|
PR DENOSUMAB INJECTION
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J0897
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$2,422.00 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna Medicare |
$30.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.10
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$29.24
|
| Rate for Payer: BCBS Trust/PPO |
$24.59
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: BCN Medicare Advantage |
$29.24
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$39.18
|
| Rate for Payer: Cofinity Commercial |
$42.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.24
|
| Rate for Payer: Healthscope Commercial |
$54.09
|
| Rate for Payer: Healthscope Commercial |
$46.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,422.00
|
| Rate for Payer: Nomi Health Commercial |
$35.08
|
| Rate for Payer: PACE SWMI |
$29.24
|
| Rate for Payer: PHP Medicare Advantage |
$29.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$29.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.24
|
| Rate for Payer: UHC Exchange |
$29.32
|
| Rate for Payer: UHC Medicare Advantage |
$29.24
|
|
|
PR DEPO-ESTRADIOL CYPIONATE INJ
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J1000
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$3,267.00 |
| Rate for Payer: Aetna Commercial |
$62.86
|
| Rate for Payer: Aetna Medicare |
$48.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.55
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$46.91
|
| Rate for Payer: BCBS Trust/PPO |
$36.42
|
| Rate for Payer: BCN Commercial |
$29.80
|
| Rate for Payer: BCN Medicare Advantage |
$46.91
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$62.86
|
| Rate for Payer: Cofinity Commercial |
$67.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.91
|
| Rate for Payer: Healthscope Commercial |
$86.79
|
| Rate for Payer: Healthscope Commercial |
$75.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,267.00
|
| Rate for Payer: Nomi Health Commercial |
$56.29
|
| Rate for Payer: PACE SWMI |
$46.91
|
| Rate for Payer: PHP Medicare Advantage |
$46.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Medicare |
$46.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.91
|
| Rate for Payer: UHC Exchange |
$40.97
|
| Rate for Payer: UHC Medicare Advantage |
$46.91
|
|
|
PR DEPRESSION SCREEN ANNUAL
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0444
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.33
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$8.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,280.07
|
| Rate for Payer: BCN Commercial |
$26.88
|
| 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 |
$1,340.00
|
| 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 HMO/PPO/Tiered Network |
$10.80
|
| Rate for Payer: Priority Health Medicare |
$8.56
|
| Rate for Payer: Priority Health Narrow Network |
$10.80
|
| Rate for Payer: Priority Health SBD |
$10.80
|
| 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 |
$2,783.00 |
| Rate for Payer: Aetna Commercial |
$46.29
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.29
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$281.06
|
| Rate for Payer: BCN Commercial |
$33.86
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,783.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.00
|
| Rate for Payer: UHC Exchange |
$54.00
|
|
|
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 |
$116.11 |
| Max. Negotiated Rate |
$133,576.00 |
| 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 |
$511.94
|
| Rate for Payer: BCBS MAPPO |
$719.40
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: BCN Commercial |
$1,287.66
|
| 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 |
$964.00
|
| Rate for Payer: Cofinity Commercial |
$1,035.94
|
| 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: Mclaren Medicaid |
$487.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.37
|
| Rate for Payer: Meridian Medicaid |
$511.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133,576.00
|
| 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 Choice Medicaid |
$487.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,026.29
|
| Rate for Payer: Priority Health Medicare |
$719.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,026.29
|
| Rate for Payer: Priority Health SBD |
$1,026.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$863.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.40
|
| Rate for Payer: UHC Exchange |
$863.08
|
| Rate for Payer: UHC Medicare Advantage |
$719.40
|
| Rate for Payer: UHCCP Medicaid |
$487.56
|
|
|
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: 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 |
$5,000.00 |
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.00
|
| 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 |
$54.32 |
| Max. Negotiated Rate |
$14,242.00 |
| 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 |
$57.04
|
| Rate for Payer: BCBS MAPPO |
$78.78
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$156.28
|
| 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 |
$126.05
|
| Rate for Payer: Healthscope Commercial |
$145.74
|
| Rate for Payer: Mclaren Medicaid |
$54.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.72
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,242.00
|
| 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 Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.33
