|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$2,378.41 |
| Rate for Payer: Aetna Commercial |
$122.49
|
| Rate for Payer: Aetna Medicare |
$95.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.63
|
| Rate for Payer: BCBS Complete |
$65.53
|
| Rate for Payer: BCBS MAPPO |
$91.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.41
|
| Rate for Payer: BCN Commercial |
$209.15
|
| 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 |
$122.49
|
| Rate for Payer: Cofinity Commercial |
$131.63
|
| 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: Meridian Medicaid |
$65.53
|
| 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 Choice Medicaid |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.65
|
| Rate for Payer: Priority Health Medicare |
$91.41
|
| Rate for Payer: Priority Health Narrow Network |
$157.65
|
| Rate for Payer: Priority Health SBD |
$157.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.41
|
| Rate for Payer: UHC Medicare Advantage |
$91.41
|
| Rate for Payer: UHCCP Medicaid |
$62.41
|
| 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 |
$85.41 |
| Max. Negotiated Rate |
$1,575.39 |
| Rate for Payer: Aetna Commercial |
$168.71
|
| Rate for Payer: Aetna Medicare |
$130.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.30
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: BCBS MAPPO |
$125.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.39
|
| Rate for Payer: BCN Commercial |
$284.41
|
| 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 |
$168.71
|
| Rate for Payer: Cofinity Commercial |
$181.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.20
|
| Rate for Payer: Meridian Medicaid |
$89.68
|
| 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 Choice Medicaid |
$85.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.44
|
| Rate for Payer: Priority Health Medicare |
$125.90
|
| Rate for Payer: Priority Health Narrow Network |
$211.44
|
| Rate for Payer: Priority Health SBD |
$211.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.90
|
| Rate for Payer: UHC Medicare Advantage |
$125.90
|
| Rate for Payer: UHCCP Medicaid |
$85.41
|
| 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 |
$105.86 |
| Max. Negotiated Rate |
$963.62 |
| Rate for Payer: Aetna Commercial |
$203.12
|
| Rate for Payer: Aetna Medicare |
$157.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.28
|
| Rate for Payer: BCBS Complete |
$111.15
|
| Rate for Payer: BCBS MAPPO |
$151.58
|
| Rate for Payer: BCBS Trust/PPO |
$963.62
|
| Rate for Payer: BCN Commercial |
$380.68
|
| 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 |
$203.12
|
| Rate for Payer: Cofinity Commercial |
$218.28
|
| 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: Meridian Medicaid |
$111.15
|
| 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 Choice Medicaid |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.89
|
| Rate for Payer: Priority Health Medicare |
$151.58
|
| Rate for Payer: Priority Health Narrow Network |
$298.89
|
| Rate for Payer: Priority Health SBD |
$298.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.58
|
| Rate for Payer: UHC Medicare Advantage |
$151.58
|
| Rate for Payer: UHCCP Medicaid |
$105.86
|
| 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 |
$129.72 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$257.11
|
| Rate for Payer: Aetna Medicare |
$199.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.29
|
| Rate for Payer: BCBS Complete |
$136.21
|
| Rate for Payer: BCBS MAPPO |
$191.87
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$334.54
|
| 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 |
$257.11
|
| Rate for Payer: Cofinity Commercial |
$276.29
|
| 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: Meridian Medicaid |
$136.21
|
| 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 Choice Medicaid |
$129.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.26
|
| Rate for Payer: Priority Health Medicare |
$191.87
|
| Rate for Payer: Priority Health Narrow Network |
$272.26
|
| Rate for Payer: Priority Health SBD |
$272.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.87
|
| Rate for Payer: UHC Medicare Advantage |
$191.87
|
| Rate for Payer: UHCCP Medicaid |
$129.72
|
| 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 |
$309.58 |
| Max. Negotiated Rate |
$1,151.81 |
| Rate for Payer: Aetna Commercial |
$629.21
|
| Rate for Payer: Aetna Medicare |
$488.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.17
|
| Rate for Payer: BCBS Complete |
$326.31
|
| Rate for Payer: BCBS MAPPO |
$469.56
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: BCN Commercial |
$1,151.81
|
| 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 |
$629.21
|
| Rate for Payer: Cofinity Commercial |
$676.17
|
| 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: Meridian Medicaid |
$326.31
|
| 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 Choice Medicaid |
$310.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.35
|
| Rate for Payer: Priority Health Medicare |
$469.56
|
| Rate for Payer: Priority Health Narrow Network |
$826.35
|
| Rate for Payer: Priority Health SBD |
$826.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$469.56
|
| Rate for Payer: UHC Medicare Advantage |
$469.56
|
| Rate for Payer: UHCCP Medicaid |
$310.77
|
| 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 |
$114.59 |
| Max. Negotiated Rate |
$1,271.09 |
| Rate for Payer: Aetna Commercial |
$227.56
|
| Rate for Payer: Aetna Medicare |
$176.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.54
