|
PR DERMAL FILLER JUVEDERM ULTRA PR PLUS
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00089
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR DERMAL FILLER JUVEDERM ULTRA PR PLUS >1
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 00090
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$447.85 |
| Rate for Payer: Aetna Medicare |
$344.50
|
| Rate for Payer: BCBS Complete |
$275.60
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
| Rate for Payer: UMR Bronson Commercial |
$316.94
|
|
|
PR DERMAL FILLER JUVEDERM VOLLURE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 00118
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR DERMAL FILLER JUVEDERM VOLUMA
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 00091
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
PR DERMAL FILLER RESTYLANE 1/2 UNIT
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00252
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR DERMAL FILLER RESTYLANE 1 UNIT
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
HCPCS 00253
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Aetna Medicare |
$331.50
|
| Rate for Payer: BCBS Complete |
$265.20
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: UMR Bronson Commercial |
$304.98
|
|
|
PR DERMAL FILLER RESTYLANE DEFYNE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 00360
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR DERMAL FILLER RESTYLANE LYFT
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
HCPCS 00359
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Aetna Medicare |
$331.50
|
| Rate for Payer: BCBS Complete |
$265.20
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: UMR Bronson Commercial |
$304.98
|
|
|
PR DERMAL FILLER RESTYLANE REFYNE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 00361
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR DERMAL FILLER VOLBELLA
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00092
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR DERMAL FILLER VOLBELLA >1
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 00120
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR DESTROY NERVE,CERV SPINAL MUSCLES
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 64613
|
| Min. Negotiated Rate |
$144.40 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Medicare |
$180.50
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: UMR Bronson Commercial |
$166.06
|
|
|
PR DESTRUCTION BENIGN LESIONS 15/>
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 17111
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$81.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.44
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS MAPPO |
$78.78
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$156.28
|
| Rate for Payer: BCN Medicare Advantage |
$78.78
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$105.57
|
| Rate for Payer: Cofinity Commercial |
$113.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.72
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Nomi Health Commercial |
$94.54
|
| Rate for Payer: PACE SWMI |
$78.78
|
| Rate for Payer: PHP Commercial |
$110.29
|
| Rate for Payer: PHP Medicare Advantage |
$78.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.33
|
| Rate for Payer: Priority Health Medicare |
$78.78
|
| Rate for Payer: Priority Health Narrow Network |
$113.33
|
| Rate for Payer: Priority Health SBD |
$113.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.78
|
| Rate for Payer: UHC Medicare Advantage |
$78.78
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
| Rate for Payer: UMR Bronson Commercial |
$99.82
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
17110
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Aetna American Axle |
$118.95
|
| Rate for Payer: Aetna Commercial |
$155.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.95
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$128.10
|
| Rate for Payer: Cofinity Commercial |
$157.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.40
|
| Rate for Payer: Healthscope Commercial |
$164.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.55
|
| Rate for Payer: PHP Commercial |
$155.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health SBD |
$115.29
|
| Rate for Payer: UMR Bronson Commercial |
$80.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.25
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
17110
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$64.39 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$118.95
|
| Rate for Payer: Aetna Commercial |
$155.55
|
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$104.41
|
| Rate for Payer: BCN Commercial |
$104.41
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$128.10
|
| Rate for Payer: Cofinity Commercial |
$157.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$164.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.25
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.55
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$155.55
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Priority Health SBD |
$115.29
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.83
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$64.39
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: UMR Bronson Commercial |
$67.71
|
| Rate for Payer: VA VA |
$194.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.25
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 17110
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$85.91
|