|
| Rate for Payer: Priority Health Medicare |
$78.78
|
| Rate for Payer: Priority Health Narrow Network |
$113.33
|
| Rate for Payer: Priority Health SBD |
$113.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.78
|
| Rate for Payer: UHC Exchange |
$104.88
|
| Rate for Payer: UHC Medicare Advantage |
$78.78
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
17110
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$11,565.00 |
| 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 |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$64.11
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.00
|
| Rate for Payer: BCN Commercial |
$133.89
|
| 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 |
$118.60
|
| Rate for Payer: Healthscope Commercial |
$102.58
|
| Rate for Payer: Mclaren Medicaid |
$44.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.32
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,565.00
|
| 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 Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.47
|
| Rate for Payer: Priority Health Medicare |
$64.11
|
| Rate for Payer: Priority Health Narrow Network |
$93.47
|
| Rate for Payer: Priority Health SBD |
$93.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.11
|
| Rate for Payer: UHC Exchange |
$92.22
|
| Rate for Payer: UHC Medicare Advantage |
$64.11
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
|
|
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 |
$59.92 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$155.55
|
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$59.92
|
| Rate for Payer: BCN Commercial |
$59.92
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$146.40
|
| 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 |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$164.70
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.55
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$155.55
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Priority Health SBD |
$115.29
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.83
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 17110
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$11,565.00 |
| 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 |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$64.11
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.00
|
| Rate for Payer: BCN Commercial |
$133.89
|
| 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 |
$118.60
|
| Rate for Payer: Healthscope Commercial |
$102.58
|
| Rate for Payer: Mclaren Medicaid |
$44.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.32
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,565.00
|
| 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 Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.47
|
| Rate for Payer: Priority Health Medicare |
$64.11
|
| Rate for Payer: Priority Health Narrow Network |
$93.47
|
| Rate for Payer: Priority Health SBD |
$93.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.11
|
| Rate for Payer: UHC Exchange |
$92.22
|
| Rate for Payer: UHC Medicare Advantage |
$64.11
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
17110
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$115.29 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Aetna Commercial |
$155.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.95
|
| 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: Healthscope Commercial |
$164.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.55
|
| Rate for Payer: PHP Commercial |
$155.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health SBD |
$115.29
|
|
|
PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
17106
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$396.90 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
|
|
PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
17106
|
| Min. Negotiated Rate |
$178.71 |
| Max. Negotiated Rate |
$48,047.00 |
| Rate for Payer: Aetna Commercial |
$350.53
|
| Rate for Payer: Aetna Medicare |
$272.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.69
|
| Rate for Payer: BCBS Complete |
$187.65
|
| Rate for Payer: BCBS MAPPO |
$261.59
|
| Rate for Payer: BCBS Trust/PPO |
$947.65
|
| Rate for Payer: BCN Commercial |
$403.66
|
| Rate for Payer: BCN Medicare Advantage |
$261.59
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$376.69
|
| Rate for Payer: Cofinity Commercial |
$350.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.59
|
| Rate for Payer: Healthscope Commercial |
$483.94
|
| Rate for Payer: Healthscope Commercial |
$418.54
|
| Rate for Payer: Mclaren Medicaid |
$178.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.67
|
| Rate for Payer: Meridian Medicaid |
$187.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48,047.00
|
| Rate for Payer: Nomi Health Commercial |
$313.91
|
| Rate for Payer: PACE SWMI |
$261.59
|
| Rate for Payer: PHP Medicare Advantage |
$261.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.21
|
| Rate for Payer: Priority Health Medicare |
$261.59
|
| Rate for Payer: Priority Health Narrow Network |
$375.21
|
| Rate for Payer: Priority Health SBD |
$375.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$261.59
|
| Rate for Payer: UHC Exchange |
$387.46
|
| Rate for Payer: UHC Medicare Advantage |
$261.59
|
| Rate for Payer: UHCCP Medicaid |
$178.71
|
|
