|
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 |
$409.50 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: BCBS Trust/PPO |
$514.27
|
| Rate for Payer: BCN Commercial |
$486.86
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: Nomi Health Commercial |
$516.60
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health HMO/PPO |
$548.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$422.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.40
|
| Rate for Payer: UHC Core |
$526.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 17106
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Commercial |
$350.53
|
| Rate for Payer: Aetna Medicare |
$272.05
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: BCBS MAPPO |
$261.59
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.67
|
| 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 Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health Medicare |
$264.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$261.59
|
| Rate for Payer: UHC Exchange |
$261.59
|
| Rate for Payer: UHC Medicare Advantage |
$261.59
|
|
|
PR DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 46930
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$193.23
|
| Rate for Payer: Aetna Medicare |
$149.97
|
| Rate for Payer: BCBS Complete |
$135.20
|
| Rate for Payer: BCBS MAPPO |
$144.20
|
| Rate for Payer: BCN Medicare Advantage |
$144.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$207.65
|
| Rate for Payer: Cofinity Commercial |
$193.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.41
|
| Rate for Payer: Nomi Health Commercial |
$173.04
|
| Rate for Payer: PACE SWMI |
$144.20
|
| Rate for Payer: PHP Medicare Advantage |
$144.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health Medicare |
$145.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.20
|
| Rate for Payer: UHC Exchange |
$144.20
|
| Rate for Payer: UHC Medicare Advantage |
$144.20
|
|
|
PR DESTRUCTION LESION LID MARGIN < 1 CM
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 67850
|
| Min. Negotiated Rate |
$122.47 |
| Max. Negotiated Rate |
$316.55 |
| Rate for Payer: Aetna Commercial |
$164.11
|
| Rate for Payer: Aetna Medicare |
$127.37
|
| Rate for Payer: BCBS Complete |
$194.80
|
| Rate for Payer: BCBS MAPPO |
$122.47
|
| Rate for Payer: BCN Medicare Advantage |
$122.47
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cofinity Commercial |
$176.36
|
| Rate for Payer: Cofinity Commercial |
$164.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.59
|
| Rate for Payer: Nomi Health Commercial |
$146.96
|
| Rate for Payer: PACE SWMI |
$122.47
|
| Rate for Payer: PHP Medicare Advantage |
$122.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.55
|
| Rate for Payer: Priority Health Medicare |
$123.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.47
|
| Rate for Payer: UHC Exchange |
$122.47
|
| Rate for Payer: UHC Medicare Advantage |
$122.47
|
|
|
PR DESTRUCTION LESIONS VULVA EXTENSIVE
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 56515
|
| Min. Negotiated Rate |
$202.29 |
| Max. Negotiated Rate |
$377.00 |
| Rate for Payer: Aetna Commercial |
$271.07
|
| Rate for Payer: Aetna Medicare |
$210.38
|
| Rate for Payer: BCBS Complete |
$232.00
|
| Rate for Payer: BCBS MAPPO |
$202.29
|
| Rate for Payer: BCN Medicare Advantage |
$202.29
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cofinity Commercial |
$291.30
|
| Rate for Payer: Cofinity Commercial |
$271.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.40
|
| Rate for Payer: Nomi Health Commercial |
$242.75
|
| Rate for Payer: PACE SWMI |
$202.29
|
| Rate for Payer: PHP Medicare Advantage |
$202.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.00
|
| Rate for Payer: Priority Health Medicare |
$204.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.29
|
| Rate for Payer: UHC Exchange |
$202.29
|
| Rate for Payer: UHC Medicare Advantage |
$202.29
|
|
|
PR DESTRUCTION LESIONS VULVA SIMPLE
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 56501
|
| Min. Negotiated Rate |
$125.63 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$168.34
|
| Rate for Payer: Aetna Medicare |
$130.66
|
| Rate for Payer: BCBS Complete |
$153.60
|
| Rate for Payer: BCBS MAPPO |
$125.63
|
| Rate for Payer: BCN Medicare Advantage |
$125.63
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cofinity Commercial |
$180.91
|
| Rate for Payer: Cofinity Commercial |
