|
PR DELAY FLAP/SECTIONING FLAP TRUNK
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 15600
|
| Min. Negotiated Rate |
$198.78 |
| Max. Negotiated Rate |
$367.74 |
| 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: Healthscope Commercial |
$318.05
|
| Rate for Payer: Healthscope Commercial |
$367.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.85
|
| Rate for Payer: Nomi Health Commercial |
$238.54
|
| Rate for Payer: PACE SWMI |
$198.78
|
| 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
|
|
|
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: Healthscope Commercial |
$247.16
|
| Rate for Payer: Healthscope Commercial |
$213.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.25
|
| Rate for Payer: Nomi Health Commercial |
$160.32
|
| Rate for Payer: PACE SWMI |
$133.60
|
| 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
|
|
|
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: Healthscope Commercial |
$142.91
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.35
|
| Rate for Payer: Nomi Health Commercial |
$107.18
|
| Rate for Payer: PACE SWMI |
$89.32
|
| 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
|
|
|
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: Healthscope Commercial |
$29.75
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.40
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: PACE SWMI |
$16.08
|
| 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
|
|
|
PR DENOSUMAB INJECTION
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J0897
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$54.35 |
| 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: Healthscope Commercial |
$47.01
|
| Rate for Payer: Healthscope Commercial |
$54.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: PACE SWMI |
$29.38
|
| 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
|
|
|
PR DEPO-ESTRADIOL CYPIONATE INJ
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J1000
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$91.17 |
| 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: Healthscope Commercial |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$78.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.05
|
| Rate for Payer: Nomi Health Commercial |
$59.14
|
| Rate for Payer: PACE SWMI |
$49.28
|
| 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
|
|
|
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: Healthscope Commercial |
$13.70
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.80
|
| Rate for Payer: Nomi Health Commercial |
$10.27
|
| Rate for Payer: PACE SWMI |
$8.56
|
| 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
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
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 |
$1,330.89 |
| Rate for Payer: Aetna Commercial |
$964.00
|
| Rate for Payer: Aetna Medicare |
$748.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.94
|
| 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: Healthscope Commercial |
$1,330.89
|
| Rate for Payer: Healthscope Commercial |
$1,151.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.90
|
| Rate for Payer: Nomi Health Commercial |
$863.28
|
| Rate for Payer: PACE SWMI |
$719.40
|
| 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
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$447.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$447.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$464.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$430.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$464.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$430.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
|
|
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: Multiplan/Beech St/PHCS Commercial |
$464.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
|
|
PR DERMAL FILLER VOLBELLA
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00092
|
|
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: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
PR DERMAL FILLER VOLBELLA >1
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 00120
|
|
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: Multiplan/Beech St/PHCS Commercial |
$464.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
|
|
PR DESTROY NERVE,CERV SPINAL MUSCLES
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 64613
|
| Min. Negotiated Rate |
$144.40 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Medicare |
$180.50
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
|
|
PR DESTRUCTION BENIGN LESIONS 15/>
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 17111
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$145.74 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$81.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.57
|
| Rate for Payer: BCBS Complete |
$86.80
|
| Rate for Payer: BCBS MAPPO |
$78.78
|
| Rate for Payer: BCN Medicare Advantage |
$78.78
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$113.44
|
| Rate for Payer: Cofinity Commercial |
$105.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.78
|
| Rate for Payer: Healthscope Commercial |
$145.74
|
| Rate for Payer: Healthscope Commercial |
$126.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.05
|
| Rate for Payer: Nomi Health Commercial |
$94.54
|
| Rate for Payer: PACE SWMI |
$78.78
|
| Rate for Payer: PHP Medicare Advantage |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health Medicare |
$78.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.78
|
| Rate for Payer: UHC Medicare Advantage |
$78.78
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
17110
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$155.55
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$128.10
|
| Rate for Payer: Cofinity Commercial |
$157.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$164.70
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.55
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$155.55
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$115.29
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
17110
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$85.91
|
| Rate for Payer: Aetna Medicare |
$66.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.32
|
| Rate for Payer: BCBS Complete |
$73.20
|
| Rate for Payer: BCBS MAPPO |
$64.11
|
| Rate for Payer: BCN Medicare Advantage |
$64.11
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$92.32
|
| Rate for Payer: Cofinity Commercial |
$85.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.11
|
| Rate for Payer: Healthscope Commercial |
$102.58
|
| Rate for Payer: Healthscope Commercial |
$118.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.95
|
| Rate for Payer: Nomi Health Commercial |
$76.93
|
| Rate for Payer: PACE SWMI |
$64.11
|
| Rate for Payer: PHP Medicare Advantage |
$64.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health Medicare |
$64.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.11
|
| Rate for Payer: UHC Medicare Advantage |
$64.11
|
|
