|
PR DSTRJ LESION ANUS SMPL ELTRDSICCATION
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 46910
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$23,677.00 |
| Rate for Payer: Aetna Commercial |
$172.16
|
| Rate for Payer: Aetna Medicare |
$133.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.01
|
| Rate for Payer: BCBS Complete |
$91.48
|
| Rate for Payer: BCBS MAPPO |
$128.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,583.92
|
| Rate for Payer: BCN Commercial |
$387.03
|
| Rate for Payer: BCN Medicare Advantage |
$128.48
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cofinity Commercial |
$185.01
|
| Rate for Payer: Cofinity Commercial |
$172.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.48
|
| Rate for Payer: Healthscope Commercial |
$237.69
|
| Rate for Payer: Healthscope Commercial |
$205.57
|
| Rate for Payer: Mclaren Medicaid |
$87.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.90
|
| Rate for Payer: Meridian Medicaid |
$91.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,677.00
|
| Rate for Payer: Nomi Health Commercial |
$154.18
|
| Rate for Payer: PACE SWMI |
$128.48
|
| Rate for Payer: PHP Medicare Advantage |
$128.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.01
|
| Rate for Payer: Priority Health Medicare |
$128.48
|
| Rate for Payer: Priority Health Narrow Network |
$244.01
|
| Rate for Payer: Priority Health SBD |
$244.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.48
|
| Rate for Payer: UHC Exchange |
$229.99
|
| Rate for Payer: UHC Medicare Advantage |
$128.48
|
| Rate for Payer: UHCCP Medicaid |
$87.12
|
|
|
PR DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 42160
|
| Min. Negotiated Rate |
$90.31 |
| Max. Negotiated Rate |
$25,150.00 |
| Rate for Payer: Aetna Commercial |
$177.05
|
| Rate for Payer: Aetna Medicare |
$137.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.27
|
| Rate for Payer: BCBS Complete |
$94.83
|
| Rate for Payer: BCBS MAPPO |
$132.13
|
| Rate for Payer: BCBS Trust/PPO |
$264.46
|
| Rate for Payer: BCN Commercial |
$342.56
|
| Rate for Payer: BCN Medicare Advantage |
$132.13
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$190.27
|
| Rate for Payer: Cofinity Commercial |
$177.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$244.44
|
| Rate for Payer: Healthscope Commercial |
$211.41
|
| Rate for Payer: Mclaren Medicaid |
$90.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.74
|
| Rate for Payer: Meridian Medicaid |
$94.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,150.00
|
| Rate for Payer: Nomi Health Commercial |
$158.56
|
| Rate for Payer: PACE SWMI |
$132.13
|
| Rate for Payer: PHP Medicare Advantage |
$132.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.55
|
| Rate for Payer: Priority Health Medicare |
$132.13
|
| Rate for Payer: Priority Health Narrow Network |
$253.55
|
| Rate for Payer: Priority Health SBD |
$253.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.13
|
| Rate for Payer: UHC Exchange |
$219.65
|
| Rate for Payer: UHC Medicare Advantage |
$132.13
|
| Rate for Payer: UHCCP Medicaid |
$90.31
|
|
|
PR DSTRJ LESION PENIS EXTENSIVE
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 54065
|
| Min. Negotiated Rate |
$112.25 |
| Max. Negotiated Rate |
$29,943.00 |
| Rate for Payer: Aetna Commercial |
$220.68
|
| Rate for Payer: Aetna Medicare |
$171.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.15
|
| Rate for Payer: BCBS Complete |
$117.86
|
| Rate for Payer: BCBS MAPPO |
$164.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,527.84
|
| Rate for Payer: BCN Commercial |
$324.48
|
| Rate for Payer: BCN Medicare Advantage |
$164.69
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$237.15
|
| Rate for Payer: Cofinity Commercial |
$220.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.69
|
| Rate for Payer: Healthscope Commercial |
$304.68
|
| Rate for Payer: Healthscope Commercial |
$263.50
|
| Rate for Payer: Mclaren Medicaid |
$112.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.92
|
| Rate for Payer: Meridian Medicaid |
$117.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,943.00
|
| Rate for Payer: Nomi Health Commercial |
$197.63
|
| Rate for Payer: PACE SWMI |
$164.69
|
| Rate for Payer: PHP Medicare Advantage |
$164.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.36
|
| Rate for Payer: Priority Health Medicare |
$164.69
|
| Rate for Payer: Priority Health Narrow Network |
$275.36
|
| Rate for Payer: Priority Health SBD |
$275.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.69
|
| Rate for Payer: UHC Exchange |
$321.14
|
