAY FLAP/SECTIONING FLAP TRUNK
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 15600
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$408.75 |
| Rate for Payer: Aetna Commercial |
$271.51
|
| Rate for Payer: Aetna Medicare |
$210.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.77
|
| Rate for Payer: BCBS Complete |
$142.46
|
| Rate for Payer: BCBS MAPPO |
$202.62
|
| Rate for Payer: BCN Commercial |
$320.70
|
| Rate for Payer: BCN Medicare Advantage |
$202.62
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cofinity Commercial |
$271.51
|
| Rate for Payer: Cofinity Commercial |
$291.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.75
|
| Rate for Payer: Meridian Medicaid |
$142.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$222.88
|
| Rate for Payer: Nomi Health Commercial |
$243.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.75
|
| Rate for Payer: PACE SWMI |
$202.62
|
| Rate for Payer: PHP Commercial |
$283.67
|
| Rate for Payer: PHP Medicare Advantage |
$202.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$293.52
|
| Rate for Payer: Priority Health Medicare |
$202.62
|
| Rate for Payer: Priority Health SBD |
$293.52
|
| Rate for Payer: Priority Health Tiered Network |
$293.52
|
| Rate for Payer: Railroad Medicare Medicare |
$202.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.03
|
| Rate for Payer: UHC Core |
$355.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$202.62
|
| Rate for Payer: UHC Exchange |
$355.03
|
| Rate for Payer: UHC Medicaid |
$135.68
|
| Rate for Payer: UHCCP Medicaid |
$135.68
|
| Rate for Payer: UMR Bronson Commercial |
$250.70
|
|
|
PR DELIVERY/BIRTHING ROOM RESUSCITATION
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 99465
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$164.34
|
| Rate for Payer: Aetna Medicare |
$127.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS MAPPO |
$122.64
|
| Rate for Payer: BCN Commercial |
$208.65
|
| Rate for Payer: BCN Medicare Advantage |
$122.64
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$176.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.77
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$134.90
|
| Rate for Payer: Nomi Health Commercial |
$147.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PACE SWMI |
$122.64
|
| Rate for Payer: PHP Commercial |
$171.70
|
| Rate for Payer: PHP Medicare Advantage |
$122.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$187.68
|
| Rate for Payer: Priority Health Medicare |
$122.64
|
| Rate for Payer: Priority Health SBD |
$187.68
|
| Rate for Payer: Priority Health Tiered Network |
$187.68
|
| Rate for Payer: Railroad Medicare Medicare |
$122.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.23
|
| Rate for Payer: UHC Core |
$207.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$122.64
|
| Rate for Payer: UHC Exchange |
$207.23
|
| Rate for Payer: UHC Medicaid |
$78.81
|
| Rate for Payer: UHCCP Medicaid |
$78.81
|
| Rate for Payer: UMR Bronson Commercial |
$220.34
|
|
|
PR DELIVERY PLACENTA SEPARATE PROCEDURE
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 59414
|
| Min. Negotiated Rate |
$79.13 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Aetna Commercial |
$111.62
|
| Rate for Payer: Aetna Medicare |
$86.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.95
|
| Rate for Payer: BCBS Complete |
$83.09
|
| Rate for Payer: BCBS MAPPO |
$83.30
|
| Rate for Payer: BCN Commercial |
$135.95
|
| Rate for Payer: BCN Medicare Advantage |
$83.30
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$111.62
|
| Rate for Payer: Cofinity Commercial |
$119.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.47
|
| Rate for Payer: Meridian Medicaid |
$83.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.63
|
| Rate for Payer: Nomi Health Commercial |
$99.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.25
|
| Rate for Payer: PACE SWMI |
$83.30
|
| Rate for Payer: PHP Commercial |
$116.62
|
| Rate for Payer: PHP Medicare Advantage |
$83.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$128.34
|
| Rate for Payer: Priority Health Medicare |
$83.30
|
| Rate for Payer: Priority Health SBD |
$128.34
|
| Rate for Payer: Priority Health Tiered Network |
$128.34
|
| Rate for Payer: Railroad Medicare Medicare |
$83.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.75
|
| Rate for Payer: UHC Core |
$163.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.30
|
| Rate for Payer: UHC Exchange |
$163.75
|
| Rate for Payer: UHC Medicaid |
$79.13
|
| Rate for Payer: UHCCP Medicaid |
$79.13
|
| Rate for Payer: UMR Bronson Commercial |
$122.82
|
|
|
PR DEMO&/EVAL PT UTILIZ AERSL GEN NEB INHLR/IPPB
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 94664
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Medicare |
$19.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.71
|
| Rate for Payer: BCBS MAPPO |
$18.44
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$18.44
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$26.55
|
| Rate for Payer: Cofinity Commercial |
$24.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.28
|
