|
PR DRG OF SKENE'S GLAND ABSCESS OR CYST
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 53060
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Aetna Commercial |
$214.80
|
| Rate for Payer: Aetna Medicare |
$166.71
|
| Rate for Payer: BCBS Complete |
$246.00
|
| Rate for Payer: BCBS MAPPO |
$160.30
|
| Rate for Payer: BCN Medicare Advantage |
$160.30
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$230.83
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.31
|
| Rate for Payer: Nomi Health Commercial |
$192.36
|
| Rate for Payer: PACE SWMI |
$160.30
|
| Rate for Payer: PHP Medicare Advantage |
$160.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health Medicare |
$161.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.30
|
| Rate for Payer: UHC Exchange |
$160.30
|
| Rate for Payer: UHC Medicare Advantage |
$160.30
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 16030
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: Aetna Medicare |
$132.95
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: BCBS MAPPO |
$127.84
|
| Rate for Payer: BCN Medicare Advantage |
$127.84
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$184.09
|
| Rate for Payer: Cofinity Commercial |
$171.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.23
|
| Rate for Payer: Nomi Health Commercial |
$153.41
|
| Rate for Payer: PACE SWMI |
$127.84
|
| Rate for Payer: PHP Medicare Advantage |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health Medicare |
$129.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.84
|
| Rate for Payer: UHC Exchange |
$127.84
|
| Rate for Payer: UHC Medicare Advantage |
$127.84
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 16025
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Commercial |
$141.89
|
| Rate for Payer: Aetna Medicare |
$110.13
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS MAPPO |
$105.89
|
| Rate for Payer: BCN Medicare Advantage |
$105.89
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$152.48
|
| Rate for Payer: Cofinity Commercial |
$141.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.18
|
| Rate for Payer: Nomi Health Commercial |
$127.07
|
| Rate for Payer: PACE SWMI |
$105.89
|
| Rate for Payer: PHP Medicare Advantage |
$105.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$106.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.89
|
| Rate for Payer: UHC Exchange |
$105.89
|
| Rate for Payer: UHC Medicare Advantage |
$105.89
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 16020
|
| Min. Negotiated Rate |
$52.95 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Commercial |
$70.95
|
| Rate for Payer: Aetna Medicare |
$55.07
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: BCBS MAPPO |
$52.95
|
| Rate for Payer: BCN Medicare Advantage |
$52.95
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$76.25
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.60
|
| Rate for Payer: Nomi Health Commercial |
$63.54
|
| Rate for Payer: PACE SWMI |
$52.95
|
| Rate for Payer: PHP Medicare Advantage |
$52.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Medicare |
$53.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.95
|
| Rate for Payer: UHC Exchange |
$52.95
|
| Rate for Payer: UHC Medicare Advantage |
$52.95
|
|
|
PR DRUG-ELUTING STENTS, SINGLE
|
Professional
|
Both
|
$2,525.00
|
|
|
Service Code
|
HCPCS G0290
|
| Min. Negotiated Rate |
$1,010.00 |
| Max. Negotiated Rate |
$1,641.25 |
| Rate for Payer: Aetna Medicare |
$1,262.50
|
| Rate for Payer: BCBS Complete |
$1,010.00
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
|
|
PR DRUG SCREEN MULTI DRUG CLASS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS G0434
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
|
|
PR DRUG SCREEN MULTIP CLASS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS G0431
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna Medicare |
$31.00
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
|
|
PR DRUG SCREEN PANEL 10 WITH BATH SALTS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00124
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS
|
Professional
|
Both
|
$2,434.00
|
|
|
Service Code
|
HCPCS 36838
|
| Min. Negotiated Rate |
$973.60 |
| Max. Negotiated Rate |
$1,582.10 |
| Rate for Payer: Aetna Commercial |
$1,466.88
|
| Rate for Payer: Aetna Medicare |
$1,138.48
|
| Rate for Payer: BCBS Complete |
$973.60
|
| Rate for Payer: BCBS MAPPO |
$1,094.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,094.69
|
| Rate for Payer: Cash Price |
$1,947.20
|
| Rate for Payer: Cash Price |
$1,947.20
|
| Rate for Payer: Cofinity Commercial |
$1,466.88
|
| Rate for Payer: Cofinity Commercial |
$1,576.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,094.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,149.42
|
| Rate for Payer: Nomi Health Commercial |
$1,313.63
|
| Rate for Payer: PACE SWMI |
$1,094.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,094.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,582.10
|
| Rate for Payer: Priority Health Medicare |
$1,105.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,094.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,094.69
|
| Rate for Payer: UHC Exchange |
$1,094.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,094.69
|
|
|
PR DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 17107
