|
PR MENB-4C RECOMBNT PRTN & OUTER MEMB VESIC VACC IM
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 90620
|
| Min. Negotiated Rate |
$124.66 |
| Max. Negotiated Rate |
$237.13 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna Medicare |
$135.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.42
|
| Rate for Payer: BCBS Trust/PPO |
$237.13
|
| Rate for Payer: BCN Commercial |
$233.20
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.13
|
| Rate for Payer: UHC Core |
$237.13
|
| Rate for Payer: UHC Exchange |
$237.13
|
| Rate for Payer: UMR Bronson Commercial |
$124.66
|
|
|
PR MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 90621
|
| Min. Negotiated Rate |
$87.40 |
| Max. Negotiated Rate |
$225.91 |
| Rate for Payer: Aetna Commercial |
$183.17
|
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.17
|
| Rate for Payer: BCBS Trust/PPO |
$225.91
|
| Rate for Payer: BCN Commercial |
$203.87
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.16
|
| Rate for Payer: UHC Core |
$225.16
|
| Rate for Payer: UHC Exchange |
$225.16
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
|
|
PR MEPERIDINE HYDROCHL /100 MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J2175
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: Aetna Commercial |
$11.82
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.82
|
| Rate for Payer: BCBS MAPPO |
$8.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.57
|
| Rate for Payer: BCN Medicare Advantage |
$8.82
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$12.70
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.70
|
| Rate for Payer: Nomi Health Commercial |
$10.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: PACE SWMI |
$8.82
|
| Rate for Payer: PHP Commercial |
$12.35
|
| Rate for Payer: PHP Medicare Advantage |
$8.82
|
| Rate for Payer: Priority Health Medicare |
$8.82
|
| Rate for Payer: Railroad Medicare Medicare |
$8.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.15
|
| Rate for Payer: UHC Core |
$8.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.82
|
| Rate for Payer: UHC Exchange |
$8.15
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR MEPERIDINE/PROMETHAZINE INJ
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J2180
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.58
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.79
|
| Rate for Payer: UHC Core |
$3.79
|
| Rate for Payer: UHC Exchange |
$3.79
|
| Rate for Payer: UMR Bronson Commercial |
$5.06
|
|
|
PR METATARSECTOMY
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 28140
|
| Min. Negotiated Rate |
$252.62 |
| Max. Negotiated Rate |
$827.25 |
| Rate for Payer: Aetna Commercial |
$520.35
|
| Rate for Payer: Aetna Medicare |
$403.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.18
|
| Rate for Payer: BCBS Complete |
$265.25
|
| Rate for Payer: BCBS MAPPO |
$388.32
|
| Rate for Payer: BCN Commercial |
$641.40
|
| Rate for Payer: BCN Medicare Advantage |
$388.32
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$520.35
|
| Rate for Payer: Cofinity Commercial |
$559.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.74
|
| Rate for Payer: Meridian Medicaid |
$265.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$427.15
|
| Rate for Payer: Nomi Health Commercial |
$465.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$827.25
|
| Rate for Payer: PACE SWMI |
$388.32
|
| Rate for Payer: PHP Commercial |
$543.65
|
| Rate for Payer: PHP Medicare Advantage |
$388.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.63
|
| Rate for Payer: Priority Health Medicare |
$388.32
|
| Rate for Payer: Priority Health SBD |
$685.63
|
| Rate for Payer: Priority Health Tiered Network |
$685.63
|
| Rate for Payer: Railroad Medicare Medicare |
$388.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.59
|
| Rate for Payer: UHC Core |
$764.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$388.32
|
| Rate for Payer: UHC Exchange |
$764.59
|
| Rate for Payer: UHC Medicaid |
$252.62
|
| Rate for Payer: UHCCP Medicaid |
$252.62
|
| Rate for Payer: UMR Bronson Commercial |
$507.38
|
|
|
PR METHYLPREDNISOLONE 20 MG INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1020
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$7.25
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.25
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR METHYLPREDNISOLONE 40 MG INJ
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1030
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.61
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCN Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
|
|
PR METHYLPREDNISOLONE 80 MG INJ
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS J1040
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCN Commercial |
$5.37
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR METHYLPREDNISOLONE INJECTION
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS J2930
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna Commercial |
$6.06
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR METHYLPREDNISOLONE INJECTION
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J2920
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$4.31
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$3.17
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR MGMT LVR HEMRRG CPLX SUTR WND/INJ
|
Professional
|
Both
|
$3,558.00
|
|
|
