|
PR DSTRJ LESION ANUS SMPL ELTRDSICCATION
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 46910
|
| Min. Negotiated Rate |
$128.48 |
| Max. Negotiated Rate |
$269.75 |
| Rate for Payer: Aetna Commercial |
$172.16
|
| Rate for Payer: Aetna Medicare |
$133.62
|
| Rate for Payer: BCBS Complete |
$166.00
|
| Rate for Payer: BCBS MAPPO |
$128.48
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.90
|
| 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 Cigna Priority Health |
$269.75
|
| Rate for Payer: Priority Health Medicare |
$129.76
|
| 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
|
|
|
PR DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 42160
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$177.05
|
| Rate for Payer: Aetna Medicare |
$137.42
|
| Rate for Payer: BCBS Complete |
$172.00
|
| Rate for Payer: BCBS MAPPO |
$132.13
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.74
|
| 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 Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health Medicare |
$133.45
|
| 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
|
|
|
PR DSTRJ LESION PENIS EXTENSIVE
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 54065
|
| Min. Negotiated Rate |
$164.69 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$220.68
|
| Rate for Payer: Aetna Medicare |
$171.28
|
| Rate for Payer: BCBS Complete |
$186.00
|
| Rate for Payer: BCBS MAPPO |
$164.69
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.92
|
| 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 Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health Medicare |
$166.34
|
| 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
|
|
|
PR DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 54050
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$146.06 |
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna Medicare |
$105.49
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$101.43
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.50
|
| 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 Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$102.44
|
| 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
|
|
|
PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 54056
|
| Min. Negotiated Rate |
$106.35 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$142.51
|
| Rate for Payer: Aetna Medicare |
$110.60
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS MAPPO |
$106.35
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.67
|
| 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 Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$107.41
|
| 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
|
|
|
PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 54055
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$137.15 |
| Rate for Payer: Aetna Commercial |
$123.01
|
| Rate for Payer: Aetna Medicare |
$95.47
|
| Rate for Payer: BCBS Complete |
$84.40
|
| Rate for Payer: BCBS MAPPO |
$91.80
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.39
|
| 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 Cigna Priority Health |
$137.15
|
| Rate for Payer: Priority Health Medicare |
$92.72
|
| 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
|
|
|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$91.41 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Aetna Commercial |
$122.49
|
| Rate for Payer: Aetna Medicare |
$95.07
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$91.41
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.98
|
| 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 Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health Medicare |
$92.32
|
| 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
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$125.90 |
| Max. Negotiated Rate |
$238.55 |
| Rate for Payer: Aetna Commercial |
$168.71
|
| Rate for Payer: Aetna Medicare |
$130.94
|
| Rate for Payer: BCBS Complete |
$146.80
|
| Rate for Payer: BCBS MAPPO |
$125.90
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.19
|
| 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 Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health Medicare |
$127.16
|
| 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
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$151.58 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Aetna Commercial |
$203.12
|
| Rate for Payer: Aetna Medicare |
$157.64
|
| Rate for Payer: BCBS Complete |
$187.60
|
| Rate for Payer: BCBS MAPPO |
$151.58
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.16
|
| 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 Cigna Priority Health |
$304.85
|
| Rate for Payer: Priority Health Medicare |
$153.10
|
| 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
|
|
|
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 |
$191.87 |
| Max. Negotiated Rate |
$369.20 |
| Rate for Payer: Aetna Commercial |
$257.11
|
| Rate for Payer: Aetna Medicare |
$199.54
|
| Rate for Payer: BCBS Complete |
$227.20
|
| Rate for Payer: BCBS MAPPO |
$191.87
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.46
|
| 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 Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| 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