| Rate for Payer: UHC Medicare Advantage |
$164.69
|
| Rate for Payer: UHCCP Medicaid |
$112.25
|
|
|
PR DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 54050
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$18,598.00 |
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna Medicare |
$105.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.06
|
| Rate for Payer: BCBS Complete |
$73.13
|
| Rate for Payer: BCBS MAPPO |
$101.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.67
|
| Rate for Payer: BCN Commercial |
$211.11
|
| Rate for Payer: BCN Medicare Advantage |
$101.43
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$146.06
|
| Rate for Payer: Cofinity Commercial |
$135.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.43
|
| Rate for Payer: Healthscope Commercial |
$187.65
|
| Rate for Payer: Healthscope Commercial |
$162.29
|
| Rate for Payer: Mclaren Medicaid |
$69.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.50
|
| Rate for Payer: Meridian Medicaid |
$73.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,598.00
|
| Rate for Payer: Nomi Health Commercial |
$121.72
|
| Rate for Payer: PACE SWMI |
$101.43
|
| Rate for Payer: PHP Medicare Advantage |
$101.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.03
|
| Rate for Payer: Priority Health Medicare |
$101.43
|
| Rate for Payer: Priority Health Narrow Network |
$172.03
|
| Rate for Payer: Priority Health SBD |
$172.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.43
|
| Rate for Payer: UHC Exchange |
$167.27
|
| Rate for Payer: UHC Medicare Advantage |
$101.43
|
| Rate for Payer: UHCCP Medicaid |
$69.65
|
|
|
PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 54056
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$19,291.00 |
| Rate for Payer: Aetna Commercial |
$142.51
|
| Rate for Payer: Aetna Medicare |
$110.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.14
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: BCBS MAPPO |
$106.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.45
|
| Rate for Payer: BCN Commercial |
$169.24
|
| Rate for Payer: BCN Medicare Advantage |
$106.35
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$153.14
|
| Rate for Payer: Cofinity Commercial |
$142.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.35
|
| Rate for Payer: Healthscope Commercial |
$196.75
|
| Rate for Payer: Healthscope Commercial |
$170.16
|
| Rate for Payer: Mclaren Medicaid |
$73.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.67
|
| Rate for Payer: Meridian Medicaid |
$76.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,291.00
|
| Rate for Payer: Nomi Health Commercial |
$127.62
|
| Rate for Payer: PACE SWMI |
$106.35
|
| Rate for Payer: PHP Medicare Advantage |
$106.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.02
|
| Rate for Payer: Priority Health Medicare |
$106.35
|
| Rate for Payer: Priority Health Narrow Network |
$180.02
|
| Rate for Payer: Priority Health SBD |
$180.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.35
|
| Rate for Payer: UHC Exchange |
$180.09
|
| Rate for Payer: UHC Medicare Advantage |
$106.35
|
| Rate for Payer: UHCCP Medicaid |
$73.27
|
|
|
PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 54055
|
| Min. Negotiated Rate |
$62.84 |
| Max. Negotiated Rate |
$16,742.00 |
| Rate for Payer: Aetna Commercial |
$123.01
|
| Rate for Payer: Aetna Medicare |
$95.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.19
|
| Rate for Payer: BCBS Complete |
$65.98
|
| Rate for Payer: BCBS MAPPO |
$91.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: BCN Commercial |
$201.34
|
| Rate for Payer: BCN Medicare Advantage |
$91.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.80
|
| Rate for Payer: Healthscope Commercial |
$169.83
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Mclaren Medicaid |
$62.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.39
|
| Rate for Payer: Meridian Medicaid |
$65.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,742.00
|
| Rate for Payer: Nomi Health Commercial |
$110.16
|
| Rate for Payer: PACE SWMI |
$91.80
|
| Rate for Payer: PHP Medicare Advantage |
$91.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.45
|
| Rate for Payer: Priority Health Medicare |
$91.80
|
| Rate for Payer: Priority Health Narrow Network |
$154.45
|
| Rate for Payer: Priority Health SBD |
$154.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.80
|
| Rate for Payer: UHC Exchange |
$238.22
|
| Rate for Payer: UHC Medicare Advantage |
$91.80
|
| Rate for Payer: UHCCP Medicaid |
$62.84
|
|
|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$17,098.00 |
