|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 46900
|
| Min. Negotiated Rate |
$131.55 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$176.28
|
| Rate for Payer: Aetna Medicare |
$136.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.28
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$131.55
|
| Rate for Payer: BCN Medicare Advantage |
$131.55
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$189.43
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.13
|
| Rate for Payer: Nomi Health Commercial |
$157.86
|
| Rate for Payer: PACE SWMI |
$131.55
|
| Rate for Payer: PHP Commercial |
$184.17
|
| Rate for Payer: PHP Medicare Advantage |
$131.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$131.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.55
|
| Rate for Payer: UHC Medicare Advantage |
$131.55
|
| Rate for Payer: UMR Bronson Commercial |
$176.18
|
|
|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
46900
|
| Min. Negotiated Rate |
$168.52 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna American Axle |
$248.95
|
| Rate for Payer: Aetna Commercial |
$325.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.95
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$268.10
|
| Rate for Payer: Cofinity Commercial |
$329.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.40
|
| Rate for Payer: Healthscope Commercial |
$344.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.55
|
| Rate for Payer: PHP Commercial |
$325.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health SBD |
$241.29
|
| Rate for Payer: UMR Bronson Commercial |
$168.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.25
|
|
|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
46900
|
| Min. Negotiated Rate |
$141.71 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna American Axle |
$248.95
|
| Rate for Payer: Aetna Commercial |
$325.55
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$329.38
|
| Rate for Payer: Cofinity Commercial |
$268.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$344.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.25
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.55
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$325.55
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$241.29
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: UMR Bronson Commercial |
$141.71
|
| Rate for Payer: VA VA |
$389.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.25
|
|
|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
46900
|
| Min. Negotiated Rate |
$131.55 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$176.28
|
| Rate for Payer: Aetna Medicare |
$136.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.28
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$131.55
|
| Rate for Payer: BCN Medicare Advantage |
$131.55
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$189.43
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.13
|
| Rate for Payer: Nomi Health Commercial |
$157.86
|
| Rate for Payer: PACE SWMI |
$131.55
|
| Rate for Payer: PHP Commercial |
$184.17
|
| Rate for Payer: PHP Medicare Advantage |
$131.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$131.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.55
|
| Rate for Payer: UHC Medicare Advantage |
$131.55
|
| Rate for Payer: UMR Bronson Commercial |
$176.18
|
|
|
PR DSTRJ LESION ANUS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 46916
|
| Min. Negotiated Rate |
$133.99 |
| Max. Negotiated Rate |
$267.80 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Medicare |
$139.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.55
|
| Rate for Payer: BCBS Complete |
$164.80
|
| Rate for Payer: BCBS MAPPO |
$133.99
|
| Rate for Payer: BCN Medicare Advantage |
$133.99
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$192.95
|
| Rate for Payer: Cofinity Commercial |
$179.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.69
|
| Rate for Payer: Nomi Health Commercial |
$160.79
|
| Rate for Payer: PACE SWMI |
$133.99
|
| Rate for Payer: PHP Commercial |
$187.59
|
| Rate for Payer: PHP Medicare Advantage |
$133.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health Medicare |
$133.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.99
|
| Rate for Payer: UHC Medicare Advantage |
$133.99
|
| Rate for Payer: UMR Bronson Commercial |
$189.52
|
|
|
PR DSTRJ LESION ANUS SIMPLE LASER SURG
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 46917
|
| Min. Negotiated Rate |
$123.47 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Commercial |
$165.45
|
| Rate for Payer: Aetna Medicare |
$128.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.45
