|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
46900
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna American Axle |
$243.75
|
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health SBD |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$165.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
PR DSTRJ LESION ANUS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 46916
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$1,647.77 |
| Rate for Payer: Aetna Commercial |
$184.99
|
| Rate for Payer: BCBS Complete |
$95.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,647.77
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Meridian Medicaid |
$95.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.12
|
| Rate for Payer: Priority Health Narrow Network |
$248.12
|
| Rate for Payer: Priority Health SBD |
$248.12
|
| Rate for Payer: UMR Bronson Commercial |
$185.84
|
|
|
PR DSTRJ LESION ANUS SIMPLE LASER SURG
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 46917
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$1,832.14 |
| Rate for Payer: Aetna Commercial |
$169.46
|
| Rate for Payer: BCBS Complete |
$87.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,832.14
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Meridian Medicaid |
$87.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.38
|
| Rate for Payer: Priority Health Narrow Network |
$226.38
|
| Rate for Payer: Priority Health SBD |
$226.38
|
| Rate for Payer: UMR Bronson Commercial |
$322.00
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
46922
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$414.90 |
| Rate for Payer: Aetna American Axle |
$299.65
|
| Rate for Payer: Aetna Commercial |
$391.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.65
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$322.70
|
| Rate for Payer: Cofinity Commercial |
$396.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.80
|
| Rate for Payer: Healthscope Commercial |
$414.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$322.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$391.85
|
| Rate for Payer: PHP Commercial |
$391.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health SBD |
$290.43
|
| Rate for Payer: UMR Bronson Commercial |
$202.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.75
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
46922
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$1,491.39 |
| Rate for Payer: Aetna Commercial |
$181.18
|
| Rate for Payer: BCBS Complete |
$93.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.39
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Meridian Medicaid |
$93.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.83
|
| Rate for Payer: Priority Health Narrow Network |
$242.83
|
| Rate for Payer: Priority Health SBD |
$242.83
|
| Rate for Payer: UMR Bronson Commercial |
$233.22
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 46922
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$1,491.39 |
| Rate for Payer: Aetna Commercial |
$181.18
|
| Rate for Payer: BCBS Complete |
$93.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.39
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Meridian Medicaid |
$93.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.83
|
| Rate for Payer: Priority Health Narrow Network |
$242.83
|
| Rate for Payer: Priority Health SBD |
$242.83
|
| Rate for Payer: UMR Bronson Commercial |
$233.22
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
46922
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.54 |
| Max. Negotiated Rate |
$7,856.86 |
| Rate for Payer: Aetna American Axle |
$299.65
|
| Rate for Payer: Aetna Commercial |
$391.85
|
| Rate for Payer: Aetna Medicare |
$2,595.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,294.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$396.46
|
| Rate for Payer: Cofinity Commercial |
$322.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Healthscope Commercial |
$414.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$322.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.75
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$391.85
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Commercial |
$391.85
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,856.86
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$6,285.49
|
| Rate for Payer: Priority Health SBD |
$290.43
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,495.78
|
| Rate for Payer: UHC Exchange |
$136.54
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: UMR Bronson Commercial |
$170.57
|
| Rate for Payer: VA VA |
$2,495.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.75
|
|
|
PR DSTRJ LESION ANUS SMPL ELTRDSICCATION
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 46910
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$2,583.92 |
| Rate for Payer: Aetna Commercial |
$178.48
|
| Rate for Payer: BCBS Complete |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,583.92
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Meridian Medicaid |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.37
|
| Rate for Payer: Priority Health Narrow Network |
$236.37
|
| Rate for Payer: Priority Health SBD |
$236.37
|
| Rate for Payer: UMR Bronson Commercial |
$187.22
|
|
|
PR DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 42160
|
| Min. Negotiated Rate |
$90.53 |
| Max. Negotiated Rate |
$295.40 |
| Rate for Payer: Aetna Commercial |
$189.22
|
| Rate for Payer: BCBS Complete |
$95.06
|
| Rate for Payer: BCBS Trust/PPO |
$264.46
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Meridian Medicaid |
$95.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.82
|
| Rate for Payer: Priority Health Narrow Network |
$252.82
|
| Rate for Payer: Priority Health SBD |
$252.82
|
| Rate for Payer: UMR Bronson Commercial |
$194.12
|
|
|
PR DSTRJ LESION PENIS EXTENSIVE
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 54065
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$1,527.84 |
| Rate for Payer: Aetna Commercial |
$215.30
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,527.84
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.57
|
| Rate for Payer: Priority Health Narrow Network |
$275.57
|
| Rate for Payer: Priority Health SBD |
$275.57
|
| Rate for Payer: UMR Bronson Commercial |
$209.76
|
|
|
PR DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 54050
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$1,664.67 |
| Rate for Payer: Aetna Commercial |
$132.50
|
| Rate for Payer: BCBS Complete |
$72.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.67
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Meridian Medicaid |
$72.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.37
|
| Rate for Payer: Priority Health Narrow Network |
$172.37
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$101.20
|
|
|
PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 54056
|
| Min. Negotiated Rate |
$71.99 |
| Max. Negotiated Rate |
$1,380.45 |
| Rate for Payer: Aetna Commercial |
$137.02
|
| Rate for Payer: BCBS Complete |
$75.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.45
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Meridian Medicaid |