| Rate for Payer: Aetna Commercial |
$122.49
|
| Rate for Payer: Aetna Medicare |
$95.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.63
|
| Rate for Payer: BCBS Complete |
$65.53
|
| Rate for Payer: BCBS MAPPO |
$91.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.41
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Medicare Advantage |
$91.41
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$131.63
|
| Rate for Payer: Cofinity Commercial |
$122.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.41
|
| Rate for Payer: Healthscope Commercial |
$169.11
|
| Rate for Payer: Healthscope Commercial |
$146.26
|
| Rate for Payer: Mclaren Medicaid |
$62.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.98
|
| Rate for Payer: Meridian Medicaid |
$65.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,098.00
|
| Rate for Payer: Nomi Health Commercial |
$109.69
|
| Rate for Payer: PACE SWMI |
$91.41
|
| Rate for Payer: PHP Medicare Advantage |
$91.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.65
|
| Rate for Payer: Priority Health Medicare |
$91.41
|
| Rate for Payer: Priority Health Narrow Network |
$157.65
|
| Rate for Payer: Priority Health SBD |
$157.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.41
|
| Rate for Payer: UHC Exchange |
$180.23
|
| Rate for Payer: UHC Medicare Advantage |
$91.41
|
| Rate for Payer: UHCCP Medicaid |
$62.41
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$22,923.00 |
| Rate for Payer: Aetna Commercial |
$168.71
|
| Rate for Payer: Aetna Medicare |
$130.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.30
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: BCBS MAPPO |
$125.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.39
|
| Rate for Payer: BCN Commercial |
$284.41
|
| Rate for Payer: BCN Medicare Advantage |
$125.90
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$181.30
|
| Rate for Payer: Cofinity Commercial |
$168.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.90
|
| Rate for Payer: Healthscope Commercial |
$232.92
|
| Rate for Payer: Healthscope Commercial |
$201.44
|
| Rate for Payer: Mclaren Medicaid |
$85.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.20
|
| Rate for Payer: Meridian Medicaid |
$89.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,923.00
|
| Rate for Payer: Nomi Health Commercial |
$151.08
|
| Rate for Payer: PACE SWMI |
$125.90
|
| Rate for Payer: PHP Medicare Advantage |
$125.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.44
|
| Rate for Payer: Priority Health Medicare |
$125.90
|
| Rate for Payer: Priority Health Narrow Network |
$211.44
|
| Rate for Payer: Priority Health SBD |
$211.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.90
|
| Rate for Payer: UHC Exchange |
$283.42
|
| Rate for Payer: UHC Medicare Advantage |
$125.90
|
| Rate for Payer: UHCCP Medicaid |
$85.41
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$28,541.00 |
| Rate for Payer: Aetna Commercial |
$203.12
|
| Rate for Payer: Aetna Medicare |
$157.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.28
|
| Rate for Payer: BCBS Complete |
$111.15
|
| Rate for Payer: BCBS MAPPO |
$151.58
|
| Rate for Payer: BCBS Trust/PPO |
$963.62
|
| Rate for Payer: BCN Commercial |
$380.68
|
| Rate for Payer: BCN Medicare Advantage |
$151.58
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cofinity Commercial |
$218.28
|
| Rate for Payer: Cofinity Commercial |
$203.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.58
|
| Rate for Payer: Healthscope Commercial |
$280.42
|
| Rate for Payer: Healthscope Commercial |
$242.53
|
| Rate for Payer: Mclaren Medicaid |
$105.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.16
|
| Rate for Payer: Meridian Medicaid |
$111.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,541.00
|
| Rate for Payer: Nomi Health Commercial |
$181.90
|
| Rate for Payer: PACE SWMI |
$151.58
|
| Rate for Payer: PHP Medicare Advantage |
$151.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.89
|
| Rate for Payer: Priority Health Medicare |
$151.58
|
| Rate for Payer: Priority Health Narrow Network |
$298.89
|
| Rate for Payer: Priority Health SBD |
$298.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.58
|
| Rate for Payer: UHC Exchange |
$161.08
|
| Rate for Payer: UHC Medicare Advantage |
$151.58
|
| Rate for Payer: UHCCP Medicaid |
$105.86
|
|
|
PR DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 17276
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$35,402.00 |
| Rate for Payer: Aetna Commercial |
$257.11
|
| Rate for Payer: Aetna Medicare |
