|
PR DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 64632
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$130.96 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Aetna Medicare |
$67.08
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCBS MAPPO |
$64.50
|
| Rate for Payer: BCN Commercial |
$130.96
|
| Rate for Payer: BCN Medicare Advantage |
$64.50
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Cofinity Commercial |
$86.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.50
|
| Rate for Payer: Mclaren Medicaid |
$43.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.72
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Nomi Health Commercial |
$77.40
|
| Rate for Payer: PACE SWMI |
$64.50
|
| Rate for Payer: PHP Medicare Advantage |
$64.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO |
$114.32
|
| Rate for Payer: Priority Health Medicare |
$65.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.32
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$43.45
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$1,009.58 |
| Rate for Payer: Aetna Commercial |
$204.87
|
| Rate for Payer: Aetna Medicare |
$159.01
|
| Rate for Payer: BCBS Complete |
$108.48
|
| Rate for Payer: BCBS MAPPO |
$152.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$152.89
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Cofinity Commercial |
$204.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.89
|
| Rate for Payer: Mclaren Medicaid |
$103.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.53
|
| Rate for Payer: Meridian Medicaid |
$108.48
|
| Rate for Payer: Nomi Health Commercial |
$183.47
|
| Rate for Payer: PACE SWMI |
$152.89
|
| Rate for Payer: PHP Medicare Advantage |
$152.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO |
$272.42
|
| Rate for Payer: Priority Health Medicare |
$154.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$272.42
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$103.31
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$281.60
|
| Rate for Payer: Aetna Medicare |
$218.56
|
| Rate for Payer: BCBS Complete |
$148.73
|
| Rate for Payer: BCBS MAPPO |
$210.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: BCN Medicare Advantage |
$210.15
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$302.62
|
| Rate for Payer: Cofinity Commercial |
$281.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.15
|
| Rate for Payer: Mclaren Medicaid |
$141.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.66
|
| Rate for Payer: Meridian Medicaid |
$148.73
|
| Rate for Payer: Nomi Health Commercial |
$252.18
|
| Rate for Payer: PACE SWMI |
$210.15
|
| Rate for Payer: PHP Medicare Advantage |
$210.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.45
|
| Rate for Payer: Priority Health HMO/PPO |
$370.79
|
| Rate for Payer: Priority Health Medicare |
$212.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.79
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$141.65
|
|
|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$3,486.25 |
| Rate for Payer: Aetna Commercial |
$310.87
|
| Rate for Payer: Aetna Medicare |
$241.27
|
| Rate for Payer: BCBS Complete |
$163.04
|
| Rate for Payer: BCBS MAPPO |
$231.99
|
| Rate for Payer: BCBS Trust/PPO |
$3,486.25
|
| Rate for Payer: BCN Commercial |
$682.69
|
| Rate for Payer: BCN Medicare Advantage |
$231.99
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cofinity Commercial |
$334.07
|
| Rate for Payer: Cofinity Commercial |
$310.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.99
|
| Rate for Payer: Mclaren Medicaid |
$155.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.59
|
| Rate for Payer: Meridian Medicaid |
$163.04
|
| Rate for Payer: Nomi Health Commercial |
$278.39
|
| Rate for Payer: PACE SWMI |
$231.99
|
| Rate for Payer: PHP Medicare Advantage |
$231.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health HMO/PPO |
$406.64
|
| Rate for Payer: Priority Health Medicare |
$234.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$406.64
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$155.28
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$85.55
|
| Rate for Payer: Aetna Medicare |
$66.39
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: BCBS MAPPO |
$63.84
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: BCN Medicare Advantage |
$63.84
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Cofinity Commercial |
$85.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.84
|
| Rate for Payer: Mclaren Medicaid |
$42.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.03
|
| Rate for Payer: Meridian Medicaid |
$44.73
|
| Rate for Payer: Nomi Health Commercial |
$76.61
|
| Rate for Payer: PACE SWMI |
$63.84
|
| Rate for Payer: PHP Medicare Advantage |
$63.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO |
$113.17
|
| Rate for Payer: Priority Health Medicare |
$64.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.17
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$42.60
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$654.04 |
| Rate for Payer: Aetna Commercial |
$75.33
|
| Rate for Payer: Aetna Medicare |
$58.47
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$56.22
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$56.22
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$80.96
|
| Rate for Payer: Cofinity Commercial |
$75.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.22
|
| Rate for Payer: Mclaren Medicaid |
$37.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.03
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$67.46
|
| Rate for Payer: PACE SWMI |
$56.22
|
| Rate for Payer: PHP Medicare Advantage |
$56.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health HMO/PPO |
$98.96
|
| Rate for Payer: Priority Health Medicare |
$56.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.96
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
|
|
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
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$189.42
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Mclaren Medicaid |
$122.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO |