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$531.70 |
| Rate for Payer: Aetna Commercial |
$456.48
|
| Rate for Payer: Aetna Medicare |
$354.29
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$340.66
|
| Rate for Payer: BCN Medicare Advantage |
$340.66
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$490.55
|
| Rate for Payer: Cofinity Commercial |
$456.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.69
|
| Rate for Payer: Nomi Health Commercial |
$408.79
|
| Rate for Payer: PACE SWMI |
$340.66
|
| Rate for Payer: PHP Medicare Advantage |
$340.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health Medicare |
$344.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.66
|
| Rate for Payer: UHC Exchange |
$340.66
|
| Rate for Payer: UHC Medicare Advantage |
$340.66
|
|
|
PR DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 17108
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$671.65
|
| Rate for Payer: Aetna Medicare |
$521.28
|
| Rate for Payer: BCBS Complete |
$468.00
|
| Rate for Payer: BCBS MAPPO |
$501.23
|
| Rate for Payer: BCN Medicare Advantage |
$501.23
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$721.77
|
| Rate for Payer: Cofinity Commercial |
$671.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$501.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$526.29
|
| Rate for Payer: Nomi Health Commercial |
$601.48
|
| Rate for Payer: PACE SWMI |
$501.23
|
| Rate for Payer: PHP Medicare Advantage |
$501.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health Medicare |
$506.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$501.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$501.23
|
| Rate for Payer: UHC Exchange |
$501.23
|
| Rate for Payer: UHC Medicare Advantage |
$501.23
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
46924
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$205.44 |
| Max. Negotiated Rate |
$2,082.02 |
| Rate for Payer: Aetna Commercial |
$735.25
|
| Rate for Payer: Aetna Medicare |
$224.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$270.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$270.31
|
| Rate for Payer: BCBS Complete |
$2,082.02
|
| Rate for Payer: BCBS MAPPO |
$216.25
|
| Rate for Payer: BCBS Trust/PPO |
$711.12
|
| Rate for Payer: BCN Commercial |
$672.54
|
| Rate for Payer: BCN Medicare Advantage |
$216.25
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$743.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.25
|
| Rate for Payer: Healthscope Commercial |
$778.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.75
|
| Rate for Payer: Mclaren Medicaid |
$1,982.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.06
|
| Rate for Payer: Meridian Medicaid |
$2,082.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: Nomi Health Commercial |
$709.30
|
| Rate for Payer: PACE Senior Care Partners |
$205.44
|
| Rate for Payer: PACE SWMI |
$216.25
|
| Rate for Payer: PHP Commercial |
$735.25
|
| Rate for Payer: PHP Medicare Advantage |
$216.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,982.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO |
$752.55
|
| Rate for Payer: Priority Health Medicare |
$218.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$579.55
|
| Rate for Payer: Railroad Medicare Medicare |
$216.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$761.20
|
| Rate for Payer: UHC Core |
$722.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.25
|
| Rate for Payer: UHC Exchange |
$216.25
|
| Rate for Payer: UHC Medicare Advantage |
$216.25
|
| Rate for Payer: UHCCP Medicaid |
$1,982.75
|
| Rate for Payer: VA VA |
$216.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.75
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
46924
|
| Min. Negotiated Rate |
$174.98 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$234.47
|
| Rate for Payer: Aetna Medicare |
$181.98
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$174.98
|
| Rate for Payer: BCN Medicare Advantage |
$174.98
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Cofinity Commercial |
$234.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.73
|
| Rate for Payer: Nomi Health Commercial |
$209.98
|
| Rate for Payer: PACE SWMI |
$174.98
|
| Rate for Payer: PHP Medicare Advantage |
$174.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$176.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.98
|
| Rate for Payer: UHC Exchange |
$174.98
|
| Rate for Payer: UHC Medicare Advantage |
$174.98
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 46924
|
| Min. Negotiated Rate |
$174.98 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$234.47
|
| Rate for Payer: Aetna Medicare |
$181.98
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$174.98
|
| Rate for Payer: BCN Medicare Advantage |
$174.98
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Cofinity Commercial |
$234.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.73
|
| Rate for Payer: Nomi Health Commercial |
$209.98
|
| Rate for Payer: PACE SWMI |
$174.98
|
| Rate for Payer: PHP Medicare Advantage |
$174.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$176.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.98
|
| Rate for Payer: UHC Exchange |
$174.98
|
| Rate for Payer: UHC Medicare Advantage |
$174.98
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
46924