$75.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.41
|
| Rate for Payer: Priority Health Narrow Network |
$179.41
|
| Rate for Payer: Priority Health SBD |
$179.41
|
| Rate for Payer: UMR Bronson Commercial |
$121.90
|
|
|
PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 54055
|
| Min. Negotiated Rate |
$61.77 |
| Max. Negotiated Rate |
$1,009.58 |
| Rate for Payer: Aetna Commercial |
$119.53
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Meridian Medicaid |
$64.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.55
|
| Rate for Payer: Priority Health Narrow Network |
$154.55
|
| Rate for Payer: Priority Health SBD |
$154.55
|
| Rate for Payer: UMR Bronson Commercial |
$95.22
|
|
|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$2,378.41 |
| Rate for Payer: Aetna Commercial |
$121.38
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.41
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.78
|
| Rate for Payer: Priority Health Narrow Network |
$157.78
|
| Rate for Payer: Priority Health SBD |
$157.78
|
| Rate for Payer: UMR Bronson Commercial |
$112.24
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$1,575.39 |
| Rate for Payer: Aetna Commercial |
$165.73
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.39
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.20
|
| Rate for Payer: Priority Health Narrow Network |
$210.20
|
| Rate for Payer: Priority Health SBD |
$210.20
|
| Rate for Payer: UMR Bronson Commercial |
$165.60
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$963.62 |
| Rate for Payer: Aetna Commercial |
$221.49
|
| Rate for Payer: BCBS Complete |
$112.05
|
| Rate for Payer: BCBS Trust/PPO |
$963.62
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Meridian Medicaid |
$112.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.81
|
| Rate for Payer: Priority Health Narrow Network |
$292.81
|
| Rate for Payer: Priority Health SBD |
$292.81
|
| Rate for Payer: UMR Bronson Commercial |
$211.60
|
|
|
PR DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
HCPCS 17276
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$216.11
|
| Rate for Payer: BCBS Complete |
$134.86
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Meridian Medicaid |
$134.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.21
|
| Rate for Payer: Priority Health Narrow Network |
$246.21
|
| Rate for Payer: Priority Health SBD |
$246.21
|
| Rate for Payer: UMR Bronson Commercial |
$256.22
|
|
|
PR DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 64610
|
| Min. Negotiated Rate |
$309.49 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Aetna Commercial |
$624.37
|
| Rate for Payer: BCBS Complete |
$324.96
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Meridian Medicaid |
$324.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$819.90
|
| Rate for Payer: Priority Health Narrow Network |
$819.90
|
| Rate for Payer: Priority Health SBD |
$819.90
|
| Rate for Payer: UMR Bronson Commercial |
$546.48
|
|
|
PR DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 64620
|
| Min. Negotiated Rate |
$113.32 |
| Max. Negotiated Rate |
$1,271.09 |
| Rate for Payer: Aetna Commercial |
$225.82
|
| Rate for Payer: BCBS Complete |
$118.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Meridian Medicaid |
$118.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.84
|
| Rate for Payer: Priority Health Narrow Network |
$297.84
|
| Rate for Payer: Priority Health SBD |
$297.84
|
| Rate for Payer: UMR Bronson Commercial |
$348.22
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$2,550.52 |
| Rate for Payer: Aetna American Axle |
$387.40
|
| Rate for Payer: Aetna Commercial |
$506.60
|
| Rate for Payer: Aetna Medicare |
$842.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$109.56
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$417.20
|
| Rate for Payer: Cofinity Commercial |
$512.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$536.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.00
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.60
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$506.60
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,550.52
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,040.42
|
| Rate for Payer: Priority Health SBD |
$375.48
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.19
|
| Rate for Payer: UHC Exchange |
$116.57
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: UMR Bronson Commercial |
$220.52
|
| Rate for Payer: VA VA |
$810.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.00
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 64640
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$151.56
|
| Rate for Payer: BCBS Complete |
$79.62
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Meridian Medicaid |
$79.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.19
|
| Rate for Payer: Priority Health Narrow Network |
$198.19
|
| Rate for Payer: Priority Health SBD |
$198.19
|
| Rate for Payer: UMR Bronson Commercial |
$274.16
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$262.24 |
| Max. Negotiated Rate |
$536.40 |
| Rate for Payer: Aetna American Axle |
$387.40
|
| Rate for Payer: Aetna Commercial |
$506.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.40
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$417.20
|
| Rate for Payer: Cofinity Commercial |
$512.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.80
|
| Rate for Payer: Healthscope Commercial |
$536.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.60
|
| Rate for Payer: PHP Commercial |
$506.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health SBD |
$375.48
|
| Rate for Payer: UMR Bronson Commercial |
$262.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.00
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
64640
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$151.56
|
| Rate for Payer: BCBS Complete |
$79.62
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Meridian Medicaid |
$79.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.19
|
| Rate for Payer: Priority Health Narrow Network |
$198.19
|
| Rate for Payer: Priority Health SBD |
$198.19
|
| Rate for Payer: UMR Bronson Commercial |
$274.16
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$1,009.58 |
| Rate for Payer: Aetna Commercial |
$206.19
|
| Rate for Payer: BCBS Complete |
$107.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.58
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Meridian Medicaid |
$107.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.22
|
| Rate for Payer: Priority Health Narrow Network |
$271.22
|
| Rate for Payer: Priority Health SBD |
$271.22
|
| Rate for Payer: UMR Bronson Commercial |
$309.58
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$138.88 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$288.28
|
| Rate for Payer: BCBS Complete |
$145.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Meridian Medicaid |
$145.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.15
|
| Rate for Payer: Priority Health Narrow Network |
$373.15
|
| Rate for Payer: Priority Health SBD |
$373.15
|
| Rate for Payer: UMR Bronson Commercial |
$411.70
|
|