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$123.47
|
| Rate for Payer: BCN Medicare Advantage |
$123.47
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$177.80
|
| Rate for Payer: Cofinity Commercial |
$165.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.64
|
| Rate for Payer: Nomi Health Commercial |
$148.16
|
| Rate for Payer: PACE SWMI |
$123.47
|
| Rate for Payer: PHP Commercial |
$172.86
|
| Rate for Payer: PHP Medicare Advantage |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$123.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.47
|
| Rate for Payer: UHC Medicare Advantage |
$123.47
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
46922
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Medicare |
$137.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.30
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS MAPPO |
$132.31
|
| Rate for Payer: BCN Medicare Advantage |
$132.31
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$190.53
|
| Rate for Payer: Cofinity Commercial |
$177.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.93
|
| Rate for Payer: Nomi Health Commercial |
$158.77
|
| Rate for Payer: PACE SWMI |
$132.31
|
| Rate for Payer: PHP Commercial |
$185.23
|
| Rate for Payer: PHP Medicare Advantage |
$132.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health Medicare |
$132.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.31
|
| Rate for Payer: UHC Medicare Advantage |
$132.31
|
| Rate for Payer: UMR Bronson Commercial |
$237.82
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 46922
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Medicare |
$137.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.30
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS MAPPO |
$132.31
|
| Rate for Payer: BCN Medicare Advantage |
$132.31
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$190.53
|
| Rate for Payer: Cofinity Commercial |
$177.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.93
|
| Rate for Payer: Nomi Health Commercial |
$158.77
|
| Rate for Payer: PACE SWMI |
$132.31
|
| Rate for Payer: PHP Commercial |
$185.23
|
| Rate for Payer: PHP Medicare Advantage |
$132.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health Medicare |
$132.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.31
|
| Rate for Payer: UHC Medicare Advantage |
$132.31
|
| Rate for Payer: UMR Bronson Commercial |
$237.82
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
46922
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$191.29 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna American Axle |
$336.05
|
| Rate for Payer: Aetna Commercial |
$439.45
|
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$444.62
|
| Rate for Payer: Cofinity Commercial |
$361.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Healthscope Commercial |
$465.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.75
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.45
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Commercial |
$439.45
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Priority Health SBD |
$325.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: UMR Bronson Commercial |
$191.29
|
| Rate for Payer: VA VA |
$2,674.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.75
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
46922
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$227.48 |
| Max. Negotiated Rate |
$465.30 |
| Rate for Payer: Aetna American Axle |
$336.05
|
| Rate for Payer: Aetna Commercial |
$439.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.05
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$361.90
|
| Rate for Payer: Cofinity Commercial |
$444.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.60
|
| Rate for Payer: Healthscope Commercial |
$465.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.45
|
| Rate for Payer: PHP Commercial |
$439.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health SBD |
$325.71
|
| Rate for Payer: UMR Bronson Commercial |
$227.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.75
|
|
|
PR DSTRJ LESION ANUS SMPL ELTRDSICCATION
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 46910
|
| Min. Negotiated Rate |
$128.48 |
| Max. Negotiated Rate |
$269.75 |
| Rate for Payer: Aetna Commercial |
$172.16
|
| Rate for Payer: Aetna Medicare |
$133.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.16
|
| Rate for Payer: BCBS Complete |
$166.00
|
| Rate for Payer: BCBS MAPPO |
$128.48
|
| Rate for Payer: BCN Medicare Advantage |
$128.48
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cofinity Commercial |
$185.01
|
