|
PR DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 15620
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Aetna Commercial |
$392.53
|
| Rate for Payer: Aetna Medicare |
$292.93
|
| Rate for Payer: BCBS Complete |
$203.97
|
| Rate for Payer: BCBS MAPPO |
$292.93
|
| Rate for Payer: BCN Commercial |
$496.49
|
| Rate for Payer: BCN Medicare Advantage |
$292.93
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cofinity Commercial |
$421.82
|
| Rate for Payer: Cofinity Commercial |
$392.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.93
|
| Rate for Payer: Healthscope Commercial |
$351.52
|
| Rate for Payer: Healthscope Whirlpool |
$351.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.58
|
| Rate for Payer: Meridian Medicaid |
$203.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$322.22
|
| Rate for Payer: Nomi Health Commercial |
$351.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.50
|
| Rate for Payer: PACE SWMI |
$292.93
|
| Rate for Payer: PHP Medicare Advantage |
$292.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$454.41
|
| Rate for Payer: Priority Health Medicare |
$292.93
|
| Rate for Payer: Priority Health Narrow Network |
$454.41
|
| Rate for Payer: Railroad Medicare Medicare |
$292.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$555.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$292.93
|
| Rate for Payer: UHC Exchange |
$555.03
|
| Rate for Payer: UHC Medicaid |
$194.26
|
| Rate for Payer: UHCCP DNSP |
$292.93
|
| Rate for Payer: UHCCP Medicaid |
$194.26
|
|
|
PR DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 15610
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$301.73
|
| Rate for Payer: Aetna Medicare |
$225.17
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$225.17
|
| Rate for Payer: BCN Commercial |
$372.99
|
| Rate for Payer: BCN Medicare Advantage |
$225.17
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$324.24
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.17
|
| Rate for Payer: Healthscope Commercial |
$270.20
|
| Rate for Payer: Healthscope Whirlpool |
$270.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.43
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$270.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: PACE SWMI |
$225.17
|
| Rate for Payer: PHP Medicare Advantage |
$225.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$341.39
|
| Rate for Payer: Priority Health Medicare |
$225.17
|
| Rate for Payer: Priority Health Narrow Network |
$341.39
|
| Rate for Payer: Railroad Medicare Medicare |
$225.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$225.17
|
| Rate for Payer: UHC Exchange |
$411.67
|
| Rate for Payer: UHC Medicaid |
$150.17
|
| Rate for Payer: UHCCP DNSP |
$225.17
|
| Rate for Payer: UHCCP Medicaid |
$150.17
|
|
|
PR DELAY FLAP/SECTIONING FLAP TRUNK
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 15600
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$408.75 |
| Rate for Payer: Aetna Commercial |
$271.51
|
| Rate for Payer: Aetna Medicare |
$202.62
|
| Rate for Payer: BCBS Complete |
$142.46
|
| Rate for Payer: BCBS MAPPO |
$202.62
|
| Rate for Payer: BCN Commercial |
$320.70
|
| Rate for Payer: BCN Medicare Advantage |
$202.62
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cofinity Commercial |
$291.77
|
| Rate for Payer: Cofinity Commercial |
$271.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.62
|
| Rate for Payer: Healthscope Commercial |
$243.14
|
| Rate for Payer: Healthscope Whirlpool |
$243.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.75
|
| Rate for Payer: Meridian Medicaid |
$142.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$222.88
|
| Rate for Payer: Nomi Health Commercial |
$243.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.75
|
| Rate for Payer: PACE SWMI |
$202.62
|
| Rate for Payer: PHP Medicare Advantage |
$202.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293.52
|
| Rate for Payer: Priority Health Medicare |
$202.62
|
| Rate for Payer: Priority Health Narrow Network |
$293.52
|
| Rate for Payer: Railroad Medicare Medicare |
$202.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$202.62
|
| Rate for Payer: UHC Exchange |
$355.03
|
| Rate for Payer: UHC Medicaid |
$135.68
|
| Rate for Payer: UHCCP DNSP |
$202.62
|
| Rate for Payer: UHCCP Medicaid |
$135.68
|
|
|
PR DELIVERY/BIRTHING ROOM RESUSCITATION
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 99465
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$164.34
|
| Rate for Payer: Aetna Medicare |
$122.64
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS MAPPO |
$122.64
|
| Rate for Payer: BCN Commercial |
$208.65
|
| Rate for Payer: BCN Medicare Advantage |
$122.64
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$176.60
|
| Rate for Payer: Cofinity Commercial |
$164.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.64
|
| Rate for Payer: Healthscope Commercial |