Service Code
|
HCPCS 47360
|
| Min. Negotiated Rate |
$1,112.71 |
| Max. Negotiated Rate |
$3,419.09 |
| Rate for Payer: Aetna Commercial |
$2,332.47
|
| Rate for Payer: Aetna Medicare |
$1,810.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,332.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,506.54
|
| Rate for Payer: BCBS Complete |
$1,168.35
|
| Rate for Payer: BCBS MAPPO |
$1,740.65
|
| Rate for Payer: BCN Commercial |
$2,806.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,740.65
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cofinity Commercial |
$2,506.54
|
| Rate for Payer: Cofinity Commercial |
$2,332.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,740.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,827.68
|
| Rate for Payer: Meridian Medicaid |
$1,168.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,914.71
|
| Rate for Payer: Nomi Health Commercial |
$2,088.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,668.50
|
| Rate for Payer: PACE SWMI |
$1,740.65
|
| Rate for Payer: PHP Commercial |
$2,436.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,740.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,112.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,419.09
|
| Rate for Payer: Priority Health Medicare |
$1,740.65
|
| Rate for Payer: Priority Health SBD |
$3,419.09
|
| Rate for Payer: Priority Health Tiered Network |
$3,419.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,740.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,355.97
|
| Rate for Payer: UHC Core |
$3,355.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,740.65
|
| Rate for Payer: UHC Exchange |
$3,355.97
|
| Rate for Payer: UHC Medicaid |
$1,112.71
|
| Rate for Payer: UHCCP Medicaid |
$1,112.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,636.68
|
|
|
PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR
|
Professional
|
Both
|
$6,566.00
|
|
|
Service Code
|
HCPCS 47361
|
| Min. Negotiated Rate |
$1,766.20 |
| Max. Negotiated Rate |
$5,474.76 |
| Rate for Payer: Aetna Commercial |
$3,713.88
|
| Rate for Payer: Aetna Medicare |
$2,882.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,713.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,991.03
|
| Rate for Payer: BCBS Complete |
$1,854.51
|
| Rate for Payer: BCBS MAPPO |
$2,771.55
|
| Rate for Payer: BCN Commercial |
$4,493.28
|
| Rate for Payer: BCN Medicare Advantage |
$2,771.55
|
| Rate for Payer: Cash Price |
$5,252.80
|
| Rate for Payer: Cash Price |
$5,252.80
|
| Rate for Payer: Cofinity Commercial |
$3,713.88
|
| Rate for Payer: Cofinity Commercial |
$3,991.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,771.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,910.13
|
| Rate for Payer: Meridian Medicaid |
$1,854.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,048.70
|
| Rate for Payer: Nomi Health Commercial |
$3,325.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,924.50
|
| Rate for Payer: PACE SWMI |
$2,771.55
|
| Rate for Payer: PHP Commercial |
$3,880.17
|
| Rate for Payer: PHP Medicare Advantage |
$2,771.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,766.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,474.76
|
| Rate for Payer: Priority Health Medicare |
$2,771.55
|
| Rate for Payer: Priority Health SBD |
$5,474.76
|
| Rate for Payer: Priority Health Tiered Network |
$5,474.76
|
| Rate for Payer: Railroad Medicare Medicare |
$2,771.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,419.93
|
| Rate for Payer: UHC Core |
$5,419.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,771.55
|
| Rate for Payer: UHC Exchange |
$5,419.93
|
| Rate for Payer: UHC Medicaid |
$1,766.20
|
| Rate for Payer: UHCCP Medicaid |
$1,766.20
|
| Rate for Payer: UMR Bronson Commercial |
$3,020.36
|
|
|
PR MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING
|
Professional
|
Both
|
$3,089.00
|
|
|
Service Code
|
HCPCS 47362
|
| Min. Negotiated Rate |
$853.28 |
| Max. Negotiated Rate |
$2,593.28 |
| Rate for Payer: Aetna Commercial |
$1,780.20
|
| Rate for Payer: Aetna Medicare |
$1,381.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,780.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,913.05
|
| Rate for Payer: BCBS Complete |
$895.94
|
| Rate for Payer: BCBS MAPPO |
$1,328.51
|
| Rate for Payer: BCN Commercial |
$2,128.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,328.51
|
| Rate for Payer: Cash Price |
$2,471.20
|
| Rate for Payer: Cash Price |
$2,471.20
|
| Rate for Payer: Cofinity Commercial |
$1,780.20
|
| Rate for Payer: Cofinity Commercial |
$1,913.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,328.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,394.94
|
| Rate for Payer: Meridian Medicaid |
$895.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,461.36
|
| Rate for Payer: Nomi Health Commercial |
$1,594.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,316.75
|
| Rate for Payer: PACE SWMI |
$1,328.51
|
| Rate for Payer: PHP Commercial |
$1,859.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,328.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$853.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,593.28
|
| Rate for Payer: Priority Health Medicare |
$1,328.51
|
| Rate for Payer: Priority Health SBD |
$2,593.28
|
| Rate for Payer: Priority Health Tiered Network |
$2,593.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,328.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,587.97