| Rate for Payer: Cofinity Commercial |
$172.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.90
|
| Rate for Payer: Nomi Health Commercial |
$154.18
|
| Rate for Payer: PACE SWMI |
$128.48
|
| Rate for Payer: PHP Commercial |
$179.87
|
| Rate for Payer: PHP Medicare Advantage |
$128.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.75
|
| Rate for Payer: Priority Health Medicare |
$128.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.48
|
| Rate for Payer: UHC Medicare Advantage |
$128.48
|
| Rate for Payer: UMR Bronson Commercial |
$190.90
|
|
|
PR DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 42160
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$177.05
|
| Rate for Payer: Aetna Medicare |
$137.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.05
|
| Rate for Payer: BCBS Complete |
$172.00
|
| Rate for Payer: BCBS MAPPO |
$132.13
|
| Rate for Payer: BCN Medicare Advantage |
$132.13
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$190.27
|
| Rate for Payer: Cofinity Commercial |
$177.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.74
|
| Rate for Payer: Nomi Health Commercial |
$158.56
|
| Rate for Payer: PACE SWMI |
$132.13
|
| Rate for Payer: PHP Commercial |
$184.98
|
| Rate for Payer: PHP Medicare Advantage |
$132.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health Medicare |
$132.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.13
|
| Rate for Payer: UHC Medicare Advantage |
$132.13
|
| Rate for Payer: UMR Bronson Commercial |
$197.80
|
|
|
PR DSTRJ LESION PENIS EXTENSIVE
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 54065
|
| Min. Negotiated Rate |
$164.69 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$220.68
|
| Rate for Payer: Aetna Medicare |
$171.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.68
|
| Rate for Payer: BCBS Complete |
$186.00
|
| Rate for Payer: BCBS MAPPO |
$164.69
|
| Rate for Payer: BCN Medicare Advantage |
$164.69
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$237.15
|
| Rate for Payer: Cofinity Commercial |
$220.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.92
|
| Rate for Payer: Nomi Health Commercial |
$197.63
|
| Rate for Payer: PACE SWMI |
$164.69
|
| Rate for Payer: PHP Commercial |
$230.57
|
| Rate for Payer: PHP Medicare Advantage |
$164.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health Medicare |
$164.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.69
|
| Rate for Payer: UHC Medicare Advantage |
$164.69
|
| Rate for Payer: UMR Bronson Commercial |
$213.90
|
|
|
PR DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 54050
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$146.06 |
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna Medicare |
$105.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.92
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$101.43
|
| Rate for Payer: BCN Medicare Advantage |
$101.43
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$146.06
|
| Rate for Payer: Cofinity Commercial |
$135.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.50
|
| Rate for Payer: Nomi Health Commercial |
$121.72
|
| Rate for Payer: PACE SWMI |
$101.43
|
| Rate for Payer: PHP Commercial |
$142.00
|
| Rate for Payer: PHP Medicare Advantage |
$101.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$101.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.43
|
| Rate for Payer: UHC Medicare Advantage |
$101.43
|
| Rate for Payer: UMR Bronson Commercial |
$103.04
|
|
|
PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 54056
|
| Min. Negotiated Rate |
$106.35 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$142.51
|
| Rate for Payer: Aetna Medicare |
$110.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.51
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS MAPPO |
$106.35
|
| Rate for Payer: BCN Medicare Advantage |
$106.35
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$153.14
|
| Rate for Payer: Cofinity Commercial |
$142.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.67
|
| Rate for Payer: Nomi Health Commercial |
$127.62
|
| Rate for Payer: PACE SWMI |
$106.35
|
| Rate for Payer: PHP Commercial |
$148.89
|
| Rate for Payer: PHP Medicare Advantage |
$106.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$106.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.35
|
| Rate for Payer: UHC Medicare Advantage |
$106.35
|
| Rate for Payer: UMR Bronson Commercial |
$124.20
|
|
|
PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 54055
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$137.15 |
| Rate for Payer: Aetna Commercial |
$123.01
|
| Rate for Payer: Aetna Medicare |
$95.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.01