$199.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.29
|
| Rate for Payer: BCBS Complete |
$136.21
|
| Rate for Payer: BCBS MAPPO |
$191.87
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$334.54
|
| Rate for Payer: BCN Medicare Advantage |
$191.87
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cofinity Commercial |
$276.29
|
| Rate for Payer: Cofinity Commercial |
$257.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.87
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Healthscope Commercial |
$306.99
|
| Rate for Payer: Mclaren Medicaid |
$129.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.46
|
| Rate for Payer: Meridian Medicaid |
$136.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,402.00
|
| Rate for Payer: Nomi Health Commercial |
$230.24
|
| Rate for Payer: PACE SWMI |
$191.87
|
| Rate for Payer: PHP Medicare Advantage |
$191.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.26
|
| Rate for Payer: Priority Health Medicare |
$191.87
|
| Rate for Payer: Priority Health Narrow Network |
$272.26
|
| Rate for Payer: Priority Health SBD |
$272.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.87
|
| Rate for Payer: UHC Exchange |
$265.17
|
| Rate for Payer: UHC Medicare Advantage |
$191.87
|
| Rate for Payer: UHCCP Medicaid |
$129.72
|
|
|
PR DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR
|
Professional
|
Both
|
$1,212.00
|
|
|
Service Code
|
HCPCS 64610
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$86,787.00 |
| Rate for Payer: Aetna Commercial |
$629.21
|
| Rate for Payer: Aetna Medicare |
$488.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.17
|
| Rate for Payer: BCBS Complete |
$326.31
|
| Rate for Payer: BCBS MAPPO |
$469.56
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: BCN Commercial |
$1,151.81
|
| Rate for Payer: BCN Medicare Advantage |
$469.56
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cofinity Commercial |
$676.17
|
| Rate for Payer: Cofinity Commercial |
$629.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$469.56
|
| Rate for Payer: Healthscope Commercial |
$868.69
|
| Rate for Payer: Healthscope Commercial |
$751.30
|
| Rate for Payer: Mclaren Medicaid |
$310.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.04
|
| Rate for Payer: Meridian Medicaid |
$326.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86,787.00
|
| Rate for Payer: Nomi Health Commercial |
$563.47
|
| Rate for Payer: PACE SWMI |
$469.56
|
| Rate for Payer: PHP Medicare Advantage |
$469.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.35
|
| Rate for Payer: Priority Health Medicare |
$469.56
|
| Rate for Payer: Priority Health Narrow Network |
$826.35
|
| Rate for Payer: Priority Health SBD |
$826.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$469.56
|
| Rate for Payer: UHC Exchange |
$648.68
|
| Rate for Payer: UHC Medicare Advantage |
$469.56
|
| Rate for Payer: UHCCP Medicaid |
$310.77
|
|
|
PR DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 64620
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$31,140.00 |
| Rate for Payer: Aetna Commercial |
$227.56
|
| Rate for Payer: Aetna Medicare |
$176.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.54
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS MAPPO |
$169.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$304.45
|
| Rate for Payer: BCN Medicare Advantage |
$169.82
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Cofinity Commercial |
$227.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.82
|
| Rate for Payer: Healthscope Commercial |
$314.17
|
| Rate for Payer: Healthscope Commercial |
$271.71
|
| Rate for Payer: Mclaren Medicaid |
$114.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.31
|
| Rate for Payer: Meridian Medicaid |
$120.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,140.00
|
| Rate for Payer: Nomi Health Commercial |
$203.78
|
| Rate for Payer: PACE SWMI |
$169.82
|
| Rate for Payer: PHP Medicare Advantage |
$169.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.56
|
| Rate for Payer: Priority Health Medicare |
$169.82
|
| Rate for Payer: Priority Health Narrow Network |
$302.56
|
| Rate for Payer: Priority Health SBD |
$302.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.82
|
| Rate for Payer: UHC Exchange |
$374.33
|
| Rate for Payer: UHC Medicare Advantage |
$169.82
|
| Rate for Payer: UHCCP Medicaid |
$114.59
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 64640
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$20,714.00 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.38
|
| Rate for Payer: BCBS Complete |
$80.97
