|
PR METHYLPREDNISOLONE 20 MG INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1020
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.25 |
| 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: BCBS Trust/PPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| 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 |
$9.75 |
| 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: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
|
|
PR METHYLPREDNISOLONE 80 MG INJ
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J1040
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$5.37
|
| Rate for Payer: BCN Commercial |
$10.71
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR METHYLPREDNISOLONE INJECTION
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J2920
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$6.50 |
| 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: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR METHYLPREDNISOLONE INJECTION
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J2930
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$6.06
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR MGMT LVR HEMRRG CPLX SUTR WND/INJ
|
Professional
|
Both
|
$3,454.00
|
|
|
Service Code
|
HCPCS 47360
|
| Min. Negotiated Rate |
$331.24 |
| Max. Negotiated Rate |
$3,346.89 |
| Rate for Payer: Aetna Commercial |
$2,436.71
|
| Rate for Payer: Aetna Medicare |
$1,891.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,436.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,618.55
|
| Rate for Payer: BCBS Complete |
$1,260.27
|
| Rate for Payer: BCBS MAPPO |
$1,818.44
|
| Rate for Payer: BCBS Trust/PPO |
$331.24
|
| Rate for Payer: BCN Commercial |
$2,732.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,818.44
|
| Rate for Payer: Cash Price |
$2,763.20
|
| Rate for Payer: Cash Price |
$2,763.20
|
| Rate for Payer: Cofinity Commercial |
$2,436.71
|
| Rate for Payer: Cofinity Commercial |
$2,618.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,818.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,909.36
|
| Rate for Payer: Meridian Medicaid |
$1,260.27
|
| Rate for Payer: Nomi Health Commercial |
$2,182.13
|
| Rate for Payer: PACE SWMI |
$1,818.44
|
| Rate for Payer: PHP Commercial |
$2,545.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,818.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,200.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,346.89
|
| Rate for Payer: Priority Health Medicare |
$1,818.44
|
| Rate for Payer: Priority Health Narrow Network |
$3,346.89
|
| Rate for Payer: Priority Health SBD |
$3,346.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,818.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,818.44
|
| Rate for Payer: UHCCP Medicaid |
$1,200.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,588.84
|
|
|
PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR
|
Professional
|
Both
|
$6,375.00
|
|
|
Service Code
|
HCPCS 47361
|
| Min. Negotiated Rate |
$1,921.90 |
| Max. Negotiated Rate |
$5,352.04 |
| Rate for Payer: Aetna Commercial |
$3,908.66
|
| Rate for Payer: Aetna Medicare |
$3,033.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,908.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,200.35
|
| Rate for Payer: BCBS Complete |
$2,018.00
|
| Rate for Payer: BCBS MAPPO |
$2,916.91
|
| Rate for Payer: BCN Commercial |
$4,387.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,916.91
|
| Rate for Payer: Cash Price |
$5,100.00
|
| Rate for Payer: Cash Price |
$5,100.00
|
| Rate for Payer: Cofinity Commercial |
$3,908.66
|
| Rate for Payer: Cofinity Commercial |
$4,200.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,916.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,062.76
|
| Rate for Payer: Meridian Medicaid |
$2,018.00
|
| Rate for Payer: Nomi Health Commercial |
$3,500.29
|
| Rate for Payer: PACE SWMI |
$2,916.91
|
| Rate for Payer: PHP Commercial |
$4,083.67
|
| Rate for Payer: PHP Medicare Advantage |
$2,916.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,921.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,143.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,352.04
|
| Rate for Payer: Priority Health Medicare |
$2,916.91
|
| Rate for Payer: Priority Health Narrow Network |
$5,352.04
|
| Rate for Payer: Priority Health SBD |
$5,352.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,916.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,916.91
|
| Rate for Payer: UHCCP Medicaid |
$1,921.90
|
| Rate for Payer: UMR Bronson Commercial |
$2,932.50
|
|
|
PR MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING
|
Professional
|
Both
|
$2,999.00
|
|
|
Service Code
|
HCPCS 47362
|
| Min. Negotiated Rate |
$910.36 |
| Max. Negotiated Rate |
$2,594.58 |
| Rate for Payer: Aetna Commercial |
$1,839.79
|
| Rate for Payer: Aetna Medicare |
$1,427.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,839.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,977.09
|
| Rate for Payer: BCBS Complete |
$955.88
|
| Rate for Payer: BCBS MAPPO |
$1,372.98