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$562.25 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Aetna Commercial |
$735.25
|
| Rate for Payer: BCBS Trust/PPO |
$706.10
|
| Rate for Payer: BCN Commercial |
$668.47
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$743.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Healthscope Commercial |
$778.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: Nomi Health Commercial |
$709.30
|
| Rate for Payer: PHP Commercial |
$735.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO |
$752.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$579.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$761.20
|
| Rate for Payer: UHC Core |
$722.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.75
|
|
|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
46900
|
| Min. Negotiated Rate |
$90.96 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna Commercial |
$325.55
|
| Rate for Payer: Aetna Medicare |
$99.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.69
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$95.75
|
| Rate for Payer: BCBS Trust/PPO |
$314.86
|
| Rate for Payer: BCN Commercial |
$297.78
|
| Rate for Payer: BCN Medicare Advantage |
$95.75
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$329.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.75
|
| Rate for Payer: Healthscope Commercial |
$344.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.25
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.54
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.55
|
| Rate for Payer: Nomi Health Commercial |
$314.06
|
| Rate for Payer: PACE Senior Care Partners |
$90.96
|
| Rate for Payer: PACE SWMI |
$95.75
|
| Rate for Payer: PHP Commercial |
$325.55
|
| Rate for Payer: PHP Medicare Advantage |
$95.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO |
$333.21
|
| Rate for Payer: Priority Health Medicare |
$96.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.61
|
| Rate for Payer: Railroad Medicare Medicare |
$95.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.04
|
| Rate for Payer: UHC Core |
$319.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.75
|
| Rate for Payer: UHC Exchange |
$95.75
|
| Rate for Payer: UHC Medicare Advantage |
$95.75
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$95.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.25
|
|
|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 46900
|
| Min. Negotiated Rate |
$131.55 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$176.28
|
| Rate for Payer: Aetna Medicare |
$136.81
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$131.55
|
| Rate for Payer: BCN Medicare Advantage |
$131.55
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$189.43
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.13
|
| Rate for Payer: Nomi Health Commercial |
$157.86
|
| Rate for Payer: PACE SWMI |
$131.55
|
| Rate for Payer: PHP Medicare Advantage |
$131.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.55
|
| Rate for Payer: UHC Exchange |
$131.55
|
| Rate for Payer: UHC Medicare Advantage |
$131.55
|
|
|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
46900
|
| Min. Negotiated Rate |
$131.55 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$176.28
|
| Rate for Payer: Aetna Medicare |
$136.81
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$131.55
|
| Rate for Payer: BCN Medicare Advantage |
$131.55
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$189.43
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.13
|
| Rate for Payer: Nomi Health Commercial |
$157.86
|
| Rate for Payer: PACE SWMI |
$131.55
|
| Rate for Payer: PHP Medicare Advantage |
$131.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.55
|
| Rate for Payer: UHC Exchange |
$131.55
|
| Rate for Payer: UHC Medicare Advantage |
$131.55
|
|
|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
46900
|
| Min. Negotiated Rate |
$248.95 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna Commercial |
$325.55
|
| Rate for Payer: BCBS Trust/PPO |
$312.64
|
| Rate for Payer: BCN Commercial |
$295.98
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$329.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.40
|
| Rate for Payer: Healthscope Commercial |
$344.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.55
|
| Rate for Payer: Nomi Health Commercial |
$314.06
|
| Rate for Payer: PHP Commercial |
$325.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO |
$333.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.04
|
| Rate for Payer: UHC Core |
$319.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.25
|
|
|
PR DSTRJ LESION ANUS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 46916
|
| Min. Negotiated Rate |
$133.99 |
| Max. Negotiated Rate |
$267.80 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Medicare |
$139.35
|
| Rate for Payer: BCBS Complete |
$164.80
|
| Rate for Payer: BCBS MAPPO |
$133.99
|
| Rate for Payer: BCN Medicare Advantage |
$133.99
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$192.95
|
| Rate for Payer: Cofinity Commercial |
$179.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.69
|
| Rate for Payer: Nomi Health Commercial |
$160.79
|
| Rate for Payer: PACE SWMI |
$133.99
|
| Rate for Payer: PHP Medicare Advantage |
$133.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health Medicare |