|
|
|
PR DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR
|
Professional
|
Both
|
$1,212.00
|
|
|
Service Code
|
HCPCS 64610
|
| Min. Negotiated Rate |
$469.56 |
| Max. Negotiated Rate |
$787.80 |
| Rate for Payer: Aetna Commercial |
$629.21
|
| Rate for Payer: Aetna Medicare |
$488.34
|
| Rate for Payer: BCBS Complete |
$484.80
|
| Rate for Payer: BCBS MAPPO |
$469.56
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.04
|
| 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 Cigna Priority Health |
$787.80
|
| Rate for Payer: Priority Health Medicare |
$474.26
|
| 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
|
|
|
PR DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 64620
|
| Min. Negotiated Rate |
$169.82 |
| Max. Negotiated Rate |
$501.80 |
| Rate for Payer: Aetna Commercial |
$227.56
|
| Rate for Payer: Aetna Medicare |
$176.61
|
| Rate for Payer: BCBS Complete |
$308.80
|
| Rate for Payer: BCBS MAPPO |
$169.82
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.31
|
| 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 Cigna Priority Health |
$501.80
|
| Rate for Payer: Priority Health Medicare |
$171.52
|
| 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
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 64640
|
| Min. Negotiated Rate |
$114.15 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| Rate for Payer: BCBS Complete |
$243.20
|
| Rate for Payer: BCBS MAPPO |
$114.15
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.86
|
| 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 Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health Medicare |
$115.29
|
| 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
|
|
|
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
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$144.40 |
| Max. Negotiated Rate |
$675.91 |
| 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 |
$675.91
|
| 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 |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.60
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| 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 |
$643.68
|
| 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 |
$643.68
|
| 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
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$114.15 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| Rate for Payer: BCBS Complete |
$243.20
|
| Rate for Payer: BCBS MAPPO |
$114.15
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.86
|
| 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 Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health Medicare |
$115.29
|
| 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
|
|
|
PR DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 64632
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Aetna Medicare |
$67.08
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: BCBS MAPPO |
$64.50
|
| Rate for Payer: BCN Medicare Advantage |
$64.50
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Cofinity Commercial |
$86.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.72
|
| Rate for Payer: Nomi Health Commercial |
$77.40
|
| Rate for Payer: PACE SWMI |
$64.50
|
| Rate for Payer: PHP Medicare Advantage |
$64.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health Medicare |
$65.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.50
|
| Rate for Payer: UHC Exchange |
$64.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$152.89 |
| Max. Negotiated Rate |
$445.90 |
| Rate for Payer: Aetna Commercial |
$204.87
|
| Rate for Payer: Aetna Medicare |
$159.01
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: BCBS MAPPO |
$152.89
|
| Rate for Payer: BCN Medicare Advantage |
$152.89
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Cofinity Commercial |
$204.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.53
|
| Rate for Payer: Nomi Health Commercial |
$183.47
|
| Rate for Payer: PACE SWMI |
$152.89
|
| Rate for Payer: PHP Medicare Advantage |
$152.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health Medicare |
$154.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.89
|
| Rate for Payer: UHC Exchange |
$152.89
|
| Rate for Payer: UHC Medicare Advantage |
$152.89
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$210.15 |
| Max. Negotiated Rate |
$593.45 |
| Rate for Payer: Aetna Commercial |
$281.60
|
| Rate for Payer: Aetna Medicare |
$218.56
|
| Rate for Payer: BCBS Complete |
$365.20
|
| Rate for Payer: BCBS MAPPO |
$210.15
|
| Rate for Payer: BCN Medicare Advantage |
$210.15
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$302.62
|
| Rate for Payer: Cofinity Commercial |
$281.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.66
|
| Rate for Payer: Nomi Health Commercial |
$252.18
|
| Rate for Payer: PACE SWMI |
$210.15
|
| Rate for Payer: PHP Medicare Advantage |
$210.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.45
|
| Rate for Payer: Priority Health Medicare |
$212.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.15
|
| Rate for Payer: UHC Exchange |
$210.15
|
| Rate for Payer: UHC Medicare Advantage |
$210.15
|
|
|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$584.35 |