|
| Rate for Payer: BCN Commercial |
$2,091.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,372.98
|
| Rate for Payer: Cash Price |
$2,399.20
|
| Rate for Payer: Cash Price |
$2,399.20
|
| Rate for Payer: Cofinity Commercial |
$1,977.09
|
| Rate for Payer: Cofinity Commercial |
$1,839.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,372.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,441.63
|
| Rate for Payer: Meridian Medicaid |
$955.88
|
| Rate for Payer: Nomi Health Commercial |
$1,647.58
|
| Rate for Payer: PACE SWMI |
$1,372.98
|
| Rate for Payer: PHP Commercial |
$1,922.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,372.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$910.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,949.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,594.58
|
| Rate for Payer: Priority Health Medicare |
$1,372.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,594.58
|
| Rate for Payer: Priority Health SBD |
$2,594.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,372.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,372.98
|
| Rate for Payer: UHCCP Medicaid |
$910.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,379.54
|
|
|
PR MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ
|
Professional
|
Both
|
$2,903.00
|
|
|
Service Code
|
HCPCS 47350
|
| Min. Negotiated Rate |
$873.51 |
| Max. Negotiated Rate |
$2,437.69 |
| Rate for Payer: Aetna Commercial |
$1,765.73
|
| Rate for Payer: Aetna Medicare |
$1,370.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,765.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,897.50
|
| Rate for Payer: BCBS Complete |
$917.19
|
| Rate for Payer: BCBS MAPPO |
$1,317.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,888.67
|
| Rate for Payer: BCN Commercial |
$1,994.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,317.71
|
| Rate for Payer: Cash Price |
$2,322.40
|
| Rate for Payer: Cash Price |
$2,322.40
|
| Rate for Payer: Cofinity Commercial |
$1,897.50
|
| Rate for Payer: Cofinity Commercial |
$1,765.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,317.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,383.60
|
| Rate for Payer: Meridian Medicaid |
$917.19
|
| Rate for Payer: Nomi Health Commercial |
$1,581.25
|
| Rate for Payer: PACE SWMI |
$1,317.71
|
| Rate for Payer: PHP Commercial |
$1,844.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,317.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$873.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,886.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,437.69
|
| Rate for Payer: Priority Health Medicare |
$1,317.71
|
| Rate for Payer: Priority Health Narrow Network |
$2,437.69
|
| Rate for Payer: Priority Health SBD |
$2,437.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,317.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,317.71
|
| Rate for Payer: UHCCP Medicaid |
$873.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,335.38
|
|
|
PR MH PARTIAL HOSP TX UNDER 24H
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS H0035
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Aetna Commercial |
$268.86
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.86
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: UMR Bronson Commercial |
$119.14
|
|
|
PR MICRONEEDLING PIN ADB/THIGHS/BACK
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 00108
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: UMR Bronson Commercial |
$211.14
|
|
|
PR MICRONEEDLING PIN FULL FACE
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00105
|
|
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 MICRONEEDLING PIN NECK
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00107
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR MICRONEEDLING PIN UPPER OR LOWER FACE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00106
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR MICRONEEDLING SCARS - UP TO 4 INCHES
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00109
|
|
Hospital Revenue Code
|
990
|
| 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 MICRONEEDLING TAT RMVL 4-6 SQ INCHES
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 00122
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: UMR Bronson Commercial |
$211.14
|
|
|
PR MICRONEEDLING TAT RMVL 6-9 SQ INCHES
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00123
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR MICRONEEDLING TAT RMVL 9-12 SQ INCHES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00124
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR MICRONEEDLING TAT RMVL UP TO 2 SQ INCH
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00110
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 69990
|
| Min. Negotiated Rate |
$139.52 |
| Max. Negotiated Rate |
$11,952.59 |
| Rate for Payer: Aetna Commercial |
$287.76
|
| Rate for Payer: Aetna Medicare |
$223.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.24
|
| Rate for Payer: BCBS Complete |
$146.50
|