$168.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.91
|
| Rate for Payer: Nomi Health Commercial |
$150.76
|
| Rate for Payer: PACE SWMI |
$125.63
|
| Rate for Payer: PHP Medicare Advantage |
$125.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.60
|
| Rate for Payer: Priority Health Medicare |
$126.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.63
|
| Rate for Payer: UHC Exchange |
$125.63
|
| Rate for Payer: UHC Medicare Advantage |
$125.63
|
|
|
PR DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 17280
|
| Min. Negotiated Rate |
$82.70 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna Commercial |
$110.82
|
| Rate for Payer: Aetna Medicare |
$86.01
|
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCBS MAPPO |
$82.70
|
| Rate for Payer: BCN Medicare Advantage |
$82.70
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$119.09
|
| Rate for Payer: Cofinity Commercial |
$110.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.83
|
| Rate for Payer: Nomi Health Commercial |
$99.24
|
| Rate for Payer: PACE SWMI |
$82.70
|
| Rate for Payer: PHP Medicare Advantage |
$82.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.10
|
| Rate for Payer: Priority Health Medicare |
$83.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.70
|
| Rate for Payer: UHC Exchange |
$82.70
|
| Rate for Payer: UHC Medicare Advantage |
$82.70
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 17270
|
| Min. Negotiated Rate |
$91.35 |
| Max. Negotiated Rate |
$162.50 |
| Rate for Payer: Aetna Commercial |
$122.41
|
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS MAPPO |
$91.35
|
| Rate for Payer: BCN Medicare Advantage |
$91.35
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$122.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.92
|
| Rate for Payer: Nomi Health Commercial |
$109.62
|
| Rate for Payer: PACE SWMI |
$91.35
|
| Rate for Payer: PHP Medicare Advantage |
$91.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.50
|
| Rate for Payer: Priority Health Medicare |
$92.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.35
|
| Rate for Payer: UHC Exchange |
$91.35
|
| Rate for Payer: UHC Medicare Advantage |
$91.35
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 17271
|
| Min. Negotiated Rate |
$99.79 |
| Max. Negotiated Rate |
$176.15 |
| Rate for Payer: Aetna Commercial |
$133.72
|
| Rate for Payer: Aetna Medicare |
$103.78
|
| Rate for Payer: BCBS Complete |
$108.40
|
| Rate for Payer: BCBS MAPPO |
$99.79
|
| Rate for Payer: BCN Medicare Advantage |
$99.79
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$143.70
|
| Rate for Payer: Cofinity Commercial |
$133.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.78
|
| Rate for Payer: Nomi Health Commercial |
$119.75
|
| Rate for Payer: PACE SWMI |
$99.79
|
| Rate for Payer: PHP Medicare Advantage |
$99.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: Priority Health Medicare |
$100.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.79
|
| Rate for Payer: UHC Exchange |
$99.79
|
| Rate for Payer: UHC Medicare Advantage |
$99.79
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 17272
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$153.59
|
| Rate for Payer: Aetna Medicare |
$119.20
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$114.62
|
| Rate for Payer: BCN Medicare Advantage |
$114.62
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$165.05
|
| Rate for Payer: Cofinity Commercial |
$153.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.35
|
| Rate for Payer: Nomi Health Commercial |
$137.54
|
| Rate for Payer: PACE SWMI |
$114.62
|
| Rate for Payer: PHP Medicare Advantage |
$114.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$115.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.62
|
| Rate for Payer: UHC Exchange |
$114.62
|
| Rate for Payer: UHC Medicare Advantage |
$114.62
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 17273
|
| Min. Negotiated Rate |
$129.82 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Aetna Commercial |
$173.96
|
| Rate for Payer: Aetna Medicare |
$135.01
|
| Rate for Payer: BCBS Complete |
$137.60
|
| Rate for Payer: BCBS MAPPO |
$129.82
|
| Rate for Payer: BCN Medicare Advantage |
$129.82
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$186.94
|
| Rate for Payer: Cofinity Commercial |
$173.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.31
|
