|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 17283
|
| Min. Negotiated Rate |
$161.58 |
| Max. Negotiated Rate |
$262.60 |
| Rate for Payer: Aetna Commercial |
$216.52
|
| Rate for Payer: Aetna Medicare |
$168.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.52
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS MAPPO |
$161.58
|
| Rate for Payer: BCN Medicare Advantage |
$161.58
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$232.68
|
| Rate for Payer: Cofinity Commercial |
$216.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.66
|
| Rate for Payer: Nomi Health Commercial |
$193.90
|
| Rate for Payer: PACE SWMI |
$161.58
|
| Rate for Payer: PHP Commercial |
$226.21
|
| Rate for Payer: PHP Medicare Advantage |
$161.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health Medicare |
$161.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.58
|
| Rate for Payer: UHC Medicare Advantage |
$161.58
|
| Rate for Payer: UMR Bronson Commercial |
$185.84
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 17284
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$278.85 |
| Rate for Payer: Aetna Commercial |
$253.13
|
| Rate for Payer: Aetna Medicare |
$196.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.13
|
| Rate for Payer: BCBS Complete |
$171.60
|
| Rate for Payer: BCBS MAPPO |
$188.90
|
| Rate for Payer: BCN Medicare Advantage |
$188.90
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$272.02
|
| Rate for Payer: Cofinity Commercial |
$253.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.34
|
| Rate for Payer: Nomi Health Commercial |
$226.68
|
| Rate for Payer: PACE SWMI |
$188.90
|
| Rate for Payer: PHP Commercial |
$264.46
|
| Rate for Payer: PHP Medicare Advantage |
$188.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health Medicare |
$188.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.90
|
| Rate for Payer: UHC Medicare Advantage |
$188.90
|
| Rate for Payer: UMR Bronson Commercial |
$197.34
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 17286
|
| Min. Negotiated Rate |
$258.47 |
| Max. Negotiated Rate |
$1,823.25 |
| Rate for Payer: Aetna Commercial |
$346.35
|
| Rate for Payer: Aetna Medicare |
$268.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.35
|
| Rate for Payer: BCBS Complete |
$1,122.00
|
| Rate for Payer: BCBS MAPPO |
$258.47
|
| Rate for Payer: BCN Medicare Advantage |
$258.47
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$372.20
|
| Rate for Payer: Cofinity Commercial |
$346.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.39
|
| Rate for Payer: Nomi Health Commercial |
$310.16
|
| Rate for Payer: PACE SWMI |
$258.47
|
| Rate for Payer: PHP Commercial |
$361.86
|
| Rate for Payer: PHP Medicare Advantage |
$258.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
| Rate for Payer: Priority Health Medicare |
$258.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.47
|
| Rate for Payer: UHC Medicare Advantage |
$258.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,290.30
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 17261
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna Medicare |
$86.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.22
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS MAPPO |
$83.00
|
| Rate for Payer: BCN Medicare Advantage |
$83.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$119.52
|
| Rate for Payer: Cofinity Commercial |
$111.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.15
|
| Rate for Payer: Nomi Health Commercial |
$99.60
|
| Rate for Payer: PACE SWMI |
$83.00
|
| Rate for Payer: PHP Commercial |
$116.20
|
| Rate for Payer: PHP Medicare Advantage |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$83.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.00
|
| Rate for Payer: UHC Medicare Advantage |
$83.00
|
| Rate for Payer: UMR Bronson Commercial |
$124.20
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 17262
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Commercial |
$139.99
|
| Rate for Payer: Aetna Medicare |
$108.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.99
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$104.47
|
| Rate for Payer: BCN Medicare Advantage |
$104.47
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$150.44
|
| Rate for Payer: Cofinity Commercial |
$139.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.69
|
| Rate for Payer: Nomi Health Commercial |
$125.36
|
| Rate for Payer: PACE SWMI |
$104.47
|
| Rate for Payer: PHP Commercial |
$146.26
|
| Rate for Payer: PHP Medicare Advantage |
$104.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$104.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.47
|
| Rate for Payer: UHC Medicare Advantage |
$104.47
