|
PR DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,963.00
|
|
|
Service Code
|
HCPCS 32220
|
| Min. Negotiated Rate |
$1,185.20 |
| Max. Negotiated Rate |
$2,210.36 |
| Rate for Payer: Aetna Commercial |
$2,056.86
|
| Rate for Payer: Aetna Medicare |
$1,596.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,210.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,056.86
|
| Rate for Payer: BCBS Complete |
$1,185.20
|
| Rate for Payer: BCBS MAPPO |
$1,534.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,534.97
|
| Rate for Payer: Cash Price |
$2,370.40
|
| Rate for Payer: Cash Price |
$2,370.40
|
| Rate for Payer: Cofinity Commercial |
$2,210.36
|
| Rate for Payer: Cofinity Commercial |
$2,056.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,534.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,611.72
|
| Rate for Payer: Nomi Health Commercial |
$1,841.96
|
| Rate for Payer: PACE SWMI |
$1,534.97
|
| Rate for Payer: PHP Commercial |
$2,148.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,534.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.95
|
| Rate for Payer: Priority Health Medicare |
$1,534.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,534.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,534.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,362.98
|
|
|
PR DEGARELIX INJECTION
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J9155
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$4.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.96
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.45
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$5.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$5.34
|
| Rate for Payer: PACE SWMI |
$4.45
|
| Rate for Payer: PHP Commercial |
$6.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.45
|
| Rate for Payer: UHC Medicare Advantage |
$4.45
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
|
|
PR DELAYED CREATION EXIT SITE EMBEDDED CATHETER
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 49436
|
| Min. Negotiated Rate |
$179.71 |
| Max. Negotiated Rate |
$838.50 |
| Rate for Payer: Aetna Commercial |
$240.81
|
| Rate for Payer: Aetna Medicare |
$186.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.81
|
| Rate for Payer: BCBS Complete |
$516.00
|
| Rate for Payer: BCBS MAPPO |
$179.71
|
| Rate for Payer: BCN Medicare Advantage |
$179.71
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Cofinity Commercial |
$258.78
|
| Rate for Payer: Cofinity Commercial |
$240.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.70
|
| Rate for Payer: Nomi Health Commercial |
$215.65
|
| Rate for Payer: PACE SWMI |
$179.71
|
| Rate for Payer: PHP Commercial |
$251.59
|
| Rate for Payer: PHP Medicare Advantage |
$179.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.50
|
| Rate for Payer: Priority Health Medicare |
$179.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.71
|
| Rate for Payer: UHC Medicare Advantage |
$179.71
|
| Rate for Payer: UMR Bronson Commercial |
$593.40
|
|
|
PR DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 15630
|
| Min. Negotiated Rate |
$325.02 |
| Max. Negotiated Rate |
$588.90 |
| Rate for Payer: Aetna Commercial |
$435.53
|
| Rate for Payer: Aetna Medicare |
$338.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.53
|
| Rate for Payer: BCBS Complete |
$362.40
|
| Rate for Payer: BCBS MAPPO |
$325.02
|
| Rate for Payer: BCN Medicare Advantage |
$325.02
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$468.03
|
| Rate for Payer: Cofinity Commercial |
$435.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.27
|
| Rate for Payer: Nomi Health Commercial |
$390.02
|
| Rate for Payer: PACE SWMI |
$325.02
|
| Rate for Payer: PHP Commercial |
$455.03
|
| Rate for Payer: PHP Medicare Advantage |
$325.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.90
|
| Rate for Payer: Priority Health Medicare |
$325.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.02
|
| Rate for Payer: UHC Medicare Advantage |
$325.02
|
| Rate for Payer: UMR Bronson Commercial |
$416.76
|
|
|
PR DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 15620
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$470.60 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Medicare |
$322.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.96
|
| Rate for Payer: BCBS Complete |
$289.60
|
| Rate for Payer: BCBS MAPPO |
$309.67
|
| Rate for Payer: BCN Medicare Advantage |
$309.67
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cofinity Commercial |
$445.92
|
| Rate for Payer: Cofinity Commercial |
$414.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.15
|
| Rate for Payer: Nomi Health Commercial |
$371.60
|
| Rate for Payer: PACE SWMI |
$309.67
|
| Rate for Payer: PHP Commercial |
$433.54
|
| Rate for Payer: PHP Medicare Advantage |
$309.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health Medicare |
$309.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.67
|
| Rate for Payer: UHC Medicare Advantage |
$309.67
|
| Rate for Payer: UMR Bronson Commercial |
$333.04
|
|