|
| Rate for Payer: BCBS MAPPO |
$114.15
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$360.16
|
| Rate for Payer: BCN Medicare Advantage |
$114.15
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$164.38
|
| Rate for Payer: Cofinity Commercial |
$152.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.15
|
| Rate for Payer: Healthscope Commercial |
$211.18
|
| Rate for Payer: Healthscope Commercial |
$182.64
|
| Rate for Payer: Mclaren Medicaid |
$77.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.86
|
| Rate for Payer: Meridian Medicaid |
$80.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,714.00
|
| Rate for Payer: Nomi Health Commercial |
$136.98
|
| Rate for Payer: PACE SWMI |
$114.15
|
| Rate for Payer: PHP Medicare Advantage |
$114.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.46
|
| Rate for Payer: Priority Health Medicare |
$114.15
|
| Rate for Payer: Priority Health Narrow Network |
$202.46
|
| Rate for Payer: Priority Health SBD |
$202.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.15
|
| Rate for Payer: UHC Exchange |
$390.37
|
| Rate for Payer: UHC Medicare Advantage |
$114.15
|
| Rate for Payer: UHCCP Medicaid |
$77.11
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$20,714.00 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.38
|
| Rate for Payer: BCBS Complete |
$80.97
|
| Rate for Payer: BCBS MAPPO |
$114.15
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$360.16
|
| Rate for Payer: BCN Medicare Advantage |
$114.15
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$164.38
|
| Rate for Payer: Cofinity Commercial |
$152.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.15
|
| Rate for Payer: Healthscope Commercial |
$211.18
|
| Rate for Payer: Healthscope Commercial |
$182.64
|
| Rate for Payer: Mclaren Medicaid |
$77.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.86
|
| Rate for Payer: Meridian Medicaid |
$80.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,714.00
|
| Rate for Payer: Nomi Health Commercial |
$136.98
|
| Rate for Payer: PACE SWMI |
$114.15
|
| Rate for Payer: PHP Medicare Advantage |
$114.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.46
|
| Rate for Payer: Priority Health Medicare |
$114.15
|
| Rate for Payer: Priority Health Narrow Network |
$202.46
|
| Rate for Payer: Priority Health SBD |
$202.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.15
|
| Rate for Payer: UHC Exchange |
$390.37
|
| Rate for Payer: UHC Medicare Advantage |
$114.15
|
| Rate for Payer: UHCCP Medicaid |
$77.11
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$65.95 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$65.95
|
| Rate for Payer: BCN Commercial |
$65.95
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$522.88
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$425.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$547.20
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.80
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$516.80
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$383.04
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.15
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$383.04 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.20
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$522.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$425.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.40
|
| Rate for Payer: Healthscope Commercial |
$547.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.80
|
| Rate for Payer: PHP Commercial |
$516.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health SBD |
$383.04
|
|
|
PR DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 64632
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$11,770.00 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Aetna Medicare |
$67.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.88
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCBS MAPPO |
$64.50
|
| Rate for Payer: BCN Commercial |
$130.96
|
| Rate for Payer: BCN Medicare Advantage |
$64.50
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Cofinity Commercial |
$86.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$119.32
|
| Rate for Payer: Healthscope Commercial |
$103.20
|
| Rate for Payer: Mclaren Medicaid |
$43.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.72
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,770.00
|
| Rate for Payer: Nomi Health Commercial |
$77.40
|
| Rate for Payer: PACE SWMI |
$64.50
|
| Rate for Payer: PHP Medicare Advantage |
$64.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.32