$134.90
|
| Rate for Payer: Healthscope Whirlpool |
$134.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.77
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$134.90
|
| Rate for Payer: Nomi Health Commercial |
$147.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PACE SWMI |
$122.64
|
| Rate for Payer: PHP Medicare Advantage |
$122.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$187.68
|
| Rate for Payer: Priority Health Medicare |
$122.64
|
| Rate for Payer: Priority Health Narrow Network |
$187.68
|
| Rate for Payer: Railroad Medicare Medicare |
$122.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$122.64
|
| Rate for Payer: UHC Exchange |
$207.23
|
| Rate for Payer: UHC Medicaid |
$78.81
|
| Rate for Payer: UHCCP DNSP |
$122.64
|
| Rate for Payer: UHCCP Medicaid |
$78.81
|
|
|
PR DELIVERY PLACENTA SEPARATE PROCEDURE
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 59414
|
| Min. Negotiated Rate |
$79.13 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Aetna Commercial |
$111.62
|
| Rate for Payer: Aetna Medicare |
$83.30
|
| Rate for Payer: BCBS Complete |
$83.09
|
| Rate for Payer: BCBS MAPPO |
$83.30
|
| Rate for Payer: BCN Commercial |
$135.95
|
| Rate for Payer: BCN Medicare Advantage |
$83.30
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$111.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.30
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$99.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.47
|
| Rate for Payer: Meridian Medicaid |
$83.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.63
|
| Rate for Payer: Nomi Health Commercial |
$99.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.25
|
| Rate for Payer: PACE SWMI |
$83.30
|
| Rate for Payer: PHP Medicare Advantage |
$83.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$128.34
|
| Rate for Payer: Priority Health Medicare |
$83.30
|
| Rate for Payer: Priority Health Narrow Network |
$128.34
|
| Rate for Payer: Railroad Medicare Medicare |
$83.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.30
|
| Rate for Payer: UHC Exchange |
$163.75
|
| Rate for Payer: UHC Medicaid |
$79.13
|
| Rate for Payer: UHCCP DNSP |
$83.30
|
| Rate for Payer: UHCCP Medicaid |
$79.13
|
|
|
PR DEMO&/EVAL PT UTILIZ AERSL GEN NEB INHLR/IPPB
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 94664
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Medicare |
$18.44
|
| Rate for Payer: BCBS MAPPO |
$18.44
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$18.44
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$24.71
|
| Rate for Payer: Cofinity Commercial |
$26.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.44
|
| Rate for Payer: Healthscope Commercial |
$22.13
|
| Rate for Payer: Healthscope Whirlpool |
$22.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.28
|
| Rate for Payer: Nomi Health Commercial |
$22.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.50
|
| Rate for Payer: PACE SWMI |
$18.44
|
| Rate for Payer: PHP Medicare Advantage |
$18.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.80
|
| Rate for Payer: Priority Health Medicare |
$18.44
|
| Rate for Payer: Priority Health Narrow Network |
$24.80
|
| Rate for Payer: Railroad Medicare Medicare |
$18.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.44
|
| Rate for Payer: UHC Exchange |
$25.04
|
| Rate for Payer: UHCCP DNSP |
$18.44
|
|
|
PR DENOSUMAB INJECTION
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS J0897
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$42.49 |
| Rate for Payer: Aetna Commercial |
$39.54
|
| Rate for Payer: Aetna Medicare |
$29.51
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS Trust/PPO |
$28.75
|
| Rate for Payer: BCN Commercial |
$26.77
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$42.49
|
| Rate for Payer: Cofinity Commercial |
$39.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Nomi Health Commercial |
$35.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UHCCP DNSP |
$29.51
|
|
|
PR DEPO-ESTRADIOL CYPIONATE INJ
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS J1000
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$74.62 |
| Rate for Payer: Aetna Commercial |
$69.44
|
| Rate for Payer: Aetna Medicare |
$51.82
|
| Rate for Payer: BCBS MAPPO |
$51.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.79
|
| Rate for Payer: BCN Commercial |
$43.12
|
| Rate for Payer: BCN Medicare Advantage |
$51.82
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$74.62
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.82
|
| Rate for Payer: Healthscope Commercial |
$62.18
|
| Rate for Payer: Healthscope Whirlpool |
$62.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.00
|
| Rate for Payer: Nomi Health Commercial |
$62.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.50
|
| Rate for Payer: PACE SWMI |
$51.82
|
| Rate for Payer: PHP Medicare Advantage |
$51.82
|