|
PR DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 15610
|
| Min. Negotiated Rate |
$231.95 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Commercial |
$310.81
|
| Rate for Payer: Aetna Medicare |
$241.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.81
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: BCBS MAPPO |
$231.95
|
| Rate for Payer: BCN Medicare Advantage |
$231.95
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$334.01
|
| Rate for Payer: Cofinity Commercial |
$310.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.55
|
| Rate for Payer: Nomi Health Commercial |
$278.34
|
| Rate for Payer: PACE SWMI |
$231.95
|
| Rate for Payer: PHP Commercial |
$324.73
|
| Rate for Payer: PHP Medicare Advantage |
$231.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Medicare |
$231.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.95
|
| Rate for Payer: UHC Medicare Advantage |
$231.95
|
| Rate for Payer: UMR Bronson Commercial |
$281.52
|
|
|
PR DELAY FLAP/SECTIONING FLAP TRUNK
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 15600
|
| Min. Negotiated Rate |
$198.78 |
| Max. Negotiated Rate |
$343.85 |
| Rate for Payer: Aetna Commercial |
$266.37
|
| Rate for Payer: Aetna Medicare |
$206.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.37
|
| Rate for Payer: BCBS Complete |
$211.60
|
| Rate for Payer: BCBS MAPPO |
$198.78
|
| Rate for Payer: BCN Medicare Advantage |
$198.78
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Cofinity Commercial |
$286.24
|
| Rate for Payer: Cofinity Commercial |
$266.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.72
|
| Rate for Payer: Nomi Health Commercial |
$238.54
|
| Rate for Payer: PACE SWMI |
$198.78
|
| Rate for Payer: PHP Commercial |
$278.29
|
| Rate for Payer: PHP Medicare Advantage |
$198.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.85
|
| Rate for Payer: Priority Health Medicare |
$198.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.78
|
| Rate for Payer: UHC Medicare Advantage |
$198.78
|
| Rate for Payer: UMR Bronson Commercial |
$243.34
|
|
|
PR DELIVERY/BIRTHING ROOM RESUSCITATION
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 99465
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$179.02
|
| Rate for Payer: Aetna Medicare |
$138.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.02
|
| Rate for Payer: BCBS Complete |
$186.00
|
| Rate for Payer: BCBS MAPPO |
$133.60
|
| Rate for Payer: BCN Medicare Advantage |
$133.60
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$192.38
|
| Rate for Payer: Cofinity Commercial |
$179.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.28
|
| Rate for Payer: Nomi Health Commercial |
$160.32
|
| Rate for Payer: PACE SWMI |
$133.60
|
| Rate for Payer: PHP Commercial |
$187.04
|
| Rate for Payer: PHP Medicare Advantage |
$133.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health Medicare |
$133.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.60
|
| Rate for Payer: UHC Medicare Advantage |
$133.60
|
| Rate for Payer: UMR Bronson Commercial |
$213.90
|
|
|
PR DELIVERY PLACENTA SEPARATE PROCEDURE
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 59414
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Aetna Commercial |
$119.69
|
| Rate for Payer: Aetna Medicare |
$92.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.69
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCBS MAPPO |
$89.32
|
| Rate for Payer: BCN Medicare Advantage |
$89.32
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$128.62
|
| Rate for Payer: Cofinity Commercial |
$119.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.79
|
| Rate for Payer: Nomi Health Commercial |
$107.18
|
| Rate for Payer: PACE SWMI |
$89.32
|
| Rate for Payer: PHP Commercial |
$125.05
|
| Rate for Payer: PHP Medicare Advantage |
$89.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$89.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.32
|
| Rate for Payer: UHC Medicare Advantage |
$89.32
|
| Rate for Payer: UMR Bronson Commercial |
$119.14
|
|
|
PR DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 94664
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Medicare |
$16.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.55
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$16.08
|
| Rate for Payer: BCN Medicare Advantage |
$16.08
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$21.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.88
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: PACE SWMI |
$16.08
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Medicare Advantage |
$16.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.08
|
| Rate for Payer: UHC Medicare Advantage |
$16.08
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
PR DENOSUMAB INJECTION
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J0897
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$42.31 |
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Medicare |
$30.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.37
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$42.31