| Rate for Payer: Nomi Health Commercial |
$155.78
|
| Rate for Payer: PACE SWMI |
$129.82
|
| Rate for Payer: PHP Medicare Advantage |
$129.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.60
|
| Rate for Payer: Priority Health Medicare |
$131.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.82
|
| Rate for Payer: UHC Exchange |
$129.82
|
| Rate for Payer: UHC Medicare Advantage |
$129.82
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 17274
|
| Min. Negotiated Rate |
$159.37 |
| Max. Negotiated Rate |
$282.10 |
| Rate for Payer: Aetna Commercial |
$213.56
|
| Rate for Payer: Aetna Medicare |
$165.74
|
| Rate for Payer: BCBS Complete |
$173.60
|
| Rate for Payer: BCBS MAPPO |
$159.37
|
| Rate for Payer: BCN Medicare Advantage |
$159.37
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cofinity Commercial |
$229.49
|
| Rate for Payer: Cofinity Commercial |
$213.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.34
|
| Rate for Payer: Nomi Health Commercial |
$191.24
|
| Rate for Payer: PACE SWMI |
$159.37
|
| Rate for Payer: PHP Medicare Advantage |
$159.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.10
|
| Rate for Payer: Priority Health Medicare |
$160.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.37
|
| Rate for Payer: UHC Exchange |
$159.37
|
| Rate for Payer: UHC Medicare Advantage |
$159.37
|
|
|
PR DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 17260
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$89.34
|
| Rate for Payer: Aetna Medicare |
$69.34
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$66.67
|
| Rate for Payer: BCN Medicare Advantage |
$66.67
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$89.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.00
|
| Rate for Payer: Nomi Health Commercial |
$80.00
|
| Rate for Payer: PACE SWMI |
$66.67
|
| Rate for Payer: PHP Medicare Advantage |
$66.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$67.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.67
|
| Rate for Payer: UHC Exchange |
$66.67
|
| Rate for Payer: UHC Medicare Advantage |
$66.67
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 17281
|
| Min. Negotiated Rate |
$112.12 |
| Max. Negotiated Rate |
$191.75 |
| Rate for Payer: Aetna Commercial |
$150.24
|
| Rate for Payer: Aetna Medicare |
$116.60
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: BCBS MAPPO |
$112.12
|
| Rate for Payer: BCN Medicare Advantage |
$112.12
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Commercial |
$161.45
|
| Rate for Payer: Cofinity Commercial |
$150.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.73
|
| Rate for Payer: Nomi Health Commercial |
$134.54
|
| Rate for Payer: PACE SWMI |
$112.12
|
| Rate for Payer: PHP Medicare Advantage |
$112.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
| Rate for Payer: Priority Health Medicare |
$113.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.12
|
| Rate for Payer: UHC Exchange |
$112.12
|
| Rate for Payer: UHC Medicare Advantage |
$112.12
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 17282
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$173.13
|
| Rate for Payer: Aetna Medicare |
$134.37
|
| Rate for Payer: BCBS Complete |
$135.20
|
| Rate for Payer: BCBS MAPPO |
$129.20
|
| Rate for Payer: BCN Medicare Advantage |
$129.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$186.05
|
| Rate for Payer: Cofinity Commercial |
$173.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.66
|
| Rate for Payer: Nomi Health Commercial |
$155.04
|
| Rate for Payer: PACE SWMI |
$129.20
|
| Rate for Payer: PHP Medicare Advantage |
$129.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health Medicare |
$130.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.20
|
| Rate for Payer: UHC Exchange |
$129.20
|
| Rate for Payer: UHC Medicare Advantage |
$129.20
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 17283
|
| Min. Negotiated Rate |
$161.58 |
| Max. Negotiated Rate |
$262.60 |
| Rate for Payer: Aetna Commercial |
$216.52
|
| Rate for Payer: Aetna Medicare |
$168.04
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS MAPPO |
$161.58
|
| Rate for Payer: BCN Medicare Advantage |
$161.58
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$232.68
|
| Rate for Payer: Cofinity Commercial |
$216.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.66
|
| Rate for Payer: Nomi Health Commercial |
$193.90
|
| Rate for Payer: PACE SWMI |