| Rate for Payer: Nomi Health Commercial |
$22.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.50
|
| Rate for Payer: PACE SWMI |
$18.44
|
| Rate for Payer: PHP Commercial |
$25.82
|
| Rate for Payer: PHP Medicare Advantage |
$18.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.80
|
| Rate for Payer: Priority Health Medicare |
$18.44
|
| Rate for Payer: Priority Health SBD |
$24.80
|
| Rate for Payer: Priority Health Tiered Network |
$24.80
|
| Rate for Payer: Railroad Medicare Medicare |
$18.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.04
|
| Rate for Payer: UHC Core |
$25.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.44
|
| Rate for Payer: UHC Exchange |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
|
|
PR DENOSUMAB INJECTION
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS J0897
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$42.49 |
| Rate for Payer: Aetna Commercial |
$39.54
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.49
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS Trust/PPO |
$28.75
|
| Rate for Payer: BCN Commercial |
$26.77
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$39.54
|
| Rate for Payer: Cofinity Commercial |
$42.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Nomi Health Commercial |
$35.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PHP Commercial |
$41.31
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.46
|
| Rate for Payer: UHC Core |
$29.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR DEPO-ESTRADIOL CYPIONATE INJ
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS J1000
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$74.62 |
| Rate for Payer: Aetna Commercial |
$69.44
|
| Rate for Payer: Aetna Medicare |
$53.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.62
|
| Rate for Payer: BCBS MAPPO |
$51.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.79
|
| Rate for Payer: BCN Commercial |
$43.12
|
| Rate for Payer: BCN Medicare Advantage |
$51.82
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Cofinity Commercial |
$74.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.00
|
| Rate for Payer: Nomi Health Commercial |
$62.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.50
|
| Rate for Payer: PACE SWMI |
$51.82
|
| Rate for Payer: PHP Commercial |
$72.55
|
| Rate for Payer: PHP Medicare Advantage |
$51.82
|
| Rate for Payer: Priority Health Medicare |
$51.82
|
| Rate for Payer: Railroad Medicare Medicare |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.82
|
| Rate for Payer: UHC Core |
$51.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.82
|
| Rate for Payer: UHC Exchange |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
|
|
PR DEPRESSION SCREEN ANNUAL
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS G0444
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.39
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: BCN Medicare Advantage |
$7.91
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$11.39
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.70
|
| Rate for Payer: Nomi Health Commercial |
$9.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
| Rate for Payer: PACE SWMI |
$7.91
|
| Rate for Payer: PHP Commercial |
$11.07
|
| Rate for Payer: PHP Medicare Advantage |
$7.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.80
|
| Rate for Payer: Priority Health Medicare |
$7.91
|
| Rate for Payer: Priority Health SBD |
$10.80
|
| Rate for Payer: Priority Health Tiered Network |
$10.80
|
| Rate for Payer: Railroad Medicare Medicare |
$7.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.30
|
| Rate for Payer: UHC Core |
$15.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.91
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR DERMABRASION SEGMENTAL FACE
|
Professional
|
Both
|
$1,249.00
|
|
|
Service Code
|
HCPCS 15781
|
| Min. Negotiated Rate |
$234.94 |
| Max. Negotiated Rate |
$936.75 |
| Rate for Payer: Aetna Commercial |
$475.37
|
| Rate for Payer: Aetna Medicare |
$368.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.84
|
| Rate for Payer: BCBS Complete |
$246.69
|
| Rate for Payer: BCBS MAPPO |
$354.75
|
| Rate for Payer: BCN Commercial |
$632.93
|
| Rate for Payer: BCN Medicare Advantage |
$354.75
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Cofinity Commercial |
$475.37
|
| Rate for Payer: Cofinity Commercial |
$510.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$372.49
|
| Rate for Payer: Meridian Medicaid |
$246.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$390.23
|
| Rate for Payer: Nomi Health Commercial |
$425.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$936.75
|
| Rate for Payer: PACE SWMI |
$354.75
|
| Rate for Payer: PHP Commercial |
$496.65
|
| Rate for Payer: PHP Medicare Advantage |
$354.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$579.29
|
| Rate for Payer: Priority Health Medicare |
$354.75
|
| Rate for Payer: Priority Health SBD |
$579.29
|
| Rate for Payer: Priority Health Tiered Network |
$579.29
|
| Rate for Payer: Railroad Medicare Medicare |
$354.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.26