|
| Rate for Payer: Priority Health Medicare |
$64.50
|
| Rate for Payer: Priority Health Narrow Network |
$114.32
|
| Rate for Payer: Priority Health SBD |
$114.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: UHCCP Medicaid |
$43.45
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$28,328.00 |
| Rate for Payer: Aetna Commercial |
$204.87
|
| Rate for Payer: Aetna Medicare |
$159.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.87
|
| Rate for Payer: BCBS Complete |
$108.48
|
| Rate for Payer: BCBS MAPPO |
$152.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$152.89
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Cofinity Commercial |
$204.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.89
|
| Rate for Payer: Healthscope Commercial |
$244.62
|
| Rate for Payer: Healthscope Commercial |
$282.85
|
| Rate for Payer: Mclaren Medicaid |
$103.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.53
|
| Rate for Payer: Meridian Medicaid |
$108.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,328.00
|
| Rate for Payer: Nomi Health Commercial |
$183.47
|
| Rate for Payer: PACE SWMI |
$152.89
|
| Rate for Payer: PHP Medicare Advantage |
$152.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.42
|
| Rate for Payer: Priority Health Medicare |
$152.89
|
| Rate for Payer: Priority Health Narrow Network |
$272.42
|
| Rate for Payer: Priority Health SBD |
$272.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.89
|
| Rate for Payer: UHC Exchange |
$409.34
|
| Rate for Payer: UHC Medicare Advantage |
$152.89
|
| Rate for Payer: UHCCP Medicaid |
$103.31
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$39,055.00 |
| Rate for Payer: Aetna Commercial |
$281.60
|
| Rate for Payer: Aetna Medicare |
$218.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.62
|
| Rate for Payer: BCBS Complete |
$148.73
|
| Rate for Payer: BCBS MAPPO |
$210.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: BCN Medicare Advantage |
$210.15
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$302.62
|
| Rate for Payer: Cofinity Commercial |
$281.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.15
|
| Rate for Payer: Healthscope Commercial |
$388.78
|
| Rate for Payer: Healthscope Commercial |
$336.24
|
| Rate for Payer: Mclaren Medicaid |
$141.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.66
|
| Rate for Payer: Meridian Medicaid |
$148.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,055.00
|
| Rate for Payer: Nomi Health Commercial |
$252.18
|
| Rate for Payer: PACE SWMI |
$210.15
|
| Rate for Payer: PHP Medicare Advantage |
$210.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.79
|
| Rate for Payer: Priority Health Medicare |
$210.15
|
| Rate for Payer: Priority Health Narrow Network |
$370.79
|
| Rate for Payer: Priority Health SBD |
$370.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.15
|
| Rate for Payer: UHC Exchange |
$514.74
|
| Rate for Payer: UHC Medicare Advantage |
$210.15
|
| Rate for Payer: UHCCP Medicaid |
$141.65
|
|
|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$41,017.00 |
| Rate for Payer: Aetna Commercial |
$310.87
|
| Rate for Payer: Aetna Medicare |
$241.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.07
|
| Rate for Payer: BCBS Complete |
$163.04
|
| Rate for Payer: BCBS MAPPO |
$231.99
|
| Rate for Payer: BCBS Trust/PPO |
$3,486.25
|
| Rate for Payer: BCN Commercial |
$682.69
|
| Rate for Payer: BCN Medicare Advantage |
$231.99
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cofinity Commercial |
$334.07
|
| Rate for Payer: Cofinity Commercial |
$310.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.99
|
| Rate for Payer: Healthscope Commercial |
$429.18
|
| Rate for Payer: Healthscope Commercial |
$371.18
|
| Rate for Payer: Mclaren Medicaid |
$155.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.59
|
| Rate for Payer: Meridian Medicaid |
$163.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,017.00
|
| Rate for Payer: Nomi Health Commercial |
$278.39
|
| Rate for Payer: PACE SWMI |
$231.99
|
| Rate for Payer: PHP Medicare Advantage |
$231.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.64
|
| Rate for Payer: Priority Health Medicare |
$231.99
|
| Rate for Payer: Priority Health Narrow Network |
$406.64
|
| Rate for Payer: Priority Health SBD |
$406.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.99
|
| Rate for Payer: UHC Exchange |
$528.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.99
|
| Rate for Payer: UHCCP Medicaid |
$155.28
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$11,785.00 |