| Rate for Payer: Priority Health Medicare |
$51.82
|
| Rate for Payer: Railroad Medicare Medicare |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.82
|
| Rate for Payer: UHC Exchange |
$51.82
|
| Rate for Payer: UHCCP DNSP |
$51.82
|
|
|
PR DEPRESSION SCREEN ANNUAL
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS G0444
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: BCN Medicare Advantage |
$7.91
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$11.39
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.91
|
| Rate for Payer: Healthscope Commercial |
$9.49
|
| Rate for Payer: Healthscope Whirlpool |
$9.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.70
|
| Rate for Payer: Nomi Health Commercial |
$9.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
| Rate for Payer: PACE SWMI |
$7.91
|
| Rate for Payer: PHP Medicare Advantage |
$7.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.80
|
| Rate for Payer: Priority Health Medicare |
$7.91
|
| Rate for Payer: Priority Health Narrow Network |
$10.80
|
| Rate for Payer: Railroad Medicare Medicare |
$7.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.91
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHCCP DNSP |
$7.91
|
|
|
PR DERMABRASION SEGMENTAL FACE
|
Professional
|
Both
|
$1,249.00
|
|
|
Service Code
|
HCPCS 15781
|
| Min. Negotiated Rate |
$234.94 |
| Max. Negotiated Rate |
$936.75 |
| Rate for Payer: Aetna Commercial |
$475.37
|
| Rate for Payer: Aetna Medicare |
$354.75
|
| Rate for Payer: BCBS Complete |
$246.69
|
| Rate for Payer: BCBS MAPPO |
$354.75
|
| Rate for Payer: BCN Commercial |
$632.93
|
| Rate for Payer: BCN Medicare Advantage |
$354.75
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Cofinity Commercial |
$510.84
|
| Rate for Payer: Cofinity Commercial |
$475.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.75
|
| Rate for Payer: Healthscope Commercial |
$425.70
|
| Rate for Payer: Healthscope Whirlpool |
$425.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$372.49
|
| Rate for Payer: Meridian Medicaid |
$246.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$390.23
|
| Rate for Payer: Nomi Health Commercial |
$425.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$936.75
|
| Rate for Payer: PACE SWMI |
$354.75
|
| Rate for Payer: PHP Medicare Advantage |
$354.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$579.29
|
| Rate for Payer: Priority Health Medicare |
$354.75
|
| Rate for Payer: Priority Health Narrow Network |
$579.29
|
| Rate for Payer: Railroad Medicare Medicare |
$354.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$354.75
|
| Rate for Payer: UHC Exchange |
$738.26
|
| Rate for Payer: UHC Medicaid |
$234.94
|
| Rate for Payer: UHCCP DNSP |
$354.75
|
| Rate for Payer: UHCCP Medicaid |
$234.94
|
|
|
PR DERMAGRAFT
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS Q4106
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$46.29 |
| Rate for Payer: Aetna Commercial |
$46.29
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCN Commercial |
$33.86
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
|
|
PR DERMAL AUTOGRAFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM
|
Professional
|
Both
|
$1,634.00
|
|
|
Service Code
|
HCPCS 15135
|
| Min. Negotiated Rate |
$429.83 |
| Max. Negotiated Rate |
$1,316.40 |
| Rate for Payer: Aetna Commercial |
$882.04
|
| Rate for Payer: Aetna Medicare |
$658.24
|
| Rate for Payer: BCBS Complete |
$451.32
|
| Rate for Payer: BCBS MAPPO |
$658.24
|
| Rate for Payer: BCN Commercial |
$1,139.88
|
| Rate for Payer: BCN Medicare Advantage |
$658.24
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cofinity Commercial |
$947.87
|
| Rate for Payer: Cofinity Commercial |
$882.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.24
|
| Rate for Payer: Healthscope Commercial |
$789.89
|
| Rate for Payer: Healthscope Whirlpool |
$789.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.15
|
| Rate for Payer: Meridian Medicaid |
$451.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$724.06
|
| Rate for Payer: Nomi Health Commercial |
$789.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,225.50
|
| Rate for Payer: PACE SWMI |
$658.24
|
| Rate for Payer: PHP Medicare Advantage |
$658.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,043.28
|
| Rate for Payer: Priority Health Medicare |
$658.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,043.28
|
| Rate for Payer: Railroad Medicare Medicare |
$658.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,316.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$658.24
|
| Rate for Payer: UHC Exchange |
$1,316.40
|
| Rate for Payer: UHC Medicaid |
$429.83
|
| Rate for Payer: UHCCP DNSP |
$658.24
|
| Rate for Payer: UHCCP Medicaid |
$429.83
|
|
|
PR DERMAL FILLER JUVEDERM ULTRA
|
Professional
|
Both
|
$773.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$579.75 |
| Rate for Payer: BCBS Complete |