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 17263
|
| Min. Negotiated Rate |
$115.56 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Commercial |
$154.85
|
| Rate for Payer: Aetna Medicare |
$120.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.85
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$115.56
|
| Rate for Payer: BCN Medicare Advantage |
$115.56
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$154.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.34
|
| Rate for Payer: Nomi Health Commercial |
$138.67
|
| Rate for Payer: PACE SWMI |
$115.56
|
| Rate for Payer: PHP Commercial |
$161.78
|
| Rate for Payer: PHP Medicare Advantage |
$115.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health Medicare |
$115.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.56
|
| Rate for Payer: UHC Medicare Advantage |
$115.56
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 17264
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$166.43
|
| Rate for Payer: Aetna Medicare |
$129.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.43
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS MAPPO |
$124.20
|
| Rate for Payer: BCN Medicare Advantage |
$124.20
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$178.85
|
| Rate for Payer: Cofinity Commercial |
$166.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.41
|
| Rate for Payer: Nomi Health Commercial |
$149.04
|
| Rate for Payer: PACE SWMI |
$124.20
|
| Rate for Payer: PHP Commercial |
$173.88
|
| Rate for Payer: PHP Medicare Advantage |
$124.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health Medicare |
$124.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.20
|
| Rate for Payer: UHC Medicare Advantage |
$124.20
|
| Rate for Payer: UMR Bronson Commercial |
$156.40
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 64624
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$516.10 |
| Rate for Payer: Aetna Commercial |
$186.39
|
| Rate for Payer: Aetna Medicare |
$144.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.39
|
| Rate for Payer: BCBS Complete |
$317.60
|
| Rate for Payer: BCBS MAPPO |
$139.10
|
| Rate for Payer: BCN Medicare Advantage |
$139.10
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$200.30
|
| Rate for Payer: Cofinity Commercial |
$186.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.06
|
| Rate for Payer: Nomi Health Commercial |
$166.92
|
| Rate for Payer: PACE SWMI |
$139.10
|
| Rate for Payer: PHP Commercial |
$194.74
|
| Rate for Payer: PHP Medicare Advantage |
$139.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health Medicare |
$139.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.10
|
| Rate for Payer: UHC Medicare Advantage |
$139.10
|
| Rate for Payer: UMR Bronson Commercial |
$365.24
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$516.10 |
| Rate for Payer: Aetna Commercial |
$186.39
|
| Rate for Payer: Aetna Medicare |
$144.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.39
|
| Rate for Payer: BCBS Complete |
$317.60
|
| Rate for Payer: BCBS MAPPO |
$139.10
|
| Rate for Payer: BCN Medicare Advantage |
$139.10
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$186.39
|
| Rate for Payer: Cofinity Commercial |
$200.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.06
|
| Rate for Payer: Nomi Health Commercial |
$166.92
|
| Rate for Payer: PACE SWMI |
$139.10
|
| Rate for Payer: PHP Commercial |
$194.74
|
| Rate for Payer: PHP Medicare Advantage |
$139.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health Medicare |
$139.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.10
|
| Rate for Payer: UHC Medicare Advantage |
$139.10
|
| Rate for Payer: UMR Bronson Commercial |
$365.24
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$349.36 |
| Max. Negotiated Rate |
$714.60 |
| Rate for Payer: Aetna American Axle |
$516.10
|
| Rate for Payer: Aetna Commercial |
$674.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.10
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$555.80
|
| Rate for Payer: Cofinity Commercial |
$682.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.20
|
| Rate for Payer: Healthscope Commercial |
$714.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$555.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$595.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.90
|
| Rate for Payer: PHP Commercial |
$674.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health SBD |
$500.22
|
| Rate for Payer: UMR Bronson Commercial |
$349.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$595.50
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$293.78 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna American Axle |
$516.10
|
| Rate for Payer: Aetna Commercial |