$135.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.99
|
| Rate for Payer: UHC Exchange |
$133.99
|
| Rate for Payer: UHC Medicare Advantage |
$133.99
|
|
|
PR DSTRJ LESION ANUS SIMPLE LASER SURG
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 46917
|
| Min. Negotiated Rate |
$123.47 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Commercial |
$165.45
|
| Rate for Payer: Aetna Medicare |
$128.41
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$123.47
|
| Rate for Payer: BCN Medicare Advantage |
$123.47
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$177.80
|
| Rate for Payer: Cofinity Commercial |
$165.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.64
|
| Rate for Payer: Nomi Health Commercial |
$148.16
|
| Rate for Payer: PACE SWMI |
$123.47
|
| Rate for Payer: PHP Medicare Advantage |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$124.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.47
|
| Rate for Payer: UHC Exchange |
$123.47
|
| Rate for Payer: UHC Medicare Advantage |
$123.47
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
46922
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Medicare |
$137.60
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS MAPPO |
$132.31
|
| Rate for Payer: BCN Medicare Advantage |
$132.31
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$190.53
|
| Rate for Payer: Cofinity Commercial |
$177.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.93
|
| Rate for Payer: Nomi Health Commercial |
$158.77
|
| Rate for Payer: PACE SWMI |
$132.31
|
| Rate for Payer: PHP Medicare Advantage |
$132.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health Medicare |
$133.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.31
|
| Rate for Payer: UHC Exchange |
$132.31
|
| Rate for Payer: UHC Medicare Advantage |
$132.31
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
46922
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.79 |
| Max. Negotiated Rate |
$2,082.02 |
| Rate for Payer: Aetna Commercial |
$439.45
|
| Rate for Payer: Aetna Medicare |
$134.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.56
|
| Rate for Payer: BCBS Complete |
$2,082.02
|
| Rate for Payer: BCBS MAPPO |
$129.25
|
| Rate for Payer: BCBS Trust/PPO |
$425.03
|
| Rate for Payer: BCN Commercial |
$401.97
|
| Rate for Payer: BCN Medicare Advantage |
$129.25
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$444.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.25
|
| Rate for Payer: Healthscope Commercial |
$465.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.75
|
| Rate for Payer: Mclaren Medicaid |
$1,982.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.71
|
| Rate for Payer: Meridian Medicaid |
$2,082.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.45
|
| Rate for Payer: Nomi Health Commercial |
$423.94
|
| Rate for Payer: PACE Senior Care Partners |
$122.79
|
| Rate for Payer: PACE SWMI |
$129.25
|
| Rate for Payer: PHP Commercial |
$439.45
|
| Rate for Payer: PHP Medicare Advantage |
$129.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,982.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health HMO/PPO |
$449.79
|
| Rate for Payer: Priority Health Medicare |
$130.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.39
|
| Rate for Payer: Railroad Medicare Medicare |
$129.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.96
|
| Rate for Payer: UHC Core |
$431.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.25
|
| Rate for Payer: UHC Exchange |
$129.25
|
| Rate for Payer: UHC Medicare Advantage |
$129.25
|
| Rate for Payer: UHCCP Medicaid |
$1,982.75
|
| Rate for Payer: VA VA |
$129.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.75
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 46922
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Medicare |
$137.60
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS MAPPO |
$132.31
|
| Rate for Payer: BCN Medicare Advantage |
$132.31
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$190.53
|
| Rate for Payer: Cofinity Commercial |
$177.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.93
|
| Rate for Payer: Nomi Health Commercial |
$158.77
|
| Rate for Payer: PACE SWMI |
$132.31
|
| Rate for Payer: PHP Medicare Advantage |
$132.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health Medicare |
$133.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.31
|
| Rate for Payer: UHC Exchange |
$132.31
|
| Rate for Payer: UHC Medicare Advantage |
$132.31
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
46922
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$336.05 |
| Max. Negotiated Rate |
$465.30 |
| Rate for Payer: Aetna Commercial |
$439.45
|
| Rate for Payer: BCBS Trust/PPO |
$422.03
|
| Rate for Payer: BCN Commercial |
$399.54
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$444.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.60
|
| Rate for Payer: Healthscope Commercial |
$465.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.45
|
| Rate for Payer: Nomi Health Commercial |
$423.94
|
| Rate for Payer: PHP Commercial |
$439.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health HMO/PPO |
$449.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.96
|
| Rate for Payer: UHC Core |
$431.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.75
|
|