$309.20
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$579.75
|
|
|
PR DERMAL FILLER JUVEDERM ULTRA PR PLUS
|
Professional
|
Both
|
$420.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
|
|
PR DERMAL FILLER JUVEDERM VOLLURE
|
Professional
|
Both
|
$876.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: BCBS Complete |
$350.40
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.00
|
|
|
PR DERMAL FILLER JUVEDERM VOLUMA
|
Professional
|
Both
|
$927.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: BCBS Complete |
$370.80
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.25
|
|
|
PR DERMAL FILLER RESTYLANE 1/2 UNIT
|
Professional
|
Both
|
$420.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
|
|
PR DERMAL FILLER RESTYLANE 1 UNIT
|
Professional
|
Both
|
$773.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$579.75 |
| Rate for Payer: BCBS Complete |
$309.20
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$579.75
|
|
|
PR DERMAL FILLER VOLBELLA
|
Professional
|
Both
|
$515.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$386.25 |
| Rate for Payer: BCBS Complete |
$206.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$386.25
|
|
|
PR DERMAL FILLER VOLBELLA >1
|
Professional
|
Both
|
$876.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: BCBS Complete |
$350.40
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.00
|
|
|
PR DESTROY NERVE,CERV SPINAL MUSCLES
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 64613
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: BCBS Complete |
$148.80
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.00
|
|
|
PR DESTRUCTION BENIGN LESIONS 15/>
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 17111
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$94.78
|
| Rate for Payer: Aetna Medicare |
$70.73
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS MAPPO |
$70.73
|
| Rate for Payer: BCN Commercial |
$100.14
|
| Rate for Payer: BCN Medicare Advantage |
$70.73
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$94.78
|
| Rate for Payer: Cofinity Commercial |
$101.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.73
|
| Rate for Payer: Healthscope Commercial |
$84.88
|
| Rate for Payer: Healthscope Whirlpool |
$84.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.27
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.80
|
| Rate for Payer: Nomi Health Commercial |
$84.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.00
|
| Rate for Payer: PACE SWMI |
$70.73
|
| Rate for Payer: PHP Medicare Advantage |
$70.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$116.22
|
| Rate for Payer: Priority Health Medicare |
$70.73
|
| Rate for Payer: Priority Health Narrow Network |
$116.22
|
| Rate for Payer: Railroad Medicare Medicare |
$70.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.73
|
| Rate for Payer: UHC Exchange |
$140.10
|
| Rate for Payer: UHC Medicaid |
$47.07
|
| Rate for Payer: UHCCP DNSP |
$70.73
|
| Rate for Payer: UHCCP Medicaid |
$47.07
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
17110
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Trust/PPO |
$154.39
|
| Rate for Payer: BCN Commercial |
$154.39
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
17110
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$249.89 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$155.01
|
| Rate for Payer: BCN Commercial |
$155.01
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.55
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$122.04
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 17110
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$79.74
|
| Rate for Payer: Aetna Medicare |
$59.51
|
| Rate for Payer: BCBS Complete |
$41.82
|
| Rate for Payer: BCBS MAPPO |
$59.51
|
| Rate for Payer: BCN Commercial |
$82.07
|
| Rate for Payer: BCN Medicare Advantage |
$59.51
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$85.69
|
| Rate for Payer: Cofinity Commercial |
$79.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.51
|
| Rate for Payer: Healthscope Commercial |
$71.41
|
| Rate for Payer: Healthscope Whirlpool |
$71.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.49
|
| Rate for Payer: Meridian Medicaid |
$41.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.46
|
| Rate for Payer: Nomi Health Commercial |
$71.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PACE SWMI |
$59.51
|
| Rate for Payer: PHP Medicare Advantage |
$59.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.25
|
| Rate for Payer: Priority Health Medicare |
$59.51
|
| Rate for Payer: Priority Health Narrow Network |
$95.25
|
| Rate for Payer: Railroad Medicare Medicare |
$59.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.51
|
| Rate for Payer: UHC Exchange |
$113.90
|
| Rate for Payer: UHC Medicaid |
$39.83
|
| Rate for Payer: UHCCP DNSP |
$59.51
|
| Rate for Payer: UHCCP Medicaid |
$39.83
|
|