| Rate for Payer: Aetna Medicare |
$66.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.32
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$64.11
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.00
|
| Rate for Payer: BCN Commercial |
$133.89
|
| Rate for Payer: BCN Medicare Advantage |
$64.11
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$85.91
|
| Rate for Payer: Cofinity Commercial |
$92.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.32
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Nomi Health Commercial |
$76.93
|
| Rate for Payer: PACE SWMI |
$64.11
|
| Rate for Payer: PHP Commercial |
$89.75
|
| Rate for Payer: PHP Medicare Advantage |
$64.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.47
|
| Rate for Payer: Priority Health Medicare |
$64.11
|
| Rate for Payer: Priority Health Narrow Network |
$93.47
|
| Rate for Payer: Priority Health SBD |
$93.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.11
|
| Rate for Payer: UHC Medicare Advantage |
$64.11
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
| Rate for Payer: UMR Bronson Commercial |
$84.18
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
17110
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$85.91
|
| Rate for Payer: Aetna Medicare |
$66.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.32
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$64.11
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.00
|
| Rate for Payer: BCN Commercial |
$133.89
|
| Rate for Payer: BCN Medicare Advantage |
$64.11
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$92.32
|
| Rate for Payer: Cofinity Commercial |
$85.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.32
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Nomi Health Commercial |
$76.93
|
| Rate for Payer: PACE SWMI |
$64.11
|
| Rate for Payer: PHP Commercial |
$89.75
|
| Rate for Payer: PHP Medicare Advantage |
$64.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.47
|
| Rate for Payer: Priority Health Medicare |
$64.11
|
| Rate for Payer: Priority Health Narrow Network |
$93.47
|
| Rate for Payer: Priority Health SBD |
$93.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.11
|
| Rate for Payer: UHC Medicare Advantage |
$64.11
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
| Rate for Payer: UMR Bronson Commercial |
$84.18
|
|
|
PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 17106
|
| Min. Negotiated Rate |
$178.71 |
| Max. Negotiated Rate |
$947.65 |
| Rate for Payer: Aetna Commercial |
$350.53
|
| Rate for Payer: Aetna Medicare |
$272.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.69
|
| Rate for Payer: BCBS Complete |
$187.65
|
| Rate for Payer: BCBS MAPPO |
$261.59
|
| Rate for Payer: BCBS Trust/PPO |
$947.65
|
| Rate for Payer: BCN Commercial |
$403.66
|
| Rate for Payer: BCN Medicare Advantage |
$261.59
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$350.53
|
| Rate for Payer: Cofinity Commercial |
$376.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.67
|
| Rate for Payer: Meridian Medicaid |
$187.65
|
| Rate for Payer: Nomi Health Commercial |
$313.91
|
| Rate for Payer: PACE SWMI |
$261.59
|
| Rate for Payer: PHP Commercial |
$366.23
|
| Rate for Payer: PHP Medicare Advantage |
$261.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.21
|
| Rate for Payer: Priority Health Medicare |
$261.59
|
| Rate for Payer: Priority Health Narrow Network |
$375.21
|
| Rate for Payer: Priority Health SBD |
$375.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$261.59
|
| Rate for Payer: UHC Medicare Advantage |
$261.59
|
| Rate for Payer: UHCCP Medicaid |
$178.71
|
| Rate for Payer: UMR Bronson Commercial |
$289.80
|
|
|
PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
17106
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$452.71
|
| Rate for Payer: BCN Commercial |
$452.71
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.56
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$262.33
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: UMR Bronson Commercial |
$233.10
|
| Rate for Payer: VA VA |
$391.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
17106
|
| Min. Negotiated Rate |
$178.71 |
| Max. Negotiated Rate |
$947.65 |
| Rate for Payer: Aetna Commercial |
$350.53
|
| Rate for Payer: Aetna Medicare |
$272.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.69
|
| Rate for Payer: BCBS Complete |
$187.65
|
| Rate for Payer: BCBS MAPPO |
$261.59
|
| Rate for Payer: BCBS Trust/PPO |
$947.65
|
| Rate for Payer: BCN Commercial |
$403.66
|
| Rate for Payer: BCN Medicare Advantage |
$261.59
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$376.69
|
| Rate for Payer: Cofinity Commercial |
$350.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.67
|
| Rate for Payer: Meridian Medicaid |
$187.65
|
| Rate for Payer: Nomi Health Commercial |
$313.91
|
| Rate for Payer: PACE SWMI |
$261.59
|
| Rate for Payer: PHP Commercial |
$366.23
|
| Rate for Payer: PHP Medicare Advantage |
$261.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.21
|
| Rate for Payer: Priority Health Medicare |
$261.59
|
| Rate for Payer: Priority Health Narrow Network |
$375.21
|
| Rate for Payer: Priority Health SBD |
$375.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$261.59
|
| Rate for Payer: UHC Medicare Advantage |
$261.59
|
| Rate for Payer: UHCCP Medicaid |
$178.71
|
| Rate for Payer: UMR Bronson Commercial |
$289.80
|
|
|
PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
17106
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UMR Bronson Commercial |