| Rate for Payer: Aetna Commercial |
$85.55
|
| Rate for Payer: Aetna Medicare |
$66.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.93
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: BCBS MAPPO |
$63.84
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: BCN Medicare Advantage |
$63.84
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Cofinity Commercial |
$85.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.84
|
| Rate for Payer: Healthscope Commercial |
$102.14
|
| Rate for Payer: Healthscope Commercial |
$118.10
|
| Rate for Payer: Mclaren Medicaid |
$42.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.03
|
| Rate for Payer: Meridian Medicaid |
$44.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,785.00
|
| Rate for Payer: Nomi Health Commercial |
$76.61
|
| Rate for Payer: PACE SWMI |
$63.84
|
| Rate for Payer: PHP Medicare Advantage |
$63.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.17
|
| Rate for Payer: Priority Health Medicare |
$63.84
|
| Rate for Payer: Priority Health Narrow Network |
$113.17
|
| Rate for Payer: Priority Health SBD |
$113.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.84
|
| Rate for Payer: UHC Medicare Advantage |
$63.84
|
| Rate for Payer: UHCCP Medicaid |
$42.60
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$10,409.00 |
| Rate for Payer: Aetna Commercial |
$75.33
|
| Rate for Payer: Aetna Medicare |
$58.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$56.22
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$56.22
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$80.96
|
| Rate for Payer: Cofinity Commercial |
$75.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.22
|
| Rate for Payer: Healthscope Commercial |
$104.01
|
| Rate for Payer: Healthscope Commercial |
$89.95
|
| Rate for Payer: Mclaren Medicaid |
$37.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.03
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,409.00
|
| Rate for Payer: Nomi Health Commercial |
$67.46
|
| Rate for Payer: PACE SWMI |
$56.22
|
| Rate for Payer: PHP Medicare Advantage |
$56.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.96
|
| Rate for Payer: Priority Health Medicare |
$56.22
|
| Rate for Payer: Priority Health Narrow Network |
$98.96
|
| Rate for Payer: Priority Health SBD |
$98.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.22
|
| Rate for Payer: UHC Medicare Advantage |
$56.22
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$790.75
|
| Rate for Payer: BCN Commercial |
$790.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$534.92
|
| Rate for Payer: Cofinity Commercial |
$435.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$559.80
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.70
|
| Rate for Payer: Nomi Health Commercial |
$4,017.89
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$528.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Priority Health SBD |
$391.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.00
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,077.18
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$33,500.00 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$189.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.27
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Healthscope Commercial |
$291.41
|
| Rate for Payer: Healthscope Commercial |
$336.94
|
| Rate for Payer: Mclaren Medicaid |
$122.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,500.00
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.44
|
| Rate for Payer: Priority Health Medicare |
$182.13
|
| Rate for Payer: Priority Health Narrow Network |
$326.44
|
| Rate for Payer: Priority Health SBD |
$326.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.13
|
| Rate for Payer: UHC Medicare Advantage |
$182.13
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$33,500.00 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$189.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.27
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Healthscope Commercial |
$291.41
|
| Rate for Payer: Healthscope Commercial |
$336.94
|
| Rate for Payer: Mclaren Medicaid |
$122.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,500.00
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.44
|
| Rate for Payer: Priority Health Medicare |
$182.13
|
| Rate for Payer: Priority Health Narrow Network |
$326.44
|
| Rate for Payer: Priority Health SBD |
$326.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.13
|
| Rate for Payer: UHC Medicare Advantage |
$182.13
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
|