| Rate for Payer: BCBS MAPPO |
$214.75
|
| Rate for Payer: BCBS Trust/PPO |
$11,952.59
|
| Rate for Payer: BCN Commercial |
$349.21
|
| Rate for Payer: BCN Medicare Advantage |
$214.75
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$287.76
|
| Rate for Payer: Cofinity Commercial |
$309.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.49
|
| Rate for Payer: Meridian Medicaid |
$146.50
|
| Rate for Payer: Nomi Health Commercial |
$257.70
|
| Rate for Payer: PACE SWMI |
$214.75
|
| Rate for Payer: PHP Commercial |
$300.65
|
| Rate for Payer: PHP Medicare Advantage |
$214.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.11
|
| Rate for Payer: Priority Health Medicare |
$214.75
|
| Rate for Payer: Priority Health Narrow Network |
$317.11
|
| Rate for Payer: Priority Health SBD |
$317.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.75
|
| Rate for Payer: UHC Medicare Advantage |
$214.75
|
| Rate for Payer: UHCCP Medicaid |
$139.52
|
| Rate for Payer: UMR Bronson Commercial |
$230.46
|
|
|
PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 69440
|
| Min. Negotiated Rate |
$441.12 |
| Max. Negotiated Rate |
$1,668.90 |
| Rate for Payer: Aetna Commercial |
$860.23
|
| Rate for Payer: Aetna Medicare |
$667.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.42
|
| Rate for Payer: BCBS Complete |
$463.18
|
| Rate for Payer: BCBS MAPPO |
$641.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.90
|
| Rate for Payer: BCN Commercial |
$1,024.27
|
| Rate for Payer: BCN Medicare Advantage |
$641.96
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cofinity Commercial |
$860.23
|
| Rate for Payer: Cofinity Commercial |
$924.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.06
|
| Rate for Payer: Meridian Medicaid |
$463.18
|
| Rate for Payer: Nomi Health Commercial |
$770.35
|
| Rate for Payer: PACE SWMI |
$641.96
|
| Rate for Payer: PHP Commercial |
$898.74
|
| Rate for Payer: PHP Medicare Advantage |
$641.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,107.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.47
|
| Rate for Payer: Priority Health Medicare |
$641.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,018.47
|
| Rate for Payer: Priority Health SBD |
$1,018.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.96
|
| Rate for Payer: UHC Medicare Advantage |
$641.96
|
| Rate for Payer: UHCCP Medicaid |
$441.12
|
| Rate for Payer: UMR Bronson Commercial |
$783.84
|
|
|
PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES
|
Professional
|
Both
|
$2,972.00
|
|
|
Service Code
|
HCPCS 15730
|
| Min. Negotiated Rate |
$584.69 |
| Max. Negotiated Rate |
$2,089.09 |
| Rate for Payer: Aetna Commercial |
$1,153.36
|
| Rate for Payer: Aetna Medicare |
$895.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,153.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,239.44
|
| Rate for Payer: BCBS Complete |
$613.92
|
| Rate for Payer: BCBS MAPPO |
$860.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,930.99
|
| Rate for Payer: BCN Commercial |
$2,089.09
|
| Rate for Payer: BCN Medicare Advantage |
$860.72
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Cofinity Commercial |
$1,153.36
|
| Rate for Payer: Cofinity Commercial |
$1,239.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$860.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$903.76
|
| Rate for Payer: Meridian Medicaid |
$613.92
|
| Rate for Payer: Nomi Health Commercial |
$1,032.86
|
| Rate for Payer: PACE SWMI |
$860.72
|
| Rate for Payer: PHP Commercial |
$1,205.01
|
| Rate for Payer: PHP Medicare Advantage |
$860.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,931.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,236.70
|
| Rate for Payer: Priority Health Medicare |
$860.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,236.70
|
| Rate for Payer: Priority Health SBD |
$1,236.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$860.72
|
| Rate for Payer: UHC Medicare Advantage |
$860.72
|
| Rate for Payer: UHCCP Medicaid |
$584.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,367.12
|
|
|
PR MIRENA, 52 MG
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7298
|
| Min. Negotiated Rate |
$677.12 |
| Max. Negotiated Rate |
$1,351.89 |
| Rate for Payer: Aetna Commercial |
$1,101.70
|
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.70
|
| Rate for Payer: BCBS Complete |
$1,351.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.90
|
| Rate for Payer: BCN Commercial |
$1,107.20
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Meridian Medicaid |
$1,351.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.80
|
| Rate for Payer: UHCCP Medicaid |
$1,287.51
|
| Rate for Payer: UMR Bronson Commercial |
$677.12
|
|
|
PR MISC VISION ITEM OR SERVICE
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS V2799
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR MISOPROSTOL, ORAL, 200 MCG
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS S0191
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$0.96
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
|
