|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
46900
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$1,703.77 |
| Rate for Payer: Aetna Commercial |
$176.28
|
| Rate for Payer: Aetna Medicare |
$136.81
|
| Rate for Payer: BCBS Complete |
$93.93
|
| Rate for Payer: BCBS MAPPO |
$131.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: BCN Commercial |
$351.36
|
| 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: Mclaren Medicaid |
$89.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.13
|
| Rate for Payer: Meridian Medicaid |
$93.93
|
| 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 Choice Medicaid |
$89.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO |
$247.58
|
| Rate for Payer: Priority Health Medicare |
$132.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.58
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$89.46
|
|
|
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 |
$297.19
|
| 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 |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.54
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| 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 |
$283.02
|
| 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 |
$319.80
|
| 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 |
$283.02
|
| 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 |
$89.46 |
| Max. Negotiated Rate |
$1,703.77 |
| Rate for Payer: Aetna Commercial |
$176.28
|
| Rate for Payer: Aetna Medicare |
$136.81
|
| Rate for Payer: BCBS Complete |
$93.93
|
| Rate for Payer: BCBS MAPPO |
$131.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: BCN Commercial |
$351.36
|
| 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: Mclaren Medicaid |
$89.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.13
|
| Rate for Payer: Meridian Medicaid |
$93.93
|
| 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 Choice Medicaid |
$89.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO |
$247.58
|
| Rate for Payer: Priority Health Medicare |
$132.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.58
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$89.46
|
|
|
PR DSTRJ LESION ANUS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 46916
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$1,647.77 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Medicare |
$139.35
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS MAPPO |
$133.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,647.77
|
| Rate for Payer: BCN Commercial |
$383.13
|
| 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: Mclaren Medicaid |
$91.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.69
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| 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 Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO |
$255.34
|
| Rate for Payer: Priority Health Medicare |
$135.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.34
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$91.59
|
|
|
PR DSTRJ LESION ANUS SIMPLE LASER SURG
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 46917
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$1,832.14 |
| Rate for Payer: Aetna Commercial |
$165.45
|
| Rate for Payer: Aetna Medicare |
$128.41
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$123.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,832.14
|
| Rate for Payer: BCN Commercial |
$659.72
|
| 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: Mclaren Medicaid |
$83.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.64
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| 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 Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO |
$232.67
|
| Rate for Payer: Priority Health Medicare |
$124.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.67
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$83.50
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
46922
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$1,491.39 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Medicare |
$137.60
|
| Rate for Payer: BCBS Complete |
$93.93
|
| Rate for Payer: BCBS MAPPO |
$132.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.39
|
| Rate for Payer: BCN Commercial |
$463.76
|
| 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: Mclaren Medicaid |
$89.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.93
|
| Rate for Payer: Meridian Medicaid |
$93.93
|
| 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 Choice Medicaid |
$89.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$133.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.78
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$89.46
|
|
|
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 |
$431.70
|
| 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 |
$89.46 |
| Max. Negotiated Rate |
$1,491.39 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Medicare |
$137.60
|
| Rate for Payer: BCBS Complete |
$93.93
|
| Rate for Payer: BCBS MAPPO |
$132.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.39
|
| Rate for Payer: BCN Commercial |
$463.76
|
| 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: Mclaren Medicaid |
$89.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.93
|
| Rate for Payer: Meridian Medicaid |
$93.93
|
| 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 Choice Medicaid |
$89.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$133.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.78
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$89.46
|
|
|
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 |
$2,039.92 |
| 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 |
$2,039.92
|
| 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 |
$1,942.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.71
|
| Rate for Payer: Meridian Medicaid |
$2,039.92
|
| 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 |
$1,942.66
|
| 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 |
$431.70
|
| 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 |
$1,942.66
|
| Rate for Payer: VA VA |
$129.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.75
|
|
|
PR DSTRJ LESION ANUS SMPL ELTRDSICCATION
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 46910
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$2,583.92 |
| Rate for Payer: Aetna Commercial |
$172.16
|
| Rate for Payer: Aetna Medicare |
$133.62
|
| 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: 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: 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 |
$244.01
|
| Rate for Payer: Priority Health Medicare |
$129.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.48
|
| Rate for Payer: UHC Exchange |
$128.48
|
| 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 |
$342.56 |
| Rate for Payer: Aetna Commercial |
$177.05
|
| Rate for Payer: Aetna Medicare |
$137.42
|
| 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: 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: 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 |
$253.55
|
| Rate for Payer: Priority Health Medicare |
$133.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.13
|
| Rate for Payer: UHC Exchange |
$132.13
|
| 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 |
$1,527.84 |
| Rate for Payer: Aetna Commercial |
$220.68
|
| Rate for Payer: Aetna Medicare |
$171.28
|
| 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: 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: 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 |
$275.36
|
| Rate for Payer: Priority Health Medicare |
$166.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.69
|
| Rate for Payer: UHC Exchange |
$164.69
|
| 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 |
$1,664.67 |
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna Medicare |