$674.90
|
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$555.80
|
| Rate for Payer: Cofinity Commercial |
$682.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$714.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$555.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$595.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.90
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$674.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health SBD |
$500.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: UMR Bronson Commercial |
$293.78
|
| Rate for Payer: VA VA |
$1,904.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$595.50
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 17004
|
| Min. Negotiated Rate |
$93.11 |
| Max. Negotiated Rate |
$202.15 |
| Rate for Payer: Aetna Commercial |
$124.77
|
| Rate for Payer: Aetna Medicare |
$96.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.77
|
| Rate for Payer: BCBS Complete |
$124.40
|
| Rate for Payer: BCBS MAPPO |
$93.11
|
| Rate for Payer: BCN Medicare Advantage |
$93.11
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$134.08
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.77
|
| Rate for Payer: Nomi Health Commercial |
$111.73
|
| Rate for Payer: PACE SWMI |
$93.11
|
| Rate for Payer: PHP Commercial |
$130.35
|
| Rate for Payer: PHP Medicare Advantage |
$93.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.15
|
| Rate for Payer: Priority Health Medicare |
$93.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.11
|
| Rate for Payer: UHC Medicare Advantage |
$93.11
|
| Rate for Payer: UMR Bronson Commercial |
$143.06
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 17000
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna Commercial |
$68.47
|
| Rate for Payer: Aetna Medicare |
$53.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.47
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS MAPPO |
$51.10
|
| Rate for Payer: BCN Medicare Advantage |
$51.10
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Cofinity Commercial |
$68.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.66
|
| Rate for Payer: Nomi Health Commercial |
$61.32
|
| Rate for Payer: PACE SWMI |
$51.10
|
| Rate for Payer: PHP Commercial |
$71.54
|
| Rate for Payer: PHP Medicare Advantage |
$51.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health Medicare |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.10
|
| Rate for Payer: UHC Medicare Advantage |
$51.10
|
| Rate for Payer: UMR Bronson Commercial |
$62.10
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 17003
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$1.88
|
| Rate for Payer: BCN Medicare Advantage |
$1.88
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.97
|
| Rate for Payer: Nomi Health Commercial |
$2.26
|
| Rate for Payer: PACE SWMI |
$1.88
|
| Rate for Payer: PHP Commercial |
$2.63
|
| Rate for Payer: PHP Medicare Advantage |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Medicare |
$1.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.88
|
| Rate for Payer: UHC Medicare Advantage |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
|
|
PR DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 45190
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$1,017.25 |
| Rate for Payer: Aetna Commercial |
$889.33
|
| Rate for Payer: Aetna Medicare |
$690.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$955.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.33
|
| Rate for Payer: BCBS Complete |
$626.00
|
| Rate for Payer: BCBS MAPPO |
$663.68
|
| Rate for Payer: BCN Medicare Advantage |
$663.68
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cofinity Commercial |
$955.70
|
| Rate for Payer: Cofinity Commercial |
$889.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.86
|
| Rate for Payer: Nomi Health Commercial |
$796.42
|
| Rate for Payer: PACE SWMI |
$663.68
|
| Rate for Payer: PHP Commercial |
$929.15
|
| Rate for Payer: PHP Medicare Advantage |
$663.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.25
|
| Rate for Payer: Priority Health Medicare |
$663.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$663.68
|
| Rate for Payer: UHC Medicare Advantage |
$663.68
|
| Rate for Payer: UMR Bronson Commercial |
$719.90
|
|
|
PR DESTRUCTION VAGINAL LESIONS EXTENSIVE
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 57065
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$473.20 |
| Rate for Payer: Aetna Commercial |
$236.78
|
| Rate for Payer: Aetna Medicare |
$183.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.78
|
| Rate for Payer: BCBS Complete |
$291.20
|
| Rate for Payer: BCBS MAPPO |
$176.70
|
| Rate for Payer: BCN Medicare Advantage |
$176.70