$326.44
|
| Rate for Payer: Priority Health Medicare |
$183.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.44
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
|
|
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 |
$1,452.56 |
| 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 |
$1,452.56
|
| Rate for Payer: BCBS MAPPO |
$155.50
|
| Rate for Payer: BCBS Trust/PPO |
$511.35
|
| Rate for Payer: BCN Commercial |
$483.60
|
| 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 |
$1,383.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.28
|
| Rate for Payer: Meridian Medicaid |
$1,452.56
|
| 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 |
$1,383.30
|
| 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 |
$1,383.30
|
| 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
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$189.42
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Mclaren Medicaid |
$122.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO |
$326.44
|
| Rate for Payer: Priority Health Medicare |
$183.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.44
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Aetna Commercial |
$522.75
|
| Rate for Payer: BCBS Trust/PPO |
$502.02
|
| Rate for Payer: BCN Commercial |
$475.27
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$528.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Healthscope Commercial |
$553.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.75
|
| Rate for Payer: Nomi Health Commercial |
$504.30
|
| Rate for Payer: PHP Commercial |
$522.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO |
$535.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$412.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.20
|
| Rate for Payer: UHC Core |
$513.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.25
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$1,452.56 |
| Rate for Payer: Aetna Commercial |
$522.75
|
| Rate for Payer: Aetna Medicare |
$159.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.19
|
| Rate for Payer: BCBS Complete |
$1,452.56
|
| Rate for Payer: BCBS MAPPO |
$153.75
|
| Rate for Payer: BCBS Trust/PPO |
$505.59
|
| Rate for Payer: BCN Commercial |
$478.16
|
| Rate for Payer: BCN Medicare Advantage |
$153.75
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$528.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.75
|
| Rate for Payer: Healthscope Commercial |
$553.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.25
|
| Rate for Payer: Mclaren Medicaid |
$1,383.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.44
|
| Rate for Payer: Meridian Medicaid |
$1,452.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.75
|
| Rate for Payer: Nomi Health Commercial |
$504.30
|
| Rate for Payer: PACE Senior Care Partners |
$146.06
|
| Rate for Payer: PACE SWMI |
$153.75
|
| Rate for Payer: PHP Commercial |
$522.75
|
| Rate for Payer: PHP Medicare Advantage |
$153.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO |
$535.05
|
| Rate for Payer: Priority Health Medicare |
$155.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$412.05
|
| Rate for Payer: Railroad Medicare Medicare |
$153.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.20
|
| Rate for Payer: UHC Core |
$513.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.75
|
| Rate for Payer: UHC Exchange |
$153.75
|
| Rate for Payer: UHC Medicare Advantage |
$153.75
|
| Rate for Payer: UHCCP Medicaid |
$1,383.30
|
| Rate for Payer: VA VA |
$153.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.25
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$189.32
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Mclaren Medicaid |
$122.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO |
$327.01
|
| Rate for Payer: Priority Health Medicare |
$183.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Exchange |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 64635
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$189.32
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Mclaren Medicaid |
$122.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO |
$327.01
|
| Rate for Payer: Priority Health Medicare |
$183.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Exchange |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$95.50 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS Trust/PPO |
$89.92
|
| Rate for Payer: BCN Commercial |
$88.25
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
|
|
PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 90697
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$175.01 |
| Rate for Payer: Aetna Commercial |
$154.01
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS Trust/PPO |
$175.01
|
| Rate for Payer: BCN Commercial |
$175.01
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
|
|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 90698
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$118.20 |
| Rate for Payer: Aetna Commercial |
$118.20
|
| Rate for Payer: Aetna Medicare |
$55.00
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$109.23
|
| Rate for Payer: BCN Commercial |
$109.23
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
|
|
PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 90696
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$62.89 |
| Rate for Payer: Aetna Commercial |
$62.89
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Trust/PPO |
$59.91
|
| Rate for Payer: BCN Commercial |
$59.91
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
|
|
PR DTP/HIB VACCINE,IM
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 90720
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 90702
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$79.01 |
| Rate for Payer: Aetna Commercial |
$67.16
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$79.01
|
| Rate for Payer: BCN Commercial |
$79.01
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
|
|
PR DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 43756
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$409.52 |
| Rate for Payer: Aetna Commercial |
$63.50
|