|
| Rate for Payer: UHC Core |
$2,587.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,328.51
|
| Rate for Payer: UHC Exchange |
$2,587.97
|
| Rate for Payer: UHC Medicaid |
$853.28
|
| Rate for Payer: UHCCP Medicaid |
$853.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,420.94
|
|
|
PR MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ
|
Professional
|
Both
|
$2,990.00
|
|
|
Service Code
|
HCPCS 47350
|
| Min. Negotiated Rate |
$819.84 |
| Max. Negotiated Rate |
$2,488.31 |
| Rate for Payer: Aetna Commercial |
$1,709.85
|
| Rate for Payer: Aetna Medicare |
$1,327.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,709.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,837.45
|
| Rate for Payer: BCBS Complete |
$860.83
|
| Rate for Payer: BCBS MAPPO |
$1,276.01
|
| Rate for Payer: BCN Commercial |
$2,042.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,276.01
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cofinity Commercial |
$1,709.85
|
| Rate for Payer: Cofinity Commercial |
$1,837.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,276.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,339.81
|
| Rate for Payer: Meridian Medicaid |
$860.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,403.61
|
| Rate for Payer: Nomi Health Commercial |
$1,531.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,242.50
|
| Rate for Payer: PACE SWMI |
$1,276.01
|
| Rate for Payer: PHP Commercial |
$1,786.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,276.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,488.31
|
| Rate for Payer: Priority Health Medicare |
$1,276.01
|
| Rate for Payer: Priority Health SBD |
$2,488.31
|
| Rate for Payer: Priority Health Tiered Network |
$2,488.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,276.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,438.80
|
| Rate for Payer: UHC Core |
$2,438.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,276.01
|
| Rate for Payer: UHC Exchange |
$2,438.80
|
| Rate for Payer: UHC Medicaid |
$819.84
|
| Rate for Payer: UHCCP Medicaid |
$819.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,375.40
|
|
|
PR MH PARTIAL HOSP TX UNDER 24H
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS H0035
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Aetna Commercial |
$268.86
|
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.86
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.25
|
| Rate for Payer: UMR Bronson Commercial |
$122.82
|
|
|
PR MICRONEEDLING PIN ADB/THIGHS/BACK
|
Professional
|
Both
|
$473.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Aetna Medicare |
$236.50
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.75
|
| Rate for Payer: UMR Bronson Commercial |
$217.58
|
|
|
PR MICRONEEDLING PIN FULL FACE
|
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 MICRONEEDLING PIN NECK
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
PR MICRONEEDLING PIN UPPER OR LOWER FACE
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
PR MICRONEEDLING SCARS - UP TO 4 INCHES
|
Professional
|
Both
|
$53.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| 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 MICRONEEDLING TAT RMVL 4-6 SQ INCHES
|
Professional
|
Both
|
$473.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Aetna Medicare |
$236.50
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.75
|
| Rate for Payer: UMR Bronson Commercial |
$217.58
|
|
|
PR MICRONEEDLING TAT RMVL 6-9 SQ INCHES
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$144.90
|
|
|
PR MICRONEEDLING TAT RMVL 9-12 SQ INCHES
|
Professional
|
Both
|
$210.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$96.60
|
|
|
PR MICRONEEDLING TAT RMVL UP TO 2 SQ INCH
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
PR MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 69990
|
| Min. Negotiated Rate |
$126.31 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$268.88
|
| Rate for Payer: Aetna Medicare |
$208.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.95
|
| Rate for Payer: BCBS Complete |
$132.63
|
| Rate for Payer: BCBS MAPPO |
$200.66
|
| Rate for Payer: BCN Commercial |
$358.33
|
| Rate for Payer: BCN Medicare Advantage |
$200.66
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$288.95
|
| Rate for Payer: Cofinity Commercial |
$268.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.69
|
| Rate for Payer: Meridian Medicaid |
$132.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$220.73
|
| Rate for Payer: Nomi Health Commercial |
$240.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.00
|
| Rate for Payer: PACE SWMI |
$200.66
|
| Rate for Payer: PHP Commercial |
$280.92
|
| Rate for Payer: PHP Medicare Advantage |
$200.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$322.30
|
| Rate for Payer: Priority Health Medicare |
$200.66
|
| Rate for Payer: Priority Health SBD |
$322.30
|
| Rate for Payer: Priority Health Tiered Network |
$322.30
|
| Rate for Payer: Railroad Medicare Medicare |
$200.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.05
|
| Rate for Payer: UHC Core |
$387.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$200.66
|
| Rate for Payer: UHC Exchange |
$387.05
|
| Rate for Payer: UHC Medicaid |
$126.31
|
| Rate for Payer: UHCCP Medicaid |
$126.31
|
| Rate for Payer: UMR Bronson Commercial |
$237.36
|
|