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cofinity Commercial |
$254.45
|
| Rate for Payer: Cofinity Commercial |
$236.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.53
|
| Rate for Payer: Nomi Health Commercial |
$212.04
|
| Rate for Payer: PACE SWMI |
$176.70
|
| Rate for Payer: PHP Commercial |
$247.38
|
| Rate for Payer: PHP Medicare Advantage |
$176.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.20
|
| Rate for Payer: Priority Health Medicare |
$176.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.70
|
| Rate for Payer: UHC Medicare Advantage |
$176.70
|
| Rate for Payer: UMR Bronson Commercial |
$334.88
|
|
|
PR DESTRUCTION VAGINAL LESIONS SIMPLE
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 57061
|
| Min. Negotiated Rate |
$108.36 |
| Max. Negotiated Rate |
$235.30 |
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Medicare |
$112.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.20
|
| Rate for Payer: BCBS Complete |
$144.80
|
| Rate for Payer: BCBS MAPPO |
$108.36
|
| Rate for Payer: BCN Medicare Advantage |
$108.36
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.78
|
| Rate for Payer: Nomi Health Commercial |
$130.03
|
| Rate for Payer: PACE SWMI |
$108.36
|
| Rate for Payer: PHP Commercial |
$151.70
|
| Rate for Payer: PHP Medicare Advantage |
$108.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.30
|
| Rate for Payer: Priority Health Medicare |
$108.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.36
|
| Rate for Payer: UHC Medicare Advantage |
$108.36
|
| Rate for Payer: UMR Bronson Commercial |
$166.52
|
|
|
PR DETERMINATION REFRACTIVE STATE
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 92015
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Medicare |
$48.00
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
| Rate for Payer: UMR Bronson Commercial |
$44.16
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 96110
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR DEVELOPMENTAL TESTING W/INTERP & REPORT
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 96111
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
PR DEXAMETHASONE SODIUM PHOS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1100
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.13
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Cofinity Commercial |
$0.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Nomi Health Commercial |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.13
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR DIABETES PREVENTION PROGRAM
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 00268
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR DIABETES PREVENTION PROG STANDARDIZED CURRICULUM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 0403T
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$454.35 |
| Max. Negotiated Rate |
$841.10 |
| Rate for Payer: Aetna Commercial |
$608.83
|
| Rate for Payer: Aetna Medicare |
$472.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.26
|
| Rate for Payer: BCBS Complete |
$517.60
|
| Rate for Payer: BCBS MAPPO |
$454.35
|
| Rate for Payer: BCN Medicare Advantage |
$454.35
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cofinity Commercial |
$608.83
|
| Rate for Payer: Cofinity Commercial |
$654.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$454.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.07
|
| Rate for Payer: Nomi Health Commercial |
$545.22
|
| Rate for Payer: PACE SWMI |
$454.35
|
| Rate for Payer: PHP Commercial |
$636.09
|
| Rate for Payer: PHP Medicare Advantage |
$454.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.10
|
| Rate for Payer: Priority Health Medicare |
$454.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$454.35
|
| Rate for Payer: UHC Medicare Advantage |
$454.35
|
| Rate for Payer: UMR Bronson Commercial |
$595.24
|
|
|
PR DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 38220
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna Medicare |
$66.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.13
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$63.53
|
| Rate for Payer: BCN Medicare Advantage |
$63.53
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$91.48
|
| Rate for Payer: Cofinity Commercial |
$85.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.71
|
| Rate for Payer: Nomi Health Commercial |
$76.24
|
| Rate for Payer: PACE SWMI |
$63.53
|
| Rate for Payer: PHP Commercial |
$88.94
|
| Rate for Payer: PHP Medicare Advantage |
$63.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$63.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.53
|
| Rate for Payer: UHC Medicare Advantage |
$63.53
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