| Rate for Payer: Aetna Medicare |
$49.29
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$47.39
|
| Rate for Payer: BCBS Trust/PPO |
$194.41
|
| Rate for Payer: BCN Commercial |
$409.52
|
| Rate for Payer: BCN Medicare Advantage |
$47.39
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$63.50
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.39
|
| Rate for Payer: Mclaren Medicaid |
$32.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.76
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Nomi Health Commercial |
$56.87
|
| Rate for Payer: PACE SWMI |
$47.39
|
| Rate for Payer: PHP Medicare Advantage |
$47.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO |
$90.69
|
| Rate for Payer: Priority Health Medicare |
$47.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.39
|
| Rate for Payer: UHC Exchange |
$47.39
|
| Rate for Payer: UHC Medicare Advantage |
$47.39
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
PR DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
HCPCS 44010
|
| Min. Negotiated Rate |
$541.66 |
| Max. Negotiated Rate |
$1,969.50 |
| Rate for Payer: Aetna Commercial |
$1,085.96
|
| Rate for Payer: Aetna Medicare |
$842.84
|
| Rate for Payer: BCBS Complete |
$568.74
|
| Rate for Payer: BCBS MAPPO |
$810.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,969.50
|
| Rate for Payer: BCN Commercial |
$1,237.34
|
| Rate for Payer: BCN Medicare Advantage |
$810.42
|
| Rate for Payer: Cash Price |
$2,348.80
|
| Rate for Payer: Cash Price |
$2,348.80
|
| Rate for Payer: Cofinity Commercial |
$1,167.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.42
|
| Rate for Payer: Mclaren Medicaid |
$541.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$850.94
|
| Rate for Payer: Meridian Medicaid |
$568.74
|
| Rate for Payer: Nomi Health Commercial |
$972.50
|
| Rate for Payer: PACE SWMI |
$810.42
|
| Rate for Payer: PHP Medicare Advantage |
$810.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$541.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,518.93
|
| Rate for Payer: Priority Health Medicare |
$818.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,518.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.42
|
| Rate for Payer: UHC Exchange |
$810.42
|
| Rate for Payer: UHC Medicare Advantage |
$810.42
|
| Rate for Payer: UHCCP Medicaid |
$541.66
|
|
|
PR DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ
|
Professional
|
Both
|
$6,281.00
|
|
|
Service Code
|
HCPCS 48547
|
| Min. Negotiated Rate |
$749.66 |
| Max. Negotiated Rate |
$4,082.65 |
| Rate for Payer: Aetna Commercial |
$2,334.60
|
| Rate for Payer: Aetna Medicare |
$1,811.93
|
| Rate for Payer: BCBS Complete |
$1,206.15
|
| Rate for Payer: BCBS MAPPO |
$1,742.24
|
| Rate for Payer: BCBS Trust/PPO |
$749.66
|
| Rate for Payer: BCN Commercial |
$2,612.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,742.24
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Cofinity Commercial |
$2,508.83
|
| Rate for Payer: Cofinity Commercial |
$2,334.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,742.24
|
| Rate for Payer: Mclaren Medicaid |
$1,148.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,829.35
|
| Rate for Payer: Meridian Medicaid |
$1,206.15
|
| Rate for Payer: Nomi Health Commercial |
$2,090.69
|
| Rate for Payer: PACE SWMI |
$1,742.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,742.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,148.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,082.65
|
| Rate for Payer: Priority Health HMO/PPO |
$3,201.33
|
| Rate for Payer: Priority Health Medicare |
$1,759.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,201.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,742.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,742.24
|
| Rate for Payer: UHC Exchange |
$1,742.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.24
|
| Rate for Payer: UHCCP Medicaid |
$1,148.71
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 93985
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$363.58 |
| Rate for Payer: Aetna Commercial |
$296.43
|
| Rate for Payer: Aetna Medicare |
$230.07
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS MAPPO |
$221.22
|
| Rate for Payer: BCBS Trust/PPO |
$243.55
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: BCN Medicare Advantage |
$221.22
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$318.56
|
| Rate for Payer: Cofinity Commercial |
$296.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.22
|
| Rate for Payer: Mclaren Medicaid |
$24.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.28
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Nomi Health Commercial |
$265.46
|
| Rate for Payer: PACE SWMI |
$221.22
|
| Rate for Payer: PHP Medicare Advantage |
$221.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health HMO/PPO |
$50.21
|
| Rate for Payer: Priority Health Medicare |
$223.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.22
|
| Rate for Payer: UHC Exchange |
$221.22
|
| Rate for Payer: UHC Medicare Advantage |
$221.22
|
| Rate for Payer: UHCCP Medicaid |
$24.07
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 93986
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$216.49 |
| Rate for Payer: Aetna Commercial |
$173.93
|
| Rate for Payer: Aetna Medicare |
$134.99
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$129.80
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: BCN Commercial |
$216.49
|
| Rate for Payer: BCN Medicare Advantage |
$129.80
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$186.91
|
| Rate for Payer: Cofinity Commercial |
$173.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.80
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.29
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Nomi Health Commercial |
$155.76
|
| Rate for Payer: PACE SWMI |
$129.80
|
| Rate for Payer: PHP Medicare Advantage |
$129.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Medicare |
$131.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.80
|
| Rate for Payer: UHC Exchange |
$129.80
|
| Rate for Payer: UHC Medicare Advantage |
$129.80
|
| Rate for Payer: UHCCP Medicaid |
$14.48
|
|
