|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$193.01
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.92 |
| Max. Negotiated Rate |
$173.71 |
| Rate for Payer: Aetna American Axle |
$125.46
|
| Rate for Payer: Aetna American Axle |
$52.19
|
| Rate for Payer: Aetna American Axle |
$396.54
|
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna American Axle |
$1,277.30
|
| Rate for Payer: Aetna American Axle |
$38.82
|
| Rate for Payer: Aetna American Axle |
$57.79
|
| Rate for Payer: Aetna Commercial |
$68.25
|
| Rate for Payer: Aetna Commercial |
$1,670.31
|
| Rate for Payer: Aetna Commercial |
$50.76
|
| Rate for Payer: Aetna Commercial |
$518.55
|
| Rate for Payer: Aetna Commercial |
$75.57
|
| Rate for Payer: Aetna Commercial |
$227.71
|
| Rate for Payer: Aetna Commercial |
$164.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,277.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.19
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$64.23
|
| Rate for Payer: Cash Price |
$1,572.06
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cofinity Commercial |
$69.05
|
| Rate for Payer: Cofinity Commercial |
$135.11
|
| Rate for Payer: Cofinity Commercial |
$51.36
|
| Rate for Payer: Cofinity Commercial |
$41.80
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Cofinity Commercial |
$1,375.55
|
| Rate for Payer: Cofinity Commercial |
$1,689.96
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$165.99
|
| Rate for Payer: Cofinity Commercial |
$427.04
|
| Rate for Payer: Cofinity Commercial |
$524.65
|
| Rate for Payer: Cofinity Commercial |
$56.20
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$76.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$427.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,375.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,572.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.41
|
| Rate for Payer: Healthscope Commercial |
$80.02
|
| Rate for Payer: Healthscope Commercial |
$549.05
|
| Rate for Payer: Healthscope Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$1,768.56
|
| Rate for Payer: Healthscope Commercial |
$173.71
|
| Rate for Payer: Healthscope Commercial |
$72.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,375.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,670.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: PHP Commercial |
$518.55
|
| Rate for Payer: PHP Commercial |
$227.71
|
| Rate for Payer: PHP Commercial |
$50.76
|
| Rate for Payer: PHP Commercial |
$164.06
|
| Rate for Payer: PHP Commercial |
$1,670.31
|
| Rate for Payer: PHP Commercial |
$75.57
|
| Rate for Payer: PHP Commercial |
$68.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,277.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.54
|
| Rate for Payer: Priority Health SBD |
$168.77
|
| Rate for Payer: Priority Health SBD |
$1,237.99
|
| Rate for Payer: Priority Health SBD |
$121.60
|
| Rate for Payer: Priority Health SBD |
$56.01
|
| Rate for Payer: Priority Health SBD |
$50.58
|
| Rate for Payer: Priority Health SBD |
$384.34
|
| Rate for Payer: Priority Health SBD |
$37.62
|
| Rate for Payer: UMR Bronson Commercial |
$26.28
|
| Rate for Payer: UMR Bronson Commercial |
$39.12
|
| Rate for Payer: UMR Bronson Commercial |
$268.43
|
| Rate for Payer: UMR Bronson Commercial |
$35.33
|
| Rate for Payer: UMR Bronson Commercial |
$84.92
|
| Rate for Payer: UMR Bronson Commercial |
$117.87
|
| Rate for Payer: UMR Bronson Commercial |
$864.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.76
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$80.29
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$72.26 |
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Aetna American Axle |
$52.19
|
| Rate for Payer: Aetna American Axle |
$396.54
|
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna American Axle |
$57.79
|
| Rate for Payer: Aetna American Axle |
$1,277.30
|
| Rate for Payer: Aetna American Axle |
$38.82
|
| Rate for Payer: Aetna American Axle |
$125.46
|
| Rate for Payer: Aetna Commercial |
$50.76
|
| Rate for Payer: Aetna Commercial |
$164.06
|
| Rate for Payer: Aetna Commercial |
$518.55
|
| Rate for Payer: Aetna Commercial |
$1,670.31
|
| Rate for Payer: Aetna Commercial |
$68.25
|
| Rate for Payer: Aetna Commercial |
$75.57
|
| Rate for Payer: Aetna Commercial |
$227.71
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,277.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$64.23
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$64.23
|
| Rate for Payer: Cash Price |
$1,572.06
|
| Rate for Payer: Cash Price |
$1,572.06
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Cofinity Commercial |
$41.80
|
| Rate for Payer: Cofinity Commercial |
$165.99
|
| Rate for Payer: Cofinity Commercial |
$135.11
|
| Rate for Payer: Cofinity Commercial |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$69.05
|
| Rate for Payer: Cofinity Commercial |
$56.20
|
| Rate for Payer: Cofinity Commercial |
$1,375.55
|
| Rate for Payer: Cofinity Commercial |
$1,689.96
|
| Rate for Payer: Cofinity Commercial |
$524.65
|
| Rate for Payer: Cofinity Commercial |
$427.04
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$51.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,375.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$427.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,572.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$72.26
|
| Rate for Payer: Healthscope Commercial |
$1,768.56
|
| Rate for Payer: Healthscope Commercial |
$80.02
|
| Rate for Payer: Healthscope Commercial |
$173.71
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$549.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,375.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.54
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,670.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$518.55
|
| Rate for Payer: PHP Commercial |
$75.57
|
| Rate for Payer: PHP Commercial |
$68.25
|
| Rate for Payer: PHP Commercial |
$227.71
|
| Rate for Payer: PHP Commercial |
$164.06
|
| Rate for Payer: PHP Commercial |
$50.76
|
| Rate for Payer: PHP Commercial |
$1,670.31
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,277.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health SBD |
$50.58
|
| Rate for Payer: Priority Health SBD |
$121.60
|
| Rate for Payer: Priority Health SBD |
$37.62
|
| Rate for Payer: Priority Health SBD |
$168.77
|
| Rate for Payer: Priority Health SBD |
$384.34
|
| Rate for Payer: Priority Health SBD |
$1,237.99
|
| Rate for Payer: Priority Health SBD |
$56.01
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$29.71
|
| Rate for Payer: UMR Bronson Commercial |
$225.72
|
| Rate for Payer: UMR Bronson Commercial |
$32.90
|
| Rate for Payer: UMR Bronson Commercial |
$71.41
|
| Rate for Payer: UMR Bronson Commercial |
$22.10
|
| Rate for Payer: UMR Bronson Commercial |
$99.12
|
| Rate for Payer: UMR Bronson Commercial |
$727.08
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.80
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION BRANCHES AT FORAMEN OVALE UNDER RADIOLOGIC MONITORING
|
Facility
|
OP
|
$6,013.44
|
|
|
Service Code
|
CPT 64610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$474.40 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| 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 |
$1,433.52
|
| Rate for Payer: BCN Commercial |
$1,433.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| 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: 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 Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| 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: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$521.84
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$474.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; 15 OR MORE LESIONS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.56 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| 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 |
$308.81
|
| Rate for Payer: BCN Commercial |
$308.81
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| 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: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| 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: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.42