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS MAPPO |
$169.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$304.45
|
| 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 |
$227.56
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| 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: Meridian Medicaid |
$120.32
|
| 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 Choice Medicaid |
$114.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.56
|
| Rate for Payer: Priority Health Medicare |
$169.82
|
| Rate for Payer: Priority Health Narrow Network |
$302.56
|
| Rate for Payer: Priority Health SBD |
$302.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.82
|
| Rate for Payer: UHC Medicare Advantage |
$169.82
|
| Rate for Payer: UHCCP Medicaid |
$114.59
|
| 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 |
$77.11 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.38
|
| Rate for Payer: BCBS Complete |
$80.97
|
| Rate for Payer: BCBS MAPPO |
$114.15
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$360.16
|
| 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: Meridian Medicaid |
$80.97
|
| 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 Choice Medicaid |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.46
|
| Rate for Payer: Priority Health Medicare |
$114.15
|
| Rate for Payer: Priority Health Narrow Network |
$202.46
|
| Rate for Payer: Priority Health SBD |
$202.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.15
|
| Rate for Payer: UHC Medicare Advantage |
$114.15
|
| Rate for Payer: UHCCP Medicaid |
$77.11
|
| 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 |
$77.11 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Aetna Medicare |
$118.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.38
|
| Rate for Payer: BCBS Complete |
$80.97
|
| Rate for Payer: BCBS MAPPO |
$114.15
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$360.16
|
| 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: Meridian Medicaid |
$80.97
|
| 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 Choice Medicaid |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.46
|
| Rate for Payer: Priority Health Medicare |
$114.15
|
| Rate for Payer: Priority Health Narrow Network |
$202.46
|
| Rate for Payer: Priority Health SBD |
$202.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.15
|
| Rate for Payer: UHC Medicare Advantage |
$114.15
|
| Rate for Payer: UHCCP Medicaid |
$77.11
|
| 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
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$113.77 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna American Axle |
$395.20
|
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$114.91
|
| Rate for Payer: BCN Commercial |
$114.91
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| 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: Health Alliance Plan Medicare Advantage |
$872.29
|
| 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: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.80
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$516.80
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$383.04
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.15
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$113.77
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: UMR Bronson Commercial |
$224.96
|
| Rate for Payer: VA VA |
$872.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$456.00
|
|
|
PR DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 64632
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$130.96 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Aetna Medicare |
$67.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.88
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCBS MAPPO |
$64.50
|
| Rate for Payer: BCN Commercial |
$130.96
|
| Rate for Payer: BCN Medicare Advantage |
$64.50
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$86.43
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.72
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Nomi Health Commercial |
$77.40
|
| Rate for Payer: PACE SWMI |
$64.50
|
| Rate for Payer: PHP Commercial |
$90.30
|
| Rate for Payer: PHP Medicare Advantage |
$64.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.32
|
| Rate for Payer: Priority Health Medicare |
$64.50
|
| Rate for Payer: Priority Health Narrow Network |
$114.32
|
| Rate for Payer: Priority Health SBD |
$114.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: UHCCP Medicaid |
$43.45
|
| Rate for Payer: UMR Bronson Commercial |
$86.94
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$1,009.58 |
| Rate for Payer: Aetna Commercial |
$204.87
|
| Rate for Payer: Aetna Medicare |
$159.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.16
|
| Rate for Payer: BCBS Complete |
$108.48
|
| Rate for Payer: BCBS MAPPO |
$152.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$152.89
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$204.87
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.53
|
| Rate for Payer: Meridian Medicaid |
$108.48
|
| Rate for Payer: Nomi Health Commercial |
$183.47
|
| Rate for Payer: PACE SWMI |
$152.89
|
| Rate for Payer: PHP Commercial |
$214.05
|
| Rate for Payer: PHP Medicare Advantage |
$152.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.42
|
| Rate for Payer: Priority Health Medicare |
$152.89
|
| Rate for Payer: Priority Health Narrow Network |
$272.42
|
| Rate for Payer: Priority Health SBD |
$272.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.89
|
| Rate for Payer: UHC Medicare Advantage |