| Rate for Payer: Aetna Commercial |
$310.87
|
| Rate for Payer: Aetna Medicare |
$241.27
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$231.99
|
| Rate for Payer: BCN Medicare Advantage |
$231.99
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cofinity Commercial |
$334.07
|
| Rate for Payer: Cofinity Commercial |
$310.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.59
|
| Rate for Payer: Nomi Health Commercial |
$278.39
|
| Rate for Payer: PACE SWMI |
$231.99
|
| Rate for Payer: PHP Medicare Advantage |
$231.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health Medicare |
$234.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.99
|
| Rate for Payer: UHC Exchange |
$231.99
|
| Rate for Payer: UHC Medicare Advantage |
$231.99
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Commercial |
$85.55
|
| Rate for Payer: Aetna Medicare |
$66.39
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$63.84
|
| Rate for Payer: BCN Medicare Advantage |
$63.84
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Cofinity Commercial |
$85.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.03
|
| Rate for Payer: Nomi Health Commercial |
$76.61
|
| Rate for Payer: PACE SWMI |
$63.84
|
| Rate for Payer: PHP Medicare Advantage |
$63.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$64.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.84
|
| Rate for Payer: UHC Exchange |
$63.84
|
| Rate for Payer: UHC Medicare Advantage |
$63.84
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial |
$75.33
|
| Rate for Payer: Aetna Medicare |
$58.47
|
| Rate for Payer: BCBS Complete |
$134.40
|
| Rate for Payer: BCBS MAPPO |
$56.22
|
| Rate for Payer: BCN Medicare Advantage |
$56.22
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$80.96
|
| Rate for Payer: Cofinity Commercial |
$75.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.03
|
| Rate for Payer: Nomi Health Commercial |
$67.46
|
| Rate for Payer: PACE SWMI |
$56.22
|
| Rate for Payer: PHP Medicare Advantage |
$56.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health Medicare |
$56.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.22
|
| Rate for Payer: UHC Exchange |
$56.22
|
| Rate for Payer: UHC Medicare Advantage |
$56.22
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$147.72 |
| Max. Negotiated Rate |
$1,482.54 |
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: Aetna Medicare |
$161.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$194.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$194.38
|
| Rate for Payer: BCBS Complete |
$1,482.54
|
| Rate for Payer: BCBS MAPPO |
$155.50
|
| Rate for Payer: BCBS Trust/PPO |
$511.35
|
| Rate for Payer: BCN Commercial |
$483.61
|
| Rate for Payer: BCN Medicare Advantage |
$155.50
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$534.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.50
|
| Rate for Payer: Healthscope Commercial |
$559.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.50
|
| Rate for Payer: Mclaren Medicaid |
$1,411.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.28
|
| Rate for Payer: Meridian Medicaid |
$1,482.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.70
|
| Rate for Payer: Nomi Health Commercial |
$510.04
|
| Rate for Payer: PACE Senior Care Partners |
$147.72
|
| Rate for Payer: PACE SWMI |
$155.50
|
| Rate for Payer: PHP Commercial |
$528.70
|
| Rate for Payer: PHP Medicare Advantage |
$155.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,411.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO |
$541.14
|
| Rate for Payer: Priority Health Medicare |
$157.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$416.74
|
| Rate for Payer: Railroad Medicare Medicare |
$155.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.36
|
| Rate for Payer: UHC Core |
$519.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.50
|
| Rate for Payer: UHC Exchange |
$155.50
|
| Rate for Payer: UHC Medicare Advantage |
$155.50
|
| Rate for Payer: UHCCP Medicaid |
$1,411.85
|
| Rate for Payer: VA VA |
$155.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.50
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$182.13 |
| Max. Negotiated Rate |
$404.30 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$189.42
|
| Rate for Payer: BCBS Complete |
$248.80
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health Medicare |
$183.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.13
|
| Rate for Payer: UHC Exchange |
$182.13
|
| Rate for Payer: UHC Medicare Advantage |
$182.13
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: BCBS Trust/PPO |
$507.74
|
| Rate for Payer: BCN Commercial |
$480.68
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$534.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Healthscope Commercial |
$559.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.70
|
| Rate for Payer: Nomi Health Commercial |
$510.04
|
| Rate for Payer: PHP Commercial |
$528.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO |
$541.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$416.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.36
|
| Rate for Payer: UHC Core |
$519.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.50
|
|