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$78.56
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.39 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| 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: Health Alliance Plan Medicare Advantage |
$194.68
|
| 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: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| 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: 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: VA VA |
$194.68
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.39 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| 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: Health Alliance Plan Medicare Advantage |
$194.68
|
| 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: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| 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: 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: VA VA |
$194.68
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES); FIRST LESION
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| 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 |
$127.86
|
| Rate for Payer: BCN Commercial |
$127.86
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| 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: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| 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: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.99
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$51.81
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES); FIRST LESION
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| 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 |
$127.86
|
| Rate for Payer: BCN Commercial |
$127.86
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| 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: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| 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: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.99
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$51.81
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES); SECOND THROUGH 14 LESIONS, EACH (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST LESION)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.10
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$1.91
|
|
|
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); LESS THAN 10 SQ CM
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 17106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Medicare |
$407.11
|
| 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: Health Alliance Plan Medicare Advantage |
$391.45
|
| 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: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| 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: 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: VA VA |
$391.45
|
|
|
DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO OR CHEMICAL)
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 42160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.23 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$217.01
|
| Rate for Payer: BCN Commercial |
$217.01
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.65
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$134.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,892.53
|
| Rate for Payer: BCN Commercial |
$2,892.53
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.22
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$174.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,440.20
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 46910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$241.70
|
| Rate for Payer: BCN Commercial |
$241.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.35
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$130.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$124.48 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,566.79
|
| Rate for Payer: BCN Commercial |
$1,566.79
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.93
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$124.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,440.20
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$133.05 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,406.74
|
| Rate for Payer: BCN Commercial |
$2,406.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.36
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$133.05
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,440.20
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 54065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$163.65 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.99
|
| Rate for Payer: BCN Commercial |
$1,401.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.02
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$163.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 54055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.44 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$94.01
|
| Rate for Payer: BCN Commercial |
$94.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.58
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$91.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 54057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.43 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.99
|
| Rate for Payer: BCN Commercial |
$1,401.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.77
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$93.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 54060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.25 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,874.65
|
| Rate for Payer: BCN Commercial |
$1,874.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.88
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$126.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 56515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$205.07 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.84
|
| Rate for Payer: BCN Commercial |
$2,925.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.58
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$205.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DESTRUCTION OF LESION(S), VULVA; SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 56501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.47 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.72
|
| Rate for Payer: BCN Commercial |
$1,935.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.22
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$127.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,350.05
|
| Rate for Payer: BCN Commercial |
$1,350.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.32
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$179.38
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
DESTRUCTION OF VAGINAL LESION(S); SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$83.12 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$83.12
|
| Rate for Payer: BCN Commercial |
$83.12
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.09
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$110.08
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$82.37
|
|
|
Service Code
|
NDC 51991000633
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna American Axle |
$53.54
|
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Commercial |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.54
|
| Rate for Payer: Priority Health SBD |
$51.89
|
| Rate for Payer: UMR Bronson Commercial |
$36.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$82.37
|
|
|
Service Code
|
NDC 51991000633
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna American Axle |
$53.54
|
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna Medicare |
$41.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: BCBS Complete |
$32.95
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Commercial |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.54
|
| Rate for Payer: Priority Health SBD |
$51.89
|
| Rate for Payer: UMR Bronson Commercial |
$30.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