|
| Rate for Payer: UHC Core |
$738.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$354.75
|
| Rate for Payer: UHC Exchange |
$738.26
|
| Rate for Payer: UHC Medicaid |
$234.94
|
| Rate for Payer: UHCCP Medicaid |
$234.94
|
| Rate for Payer: UMR Bronson Commercial |
$574.54
|
|
|
PR DERMAGRAFT
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS Q4106
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$46.29 |
| Rate for Payer: Aetna Commercial |
$46.29
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.29
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCN Commercial |
$33.86
|
| 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: UMR Bronson Commercial |
$24.38
|
|
|
PR DERMAL AUTOGRAFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM
|
Professional
|
Both
|
$1,634.00
|
|
|
Service Code
|
HCPCS 15135
|
| Min. Negotiated Rate |
$429.83 |
| Max. Negotiated Rate |
$1,316.40 |
| Rate for Payer: Aetna Commercial |
$882.04
|
| Rate for Payer: Aetna Medicare |
$684.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.87
|
| Rate for Payer: BCBS Complete |
$451.32
|
| Rate for Payer: BCBS MAPPO |
$658.24
|
| Rate for Payer: BCN Commercial |
$1,139.88
|
| Rate for Payer: BCN Medicare Advantage |
$658.24
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cofinity Commercial |
$947.87
|
| Rate for Payer: Cofinity Commercial |
$882.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.15
|
| Rate for Payer: Meridian Medicaid |
$451.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$724.06
|
| Rate for Payer: Nomi Health Commercial |
$789.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,225.50
|
| Rate for Payer: PACE SWMI |
$658.24
|
| Rate for Payer: PHP Commercial |
$921.54
|
| Rate for Payer: PHP Medicare Advantage |
$658.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,043.28
|
| Rate for Payer: Priority Health Medicare |
$658.24
|
| Rate for Payer: Priority Health SBD |
$1,043.28
|
| Rate for Payer: Priority Health Tiered Network |
$1,043.28
|
| Rate for Payer: Railroad Medicare Medicare |
$658.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,316.40
|
| Rate for Payer: UHC Core |
$1,316.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$658.24
|
| Rate for Payer: UHC Exchange |
$1,316.40
|
| Rate for Payer: UHC Medicaid |
$429.83
|
| Rate for Payer: UHCCP Medicaid |
$429.83
|
| Rate for Payer: UMR Bronson Commercial |
$751.64
|
|
|
PR DERMAL FILLER JUVEDERM ULTRA
|
Professional
|
Both
|
$773.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$579.75 |
| Rate for Payer: Aetna Medicare |
$386.50
|
| Rate for Payer: BCBS Complete |
$309.20
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$579.75
|
| Rate for Payer: UMR Bronson Commercial |
$355.58
|
|
|
PR DERMAL FILLER JUVEDERM ULTRA PR PLUS
|
Professional
|
Both
|
$420.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Medicare |
$210.00
|
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
| Rate for Payer: UMR Bronson Commercial |
$193.20
|
|
|
PR DERMAL FILLER JUVEDERM VOLLURE
|
Professional
|
Both
|
$876.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: Aetna Medicare |
$438.00
|
| Rate for Payer: BCBS Complete |
$350.40
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.00
|
| Rate for Payer: UMR Bronson Commercial |
$402.96
|
|
|
PR DERMAL FILLER JUVEDERM VOLUMA
|
Professional
|
Both
|
$927.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Aetna Medicare |
$463.50
|
| Rate for Payer: BCBS Complete |
$370.80
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.25
|
| Rate for Payer: UMR Bronson Commercial |
$426.42
|
|
|
PR DERMAL FILLER RESTYLANE 1/2 UNIT
|
Professional
|
Both
|
$420.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Medicare |
$210.00
|
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
| Rate for Payer: UMR Bronson Commercial |
$193.20
|
|
|
PR DERMAL FILLER RESTYLANE 1 UNIT
|
Professional
|
Both
|
$773.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$579.75 |
| Rate for Payer: Aetna Medicare |
$386.50
|
| Rate for Payer: BCBS Complete |
$309.20
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$579.75
|
| Rate for Payer: UMR Bronson Commercial |
$355.58
|
|
|
PR DERMAL FILLER VOLBELLA
|
Professional
|
Both
|
$515.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$386.25 |
| Rate for Payer: Aetna Medicare |
$257.50
|
| Rate for Payer: BCBS Complete |
$206.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$386.25
|
| Rate for Payer: UMR Bronson Commercial |
$236.90
|
|
|
PR DERMAL FILLER VOLBELLA >1
|
Professional
|
Both
|
$876.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: Aetna Medicare |
$438.00
|
| Rate for Payer: BCBS Complete |
$350.40
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.00
|
| Rate for Payer: UMR Bronson Commercial |
$402.96
|
|
|
PR DESTROY NERVE,CERV SPINAL MUSCLES
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 64613
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Medicare |
$186.00
|
| Rate for Payer: BCBS Complete |
$148.80
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.00
|
| Rate for Payer: UMR Bronson Commercial |
$171.12
|
|