$277.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
PR DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 46930
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$1,115.77 |
| Rate for Payer: Aetna Commercial |
$193.23
|
| Rate for Payer: Aetna Medicare |
$149.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.65
|
| Rate for Payer: BCBS Complete |
$104.44
|
| Rate for Payer: BCBS MAPPO |
$144.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,115.77
|
| Rate for Payer: BCN Commercial |
$255.24
|
| Rate for Payer: BCN Medicare Advantage |
$144.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$193.23
|
| Rate for Payer: Cofinity Commercial |
$207.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.41
|
| Rate for Payer: Meridian Medicaid |
$104.44
|
| Rate for Payer: Nomi Health Commercial |
$173.04
|
| Rate for Payer: PACE SWMI |
$144.20
|
| Rate for Payer: PHP Commercial |
$201.88
|
| Rate for Payer: PHP Medicare Advantage |
$144.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.25
|
| Rate for Payer: Priority Health Medicare |
$144.20
|
| Rate for Payer: Priority Health Narrow Network |
$273.25
|
| Rate for Payer: Priority Health SBD |
$273.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.20
|
| Rate for Payer: UHC Medicare Advantage |
$144.20
|
| Rate for Payer: UHCCP Medicaid |
$99.47
|
| Rate for Payer: UMR Bronson Commercial |
$155.48
|
|
|
PR DESTRUCTION LESION LID MARGIN < 1 CM
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 67850
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$347.09 |
| Rate for Payer: Aetna Commercial |
$164.11
|
| Rate for Payer: Aetna Medicare |
$127.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.36
|
| Rate for Payer: BCBS Complete |
$88.12
|
| Rate for Payer: BCBS MAPPO |
$122.47
|
| Rate for Payer: BCBS Trust/PPO |
$347.09
|
| Rate for Payer: BCN Commercial |
$318.13
|
| Rate for Payer: BCN Medicare Advantage |
$122.47
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cofinity Commercial |
$164.11
|
| Rate for Payer: Cofinity Commercial |
$176.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.59
|
| Rate for Payer: Meridian Medicaid |
$88.12
|
| Rate for Payer: Nomi Health Commercial |
$146.96
|
| Rate for Payer: PACE SWMI |
$122.47
|
| Rate for Payer: PHP Commercial |
$171.46
|
| Rate for Payer: PHP Medicare Advantage |
$122.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.69
|
| Rate for Payer: Priority Health Medicare |
$122.47
|
| Rate for Payer: Priority Health Narrow Network |
$228.69
|
| Rate for Payer: Priority Health SBD |
$228.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.47
|
| Rate for Payer: UHC Medicare Advantage |
$122.47
|
| Rate for Payer: UHCCP Medicaid |
$83.92
|
| Rate for Payer: UMR Bronson Commercial |
$224.02
|
|
|
PR DESTRUCTION LESIONS VULVA EXTENSIVE
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 56515
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$2,047.16 |
| Rate for Payer: Aetna Commercial |
$271.07
|
| Rate for Payer: Aetna Medicare |
$210.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.30
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS MAPPO |
$202.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,047.16
|
| Rate for Payer: BCN Commercial |
$409.52
|
| Rate for Payer: BCN Medicare Advantage |
$202.29
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cofinity Commercial |
$271.07
|
| Rate for Payer: Cofinity Commercial |
$291.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.40
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Nomi Health Commercial |
$242.75
|
| Rate for Payer: PACE SWMI |
$202.29
|
| Rate for Payer: PHP Commercial |
$283.21
|
| Rate for Payer: PHP Medicare Advantage |
$202.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.96
|
| Rate for Payer: Priority Health Medicare |
$202.29
|
| Rate for Payer: Priority Health Narrow Network |
$318.96
|
| Rate for Payer: Priority Health SBD |
$318.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.29
|
| Rate for Payer: UHC Medicare Advantage |
$202.29
|
| Rate for Payer: UHCCP Medicaid |
$136.75
|
| Rate for Payer: UMR Bronson Commercial |
$266.80
|
|
|
PR DESTRUCTION LESIONS VULVA SIMPLE
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 56501
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$1,962.11 |
| Rate for Payer: Aetna Commercial |
$168.34
|
| Rate for Payer: Aetna Medicare |
$130.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.91
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS MAPPO |
$125.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,962.11
|
| Rate for Payer: BCN Commercial |
$229.32
|
| Rate for Payer: BCN Medicare Advantage |
$125.63
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cofinity Commercial |
$168.34
|
| Rate for Payer: Cofinity Commercial |
$180.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.91
|
| Rate for Payer: Meridian Medicaid |
$90.35
|
| Rate for Payer: Nomi Health Commercial |
$150.76
|
| Rate for Payer: PACE SWMI |
$125.63
|
| Rate for Payer: PHP Commercial |
$175.88
|
| Rate for Payer: PHP Medicare Advantage |
$125.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.89
|
| Rate for Payer: Priority Health Medicare |
$125.63
|
| Rate for Payer: Priority Health Narrow Network |
$200.89
|
| Rate for Payer: Priority Health SBD |
$200.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.63
|
| Rate for Payer: UHC Medicare Advantage |
$125.63
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
| Rate for Payer: UMR Bronson Commercial |
$176.64
|
|