|
| Rate for Payer: BCBS Complete |
$84.40
|
| Rate for Payer: BCBS MAPPO |
$91.80
|
| Rate for Payer: BCN Medicare Advantage |
$91.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.39
|
| Rate for Payer: Nomi Health Commercial |
$110.16
|
| Rate for Payer: PACE SWMI |
$91.80
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: PHP Medicare Advantage |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.15
|
| Rate for Payer: Priority Health Medicare |
$91.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.80
|
| Rate for Payer: UHC Medicare Advantage |
$91.80
|
| Rate for Payer: UMR Bronson Commercial |
$97.06
|
|
|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$91.41 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Aetna Commercial |
$122.49
|
| Rate for Payer: Aetna Medicare |
$95.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.49
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$91.41
|
| Rate for Payer: BCN Medicare Advantage |
$91.41
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$131.63
|
| Rate for Payer: Cofinity Commercial |
$122.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.98
|
| Rate for Payer: Nomi Health Commercial |
$109.69
|
| Rate for Payer: PACE SWMI |
$91.41
|
| Rate for Payer: PHP Commercial |
$127.97
|
| Rate for Payer: PHP Medicare Advantage |
$91.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health Medicare |
$91.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.41
|
| Rate for Payer: UHC Medicare Advantage |
$91.41
|
| Rate for Payer: UMR Bronson Commercial |
$114.54
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$125.90 |
| Max. Negotiated Rate |
$238.55 |
| Rate for Payer: Aetna Commercial |
$168.71
|
| Rate for Payer: Aetna Medicare |
$130.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.71
|
| Rate for Payer: BCBS Complete |
$146.80
|
| Rate for Payer: BCBS MAPPO |
$125.90
|
| Rate for Payer: BCN Medicare Advantage |
$125.90
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$181.30
|
| Rate for Payer: Cofinity Commercial |
$168.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.19
|
| Rate for Payer: Nomi Health Commercial |
$151.08
|
| Rate for Payer: PACE SWMI |
$125.90
|
| Rate for Payer: PHP Commercial |
$176.26
|
| Rate for Payer: PHP Medicare Advantage |
$125.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health Medicare |
$125.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.90
|
| Rate for Payer: UHC Medicare Advantage |
$125.90
|
| Rate for Payer: UMR Bronson Commercial |
$168.82
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$151.58 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Aetna Commercial |
$203.12
|
| Rate for Payer: Aetna Medicare |
$157.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.12
|
| Rate for Payer: BCBS Complete |
$187.60
|
| Rate for Payer: BCBS MAPPO |
$151.58
|
| Rate for Payer: BCN Medicare Advantage |
$151.58
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cofinity Commercial |
$218.28
|
| Rate for Payer: Cofinity Commercial |
$203.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.16
|
| Rate for Payer: Nomi Health Commercial |
$181.90
|
| Rate for Payer: PACE SWMI |
$151.58
|
| Rate for Payer: PHP Commercial |
$212.21
|
| Rate for Payer: PHP Medicare Advantage |
$151.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.85
|
| Rate for Payer: Priority Health Medicare |
$151.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.58
|
| Rate for Payer: UHC Medicare Advantage |
$151.58
|
| Rate for Payer: UMR Bronson Commercial |
$215.74
|
|
|
PR DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 17276
|
| Min. Negotiated Rate |
$191.87 |
| Max. Negotiated Rate |
$369.20 |
| Rate for Payer: Aetna Commercial |
$257.11
|
| Rate for Payer: Aetna Medicare |
$199.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.11
|
| Rate for Payer: BCBS Complete |
$227.20
|
| Rate for Payer: BCBS MAPPO |
$191.87
|
| Rate for Payer: BCN Medicare Advantage |
$191.87
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cofinity Commercial |
$276.29
|
| Rate for Payer: Cofinity Commercial |
$257.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.46
|
| Rate for Payer: Nomi Health Commercial |
$230.24
|
| Rate for Payer: PACE SWMI |
$191.87
|
| Rate for Payer: PHP Commercial |
$268.62
|
| Rate for Payer: PHP Medicare Advantage |
$191.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health Medicare |
$191.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.87
|
| Rate for Payer: UHC Medicare Advantage |
$191.87
|
| Rate for Payer: UMR Bronson Commercial |
$261.28
|
|
|
PR DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR
|
Professional