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$41.13
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR DEPO-ESTRADIOL CYPIONATE INJ
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J1000
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna Commercial |
$66.04
|
| Rate for Payer: Aetna Medicare |
$51.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.04
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$49.28
|
| Rate for Payer: BCN Medicare Advantage |
$49.28
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$70.96
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.74
|
| Rate for Payer: Nomi Health Commercial |
$59.14
|
| Rate for Payer: PACE SWMI |
$49.28
|
| Rate for Payer: PHP Commercial |
$68.99
|
| Rate for Payer: PHP Medicare Advantage |
$49.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Medicare |
$49.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.28
|
| Rate for Payer: UHC Medicare Advantage |
$49.28
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
|
|
PR DEPRESSION SCREEN ANNUAL
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0444
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.47
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$8.56
|
| Rate for Payer: BCN Medicare Advantage |
$8.56
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.99
|
| Rate for Payer: Nomi Health Commercial |
$10.27
|
| Rate for Payer: PACE SWMI |
$8.56
|
| Rate for Payer: PHP Commercial |
$11.98
|
| Rate for Payer: PHP Medicare Advantage |
$8.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health Medicare |
$8.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.56
|
| Rate for Payer: UHC Medicare Advantage |
$8.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR DERMAGRAFT
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS Q4106
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
PR DERMAL AUTOGRAFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 15135
|
| Min. Negotiated Rate |
$634.40 |
| Max. Negotiated Rate |
$1,035.94 |
| Rate for Payer: Aetna Commercial |
$964.00
|
| Rate for Payer: Aetna Medicare |
$748.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.00
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$719.40
|
| Rate for Payer: BCN Medicare Advantage |
$719.40
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$1,035.94
|
| Rate for Payer: Cofinity Commercial |
$964.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.37
|
| Rate for Payer: Nomi Health Commercial |
$863.28
|
| Rate for Payer: PACE SWMI |
$719.40
|
| Rate for Payer: PHP Commercial |
$1,007.16
|
| Rate for Payer: PHP Medicare Advantage |
$719.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$719.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.40
|
| Rate for Payer: UHC Medicare Advantage |
$719.40
|
| Rate for Payer: UMR Bronson Commercial |
$729.56
|
|
|
PR DERMAL FILLER JUVEDERM ULTRA
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 00087
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$447.85 |
| Rate for Payer: Aetna Medicare |
$344.50
|
| Rate for Payer: BCBS Complete |
$275.60
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
| Rate for Payer: UMR Bronson Commercial |
$316.94
|
|
|
PR DERMAL FILLER JUVEDERM ULTRA PR PLUS
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00089
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR DERMAL FILLER JUVEDERM ULTRA PR PLUS >1
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 00090
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$447.85 |
| Rate for Payer: Aetna Medicare |
$344.50
|
| Rate for Payer: BCBS Complete |
$275.60
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
| Rate for Payer: UMR Bronson Commercial |
$316.94
|
|
|
PR DERMAL FILLER JUVEDERM VOLLURE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 00118
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR DERMAL FILLER JUVEDERM VOLUMA
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 00091
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
PR DERMAL FILLER RESTYLANE 1/2 UNIT
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00252
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR DERMAL FILLER RESTYLANE 1 UNIT
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
HCPCS 00253
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Aetna Medicare |
$331.50
|
| Rate for Payer: BCBS Complete |
$265.20
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: UMR Bronson Commercial |
$304.98
|
|
|
PR DERMAL FILLER RESTYLANE DEFYNE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 00360
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR DERMAL FILLER RESTYLANE LYFT
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
HCPCS 00359
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Aetna Medicare |
$331.50
|
| Rate for Payer: BCBS Complete |
$265.20
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: UMR Bronson Commercial |
$304.98
|
|
|
PR DERMAL FILLER RESTYLANE REFYNE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 00361
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