$152.89
|
| Rate for Payer: UHCCP Medicaid |
$103.31
|
| Rate for Payer: UMR Bronson Commercial |
$315.56
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$281.60
|
| Rate for Payer: Aetna Medicare |
$218.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.62
|
| Rate for Payer: BCBS Complete |
$148.73
|
| Rate for Payer: BCBS MAPPO |
$210.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: BCN Medicare Advantage |
$210.15
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$281.60
|
| Rate for Payer: Cofinity Commercial |
$302.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.66
|
| Rate for Payer: Meridian Medicaid |
$148.73
|
| Rate for Payer: Nomi Health Commercial |
$252.18
|
| Rate for Payer: PACE SWMI |
$210.15
|
| Rate for Payer: PHP Commercial |
$294.21
|
| Rate for Payer: PHP Medicare Advantage |
$210.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.79
|
| Rate for Payer: Priority Health Medicare |
$210.15
|
| Rate for Payer: Priority Health Narrow Network |
$370.79
|
| Rate for Payer: Priority Health SBD |
$370.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.15
|
| Rate for Payer: UHC Medicare Advantage |
$210.15
|
| Rate for Payer: UHCCP Medicaid |
$141.65
|
| Rate for Payer: UMR Bronson Commercial |
$419.98
|
|
|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$3,486.25 |
| Rate for Payer: Aetna Commercial |
$310.87
|
| Rate for Payer: Aetna Medicare |
$241.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.07
|
| Rate for Payer: BCBS Complete |
$163.04
|
| Rate for Payer: BCBS MAPPO |
$231.99
|
| Rate for Payer: BCBS Trust/PPO |
$3,486.25
|
| Rate for Payer: BCN Commercial |
$682.69
|
| Rate for Payer: BCN Medicare Advantage |
$231.99
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cofinity Commercial |
$310.87
|
| Rate for Payer: Cofinity Commercial |
$334.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.59
|
| Rate for Payer: Meridian Medicaid |
$163.04
|
| Rate for Payer: Nomi Health Commercial |
$278.39
|
| Rate for Payer: PACE SWMI |
$231.99
|
| Rate for Payer: PHP Commercial |
$324.79
|
| Rate for Payer: PHP Medicare Advantage |
$231.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.64
|
| Rate for Payer: Priority Health Medicare |
$231.99
|
| Rate for Payer: Priority Health Narrow Network |
$406.64
|
| Rate for Payer: Priority Health SBD |
$406.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.99
|
| Rate for Payer: UHC Medicare Advantage |
$231.99
|
| Rate for Payer: UHCCP Medicaid |
$155.28
|
| Rate for Payer: UMR Bronson Commercial |
$413.54
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$85.55
|
| Rate for Payer: Aetna Medicare |
$66.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.93
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: BCBS MAPPO |
$63.84
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: BCN Medicare Advantage |
$63.84
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$85.55
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.03
|
| Rate for Payer: Meridian Medicaid |
$44.73
|
| Rate for Payer: Nomi Health Commercial |
$76.61
|
| Rate for Payer: PACE SWMI |
$63.84
|
| Rate for Payer: PHP Commercial |
$89.38
|
| Rate for Payer: PHP Medicare Advantage |
$63.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.17
|
| Rate for Payer: Priority Health Medicare |
$63.84
|
| Rate for Payer: Priority Health Narrow Network |
$113.17
|
| Rate for Payer: Priority Health SBD |
$113.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.84
|
| Rate for Payer: UHC Medicare Advantage |
$63.84
|
| Rate for Payer: UHCCP Medicaid |
$42.60
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$654.04 |
| Rate for Payer: Aetna Commercial |
$75.33
|
| Rate for Payer: Aetna Medicare |
$58.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$56.22
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$56.22
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$75.33
|
| Rate for Payer: Cofinity Commercial |
$80.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.03
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$67.46
|
| Rate for Payer: PACE SWMI |
$56.22
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: PHP Medicare Advantage |
$56.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.96
|
| Rate for Payer: Priority Health Medicare |
$56.22
|
| Rate for Payer: Priority Health Narrow Network |
$98.96
|
| Rate for Payer: Priority Health SBD |
$98.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.22
|
| Rate for Payer: UHC Medicare Advantage |
$56.22
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
| Rate for Payer: UMR Bronson Commercial |
$154.56
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$189.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.27
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Commercial |
$254.98
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.44
|
| Rate for Payer: Priority Health Medicare |
$182.13
|
| Rate for Payer: Priority Health Narrow Network |
$326.44
|
| Rate for Payer: Priority Health SBD |
$326.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.13
|
| Rate for Payer: UHC Medicare Advantage |
$182.13
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
| Rate for Payer: UMR Bronson Commercial |
$286.12
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$183.64 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna American Axle |
$404.30
|
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,377.83
|
| Rate for Payer: BCN Commercial |
$1,377.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$435.40
|