$105.49
|
| 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: 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: 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 |
$172.03
|
| Rate for Payer: Priority Health Medicare |
$102.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.43
|
| Rate for Payer: UHC Exchange |
$101.43
|
| 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 |
$1,380.45 |
| Rate for Payer: Aetna Commercial |
$142.51
|
| Rate for Payer: Aetna Medicare |
$110.60
|
| 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: 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: 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 |
$180.02
|
| Rate for Payer: Priority Health Medicare |
$107.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.35
|
| Rate for Payer: UHC Exchange |
$106.35
|
| 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 |
$1,009.58 |
| Rate for Payer: Aetna Commercial |
$123.01
|
| Rate for Payer: Aetna Medicare |
$95.47
|
| 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: 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: 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 |
$154.45
|
| Rate for Payer: Priority Health Medicare |
$92.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.80
|
| Rate for Payer: UHC Exchange |
$91.80
|
| 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 |
$2,378.41 |
| Rate for Payer: Aetna Commercial |
$122.49
|
| Rate for Payer: Aetna Medicare |
$95.07
|
| 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: 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: 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 |
$157.65
|
| Rate for Payer: Priority Health Medicare |
$92.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.41
|
| Rate for Payer: UHC Exchange |
$91.41
|
| 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 |
$1,575.39 |
| Rate for Payer: Aetna Commercial |
$168.71
|
| Rate for Payer: Aetna Medicare |
$130.94
|
| 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: 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: 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 |
$211.44
|
| Rate for Payer: Priority Health Medicare |
$127.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.90
|
| Rate for Payer: UHC Exchange |
$125.90
|
| 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 |
$963.62 |
| Rate for Payer: Aetna Commercial |
$203.12
|
| Rate for Payer: Aetna Medicare |
$157.64
|
| 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: 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: 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 |
$298.89
|
| Rate for Payer: Priority Health Medicare |
$153.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.58
|
| Rate for Payer: UHC Exchange |
$151.58
|
| 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 |
$456.13 |
| Rate for Payer: Aetna Commercial |
$257.11
|
| Rate for Payer: Aetna Medicare |
$199.54
|
| 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: 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: 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 |
$272.26
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$272.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.87
|
| Rate for Payer: UHC Exchange |
$191.87
|
| 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 |
$1,151.81 |
| Rate for Payer: Aetna Commercial |
$629.21
|
| Rate for Payer: Aetna Medicare |
$488.34
|
| 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: 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: 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 |
$826.35
|
| Rate for Payer: Priority Health Medicare |
$474.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$826.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$469.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$469.56
|
| Rate for Payer: UHC Exchange |
$469.56
|
| 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 |
$1,271.09 |
| Rate for Payer: Aetna Commercial |
$227.56
|
| Rate for Payer: Aetna Medicare |
$176.61
|
| 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: 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: 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 |
$302.56
|
| Rate for Payer: Priority Health Medicare |
$171.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.82
|
| Rate for Payer: UHC Exchange |
$169.82
|
| 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
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| 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: 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: 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 |
$202.46
|
| Rate for Payer: Priority Health Medicare |
$115.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.15
|
| Rate for Payer: UHC Exchange |
$114.15
|
| 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 |
$144.40 |
| Max. Negotiated Rate |
$662.24 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna Medicare |
$158.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.00
|
| Rate for Payer: BCBS Complete |
$662.24
|
| Rate for Payer: BCBS MAPPO |
$152.00
|
| Rate for Payer: BCBS Trust/PPO |
$499.84
|
| Rate for Payer: BCN Commercial |
$472.72
|
| Rate for Payer: BCN Medicare Advantage |
$152.00
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$522.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.00
|
| Rate for Payer: Healthscope Commercial |
$547.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$456.00
|
| Rate for Payer: Mclaren Medicaid |
$630.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.60
|
| Rate for Payer: Meridian Medicaid |
$662.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.80
|
| Rate for Payer: Nomi Health Commercial |
$498.56
|
| Rate for Payer: PACE Senior Care Partners |
$144.40
|
| Rate for Payer: PACE SWMI |
$152.00
|
| Rate for Payer: PHP Commercial |
$516.80
|
| Rate for Payer: PHP Medicare Advantage |
$152.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO |
$528.96
|
| Rate for Payer: Priority Health Medicare |
$153.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$407.36
|
| Rate for Payer: Railroad Medicare Medicare |
$152.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.04
|
| Rate for Payer: UHC Core |
$507.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.00
|
| Rate for Payer: UHC Exchange |
$152.00
|
| Rate for Payer: UHC Medicare Advantage |
$152.00
|
| Rate for Payer: UHCCP Medicaid |
$630.67
|
| Rate for Payer: VA VA |
$152.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$456.00
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$395.20 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: BCBS Trust/PPO |
$496.31
|
| Rate for Payer: BCN Commercial |
$469.86
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$522.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.40
|
| Rate for Payer: Healthscope Commercial |
$547.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$456.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.80
|
| Rate for Payer: Nomi Health Commercial |
$498.56
|
| Rate for Payer: PHP Commercial |
$516.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO |
$528.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$407.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.04
|
| Rate for Payer: UHC Core |
$507.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$456.00
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 64640
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| 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: 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: 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 |
$202.46
|
| Rate for Payer: Priority Health Medicare |
$115.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.15
|
| Rate for Payer: UHC Exchange |
$114.15
|
| Rate for Payer: UHC Medicare Advantage |
$114.15
|
| Rate for Payer: UHCCP Medicaid |
$77.11
|
|