$161.58
|
| Rate for Payer: PHP Medicare Advantage |
$161.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health Medicare |
$163.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.58
|
| Rate for Payer: UHC Exchange |
$161.58
|
| Rate for Payer: UHC Medicare Advantage |
$161.58
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 17284
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$278.85 |
| Rate for Payer: Aetna Commercial |
$253.13
|
| Rate for Payer: Aetna Medicare |
$196.46
|
| Rate for Payer: BCBS Complete |
$171.60
|
| Rate for Payer: BCBS MAPPO |
$188.90
|
| Rate for Payer: BCN Medicare Advantage |
$188.90
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$272.02
|
| Rate for Payer: Cofinity Commercial |
$253.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.34
|
| Rate for Payer: Nomi Health Commercial |
$226.68
|
| Rate for Payer: PACE SWMI |
$188.90
|
| Rate for Payer: PHP Medicare Advantage |
$188.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health Medicare |
$190.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.90
|
| Rate for Payer: UHC Exchange |
$188.90
|
| Rate for Payer: UHC Medicare Advantage |
$188.90
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 17286
|
| Min. Negotiated Rate |
$258.47 |
| Max. Negotiated Rate |
$1,823.25 |
| Rate for Payer: Aetna Commercial |
$346.35
|
| Rate for Payer: Aetna Medicare |
$268.81
|
| Rate for Payer: BCBS Complete |
$1,122.00
|
| Rate for Payer: BCBS MAPPO |
$258.47
|
| Rate for Payer: BCN Medicare Advantage |
$258.47
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$372.20
|
| Rate for Payer: Cofinity Commercial |
$346.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.39
|
| Rate for Payer: Nomi Health Commercial |
$310.16
|
| Rate for Payer: PACE SWMI |
$258.47
|
| Rate for Payer: PHP Medicare Advantage |
$258.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
| Rate for Payer: Priority Health Medicare |
$261.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.47
|
| Rate for Payer: UHC Exchange |
$258.47
|
| Rate for Payer: UHC Medicare Advantage |
$258.47
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 17261
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna Medicare |
$86.32
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS MAPPO |
$83.00
|
| Rate for Payer: BCN Medicare Advantage |
$83.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$119.52
|
| Rate for Payer: Cofinity Commercial |
$111.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.15
|
| Rate for Payer: Nomi Health Commercial |
$99.60
|
| Rate for Payer: PACE SWMI |
$83.00
|
| Rate for Payer: PHP Medicare Advantage |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$83.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.00
|
| Rate for Payer: UHC Exchange |
$83.00
|
| Rate for Payer: UHC Medicare Advantage |
$83.00
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 17262
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Commercial |
$139.99
|
| Rate for Payer: Aetna Medicare |
$108.65
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$104.47
|
| Rate for Payer: BCN Medicare Advantage |
$104.47
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$150.44
|
| Rate for Payer: Cofinity Commercial |
$139.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.69
|
| Rate for Payer: Nomi Health Commercial |
$125.36
|
| Rate for Payer: PACE SWMI |
$104.47
|
| Rate for Payer: PHP Medicare Advantage |
$104.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$105.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.47
|
| Rate for Payer: UHC Exchange |
$104.47
|
| Rate for Payer: UHC Medicare Advantage |
$104.47
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 17263
|
| Min. Negotiated Rate |
$115.56 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Commercial |
$154.85
|
| Rate for Payer: Aetna Medicare |
$120.18
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$115.56
|
| Rate for Payer: BCN Medicare Advantage |
$115.56
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$154.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.34
|
| Rate for Payer: Nomi Health Commercial |
$138.67
|
| Rate for Payer: PACE SWMI |
$115.56
|
| Rate for Payer: PHP Medicare Advantage |
$115.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health Medicare |
$116.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.56
|
| Rate for Payer: UHC Exchange |