|
Both
|
$1,212.00
|
|
|
Service Code
|
HCPCS 64610
|
| Min. Negotiated Rate |
$469.56 |
| Max. Negotiated Rate |
$787.80 |
| Rate for Payer: Aetna Commercial |
$629.21
|
| Rate for Payer: Aetna Medicare |
$488.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.21
|
| Rate for Payer: BCBS Complete |
$484.80
|
| Rate for Payer: BCBS MAPPO |
$469.56
|
| Rate for Payer: BCN Medicare Advantage |
$469.56
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cofinity Commercial |
$676.17
|
| Rate for Payer: Cofinity Commercial |
$629.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$469.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.04
|
| Rate for Payer: Nomi Health Commercial |
$563.47
|
| Rate for Payer: PACE SWMI |
$469.56
|
| Rate for Payer: PHP Commercial |
$657.38
|
| Rate for Payer: PHP Medicare Advantage |
$469.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.80
|
| Rate for Payer: Priority Health Medicare |
$469.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$469.56
|
| Rate for Payer: UHC Medicare Advantage |
$469.56
|
| Rate for Payer: UMR Bronson Commercial |
$557.52
|
|
|
PR DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 64620
|
| Min. Negotiated Rate |
$169.82 |
| Max. Negotiated Rate |
$501.80 |
| Rate for Payer: Aetna Commercial |
$227.56
|
| Rate for Payer: Aetna Medicare |
$176.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.56
|
| Rate for Payer: BCBS Complete |
$308.80
|
| Rate for Payer: BCBS MAPPO |
$169.82
|
| Rate for Payer: BCN Medicare Advantage |
$169.82
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Cofinity Commercial |
$227.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.31
|
| Rate for Payer: Nomi Health Commercial |
$203.78
|
| Rate for Payer: PACE SWMI |
$169.82
|
| Rate for Payer: PHP Commercial |
$237.75
|
| Rate for Payer: PHP Medicare Advantage |
$169.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.80
|
| Rate for Payer: Priority Health Medicare |
$169.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.82
|
| Rate for Payer: UHC Medicare Advantage |
$169.82
|
| Rate for Payer: UMR Bronson Commercial |
$355.12
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 64640
|
| Min. Negotiated Rate |
$114.15 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.96
|
| Rate for Payer: BCBS Complete |
$243.20
|
| Rate for Payer: BCBS MAPPO |
$114.15
|
| Rate for Payer: BCN Medicare Advantage |
$114.15
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$164.38
|
| Rate for Payer: Cofinity Commercial |
$152.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.86
|
| Rate for Payer: Nomi Health Commercial |
$136.98
|
| Rate for Payer: PACE SWMI |
$114.15
|
| Rate for Payer: PHP Commercial |
$159.81
|
| Rate for Payer: PHP Medicare Advantage |
$114.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health Medicare |
$114.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.15
|
| Rate for Payer: UHC Medicare Advantage |
$114.15
|
| Rate for Payer: UMR Bronson Commercial |
$279.68
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$114.15 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.96
|
| Rate for Payer: BCBS Complete |
$243.20
|
| Rate for Payer: BCBS MAPPO |
$114.15
|
| Rate for Payer: BCN Medicare Advantage |
$114.15
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$152.96
|
| Rate for Payer: Cofinity Commercial |
$164.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.86
|
| Rate for Payer: Nomi Health Commercial |
$136.98
|
| Rate for Payer: PACE SWMI |
$114.15
|
| Rate for Payer: PHP Commercial |
$159.81
|
| Rate for Payer: PHP Medicare Advantage |
$114.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health Medicare |
$114.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.15
|
| Rate for Payer: UHC Medicare Advantage |
$114.15
|
| Rate for Payer: UMR Bronson Commercial |
$279.68
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$267.52 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna American Axle |
$395.20
|
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.20
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$522.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$425.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.40
|
| Rate for Payer: Healthscope Commercial |
$547.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$425.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$456.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.80
|
| Rate for Payer: PHP Commercial |
$516.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health SBD |
$383.04
|
| Rate for Payer: UMR Bronson Commercial |
$267.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$456.00
|
|