| Rate for Payer: Cofinity Commercial |
$534.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$559.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.50
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.70
|
| Rate for Payer: Nomi Health Commercial |
$4,017.89
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$528.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Priority Health SBD |
$391.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.00
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$183.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: UMR Bronson Commercial |
$230.14
|
| Rate for Payer: VA VA |
$1,913.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.50
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$640.16 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$189.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.27
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Commercial |
$254.98
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.44
|
| Rate for Payer: Priority Health Medicare |
$182.13
|
| Rate for Payer: Priority Health Narrow Network |
$326.44
|
| Rate for Payer: Priority Health SBD |
$326.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.13
|
| Rate for Payer: UHC Medicare Advantage |
$182.13
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
| Rate for Payer: UMR Bronson Commercial |
$286.12
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$273.68 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna American Axle |
$404.30
|
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.30
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$435.40
|
| Rate for Payer: Cofinity Commercial |
$534.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Healthscope Commercial |
$559.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.70
|
| Rate for Payer: PHP Commercial |
$528.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health SBD |
$391.86
|
| Rate for Payer: UMR Bronson Commercial |
$273.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.50
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$183.94 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna American Axle |
$399.75
|
| Rate for Payer: Aetna Commercial |
$522.75
|
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.61
|
| Rate for Payer: BCN Commercial |
$1,543.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$430.50
|
| Rate for Payer: Cofinity Commercial |
$528.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$430.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Healthscope Commercial |
$553.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$430.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.25
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.75
|
| Rate for Payer: Nomi Health Commercial |
$4,017.89
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Commercial |
$522.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Priority Health SBD |
$387.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.33
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$183.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: UMR Bronson Commercial |
$227.55
|
| Rate for Payer: VA VA |
$1,913.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.25
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$189.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.14
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Commercial |
$254.86
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.01
|
| Rate for Payer: Priority Health Medicare |
$182.04
|
| Rate for Payer: Priority Health Narrow Network |
$327.01
|
| Rate for Payer: Priority Health SBD |
$327.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
| Rate for Payer: UMR Bronson Commercial |
$282.90
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 64635
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$825.20 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$189.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.14
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCBS Trust/PPO |
$825.20
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Commercial |
$254.86
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.01
|
| Rate for Payer: Priority Health Medicare |
$182.04
|
| Rate for Payer: Priority Health Narrow Network |
$327.01
|
| Rate for Payer: Priority Health SBD |
$327.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
| Rate for Payer: UHCCP Medicaid |
$122.90
|
| Rate for Payer: UMR Bronson Commercial |
$282.90
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Aetna American Axle |
$399.75
|
| Rate for Payer: Aetna Commercial |
$522.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.75
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$430.50
|
| Rate for Payer: Cofinity Commercial |
$528.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$430.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Healthscope Commercial |
$553.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$430.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.75
|
| Rate for Payer: PHP Commercial |
$522.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health SBD |
$387.45
|
| Rate for Payer: UMR Bronson Commercial |
$270.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.25
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$95.50 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.50
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS Trust/PPO |
$89.92
|
| Rate for Payer: BCN Commercial |
$88.25
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