$115.56
|
| Rate for Payer: UHC Medicare Advantage |
$115.56
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 17264
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$166.43
|
| Rate for Payer: Aetna Medicare |
$129.17
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS MAPPO |
$124.20
|
| Rate for Payer: BCN Medicare Advantage |
$124.20
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$178.85
|
| Rate for Payer: Cofinity Commercial |
$166.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.41
|
| Rate for Payer: Nomi Health Commercial |
$149.04
|
| Rate for Payer: PACE SWMI |
$124.20
|
| Rate for Payer: PHP Medicare Advantage |
$124.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health Medicare |
$125.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.20
|
| Rate for Payer: UHC Exchange |
$124.20
|
| Rate for Payer: UHC Medicare Advantage |
$124.20
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$516.10 |
| Rate for Payer: Aetna Commercial |
$186.39
|
| Rate for Payer: Aetna Medicare |
$144.66
|
| Rate for Payer: BCBS Complete |
$317.60
|
| Rate for Payer: BCBS MAPPO |
$139.10
|
| Rate for Payer: BCN Medicare Advantage |
$139.10
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$200.30
|
| Rate for Payer: Cofinity Commercial |
$186.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.06
|
| Rate for Payer: Nomi Health Commercial |
$166.92
|
| Rate for Payer: PACE SWMI |
$139.10
|
| Rate for Payer: PHP Medicare Advantage |
$139.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health Medicare |
$140.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.10
|
| Rate for Payer: UHC Exchange |
$139.10
|
| Rate for Payer: UHC Medicare Advantage |
$139.10
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$188.57 |
| Max. Negotiated Rate |
$1,482.54 |
| Rate for Payer: Aetna Commercial |
$674.90
|
| Rate for Payer: Aetna Medicare |
$206.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.12
|
| Rate for Payer: BCBS Complete |
$1,482.54
|
| Rate for Payer: BCBS MAPPO |
$198.50
|
| Rate for Payer: BCBS Trust/PPO |
$652.75
|
| Rate for Payer: BCN Commercial |
$617.34
|
| Rate for Payer: BCN Medicare Advantage |
$198.50
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$682.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.50
|
| Rate for Payer: Healthscope Commercial |
$714.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$595.50
|
| Rate for Payer: Mclaren Medicaid |
$1,411.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.43
|
| Rate for Payer: Meridian Medicaid |
$1,482.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.90
|
| Rate for Payer: Nomi Health Commercial |
$651.08
|
| Rate for Payer: PACE Senior Care Partners |
$188.57
|
| Rate for Payer: PACE SWMI |
$198.50
|
| Rate for Payer: PHP Commercial |
$674.90
|
| Rate for Payer: PHP Medicare Advantage |
$198.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,411.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health HMO/PPO |
$690.78
|
| Rate for Payer: Priority Health Medicare |
$200.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.98
|
| Rate for Payer: Railroad Medicare Medicare |
$198.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.72
|
| Rate for Payer: UHC Core |
$662.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.50
|
| Rate for Payer: UHC Exchange |
$198.50
|
| Rate for Payer: UHC Medicare Advantage |
$198.50
|
| Rate for Payer: UHCCP Medicaid |
$1,411.85
|
| Rate for Payer: VA VA |
$198.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$595.50
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 64624
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$516.10 |
| Rate for Payer: Aetna Commercial |
$186.39
|
| Rate for Payer: Aetna Medicare |
$144.66
|
| Rate for Payer: BCBS Complete |
$317.60
|
| Rate for Payer: BCBS MAPPO |
$139.10
|
| Rate for Payer: BCN Medicare Advantage |
$139.10
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$200.30
|
| Rate for Payer: Cofinity Commercial |
$186.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.06
|
| Rate for Payer: Nomi Health Commercial |
$166.92
|
| Rate for Payer: PACE SWMI |
$139.10
|
| Rate for Payer: PHP Medicare Advantage |
$139.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health Medicare |
$140.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.10
|
| Rate for Payer: UHC Exchange |
$139.10
|
| Rate for Payer: UHC Medicare Advantage |
$139.10
|
|
