|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT
|
Professional
|
Both
|
$4,985.00
|
|
|
Service Code
|
HCPCS 34706
|
| Min. Negotiated Rate |
$1,307.82 |
| Max. Negotiated Rate |
$4,152.60 |
| Rate for Payer: Aetna Commercial |
$2,786.99
|
| Rate for Payer: Aetna Medicare |
$2,163.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,786.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,994.97
|
| Rate for Payer: BCBS Complete |
$1,373.21
|
| Rate for Payer: BCBS MAPPO |
$2,079.84
|
| Rate for Payer: BCN Commercial |
$3,319.04
|
| Rate for Payer: BCN Medicare Advantage |
$2,079.84
|
| Rate for Payer: Cash Price |
$3,988.00
|
| Rate for Payer: Cash Price |
$3,988.00
|
| Rate for Payer: Cofinity Commercial |
$2,994.97
|
| Rate for Payer: Cofinity Commercial |
$2,786.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,079.84
|
| Rate for Payer: Healthscope Commercial |
$3,847.70
|
| Rate for Payer: Healthscope Commercial |
$3,327.74
|
| Rate for Payer: Mclaren Medicaid |
$1,307.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,183.83
|
| Rate for Payer: Meridian Medicaid |
$1,373.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,287.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,036.16
|
| Rate for Payer: Nomi Health Commercial |
$2,495.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,738.75
|
| Rate for Payer: PACE SWMI |
$2,079.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,079.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,307.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,569.20
|
| Rate for Payer: Priority Health Medicare |
$2,079.84
|
| Rate for Payer: Priority Health SBD |
$3,569.20
|
| Rate for Payer: Priority Health Tiered Network |
$3,569.20
|
| Rate for Payer: Railroad Medicare Medicare |
$2,079.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,152.60
|
| Rate for Payer: UHC Core |
$4,152.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,079.84
|
| Rate for Payer: UHC Exchange |
$4,152.60
|
| Rate for Payer: UHC Medicaid |
$1,307.82
|
| Rate for Payer: UHCCP Medicaid |
$1,307.82
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 34703
|
| Min. Negotiated Rate |
$789.38 |
| Max. Negotiated Rate |
$2,465.16 |
| Rate for Payer: Aetna Commercial |
$1,677.83
|
| Rate for Payer: Aetna Medicare |
$1,302.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,803.04
|
| Rate for Payer: BCBS Complete |
$828.85
|
| Rate for Payer: BCBS MAPPO |
$1,252.11
|
| Rate for Payer: BCN Commercial |
$2,000.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,252.11
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$1,803.04
|
| Rate for Payer: Cofinity Commercial |
$1,677.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,252.11
|
| Rate for Payer: Healthscope Commercial |
$2,316.40
|
| Rate for Payer: Healthscope Commercial |
$2,003.38
|
| Rate for Payer: Mclaren Medicaid |
$789.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,314.72
|
| Rate for Payer: Meridian Medicaid |
$828.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,377.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.77
|
| Rate for Payer: Nomi Health Commercial |
$1,502.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,253.75
|
| Rate for Payer: PACE SWMI |
$1,252.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,252.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,151.17
|
| Rate for Payer: Priority Health Medicare |
$1,252.11
|
| Rate for Payer: Priority Health SBD |
$2,151.17
|
| Rate for Payer: Priority Health Tiered Network |
$2,151.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,252.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,465.16
|
| Rate for Payer: UHC Core |
$2,465.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,252.11
|
| Rate for Payer: UHC Exchange |
$2,465.16
|
| Rate for Payer: UHC Medicaid |
$789.38
|
| Rate for Payer: UHCCP Medicaid |
$789.38
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT
|
Professional
|
Both
|
$2,486.00
|
|
|
Service Code
|
HCPCS 34707
|
| Min. Negotiated Rate |
$670.10 |
| Max. Negotiated Rate |
$2,084.83 |
| Rate for Payer: Aetna Commercial |
$1,422.62
|
| Rate for Payer: Aetna Medicare |
$1,104.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,422.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,528.79
|
| Rate for Payer: BCBS Complete |
$703.61
|
| Rate for Payer: BCBS MAPPO |
$1,061.66
|
| Rate for Payer: BCN Commercial |
$1,696.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,061.66
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Cofinity Commercial |
$1,528.79
|
| Rate for Payer: Cofinity Commercial |
$1,422.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,061.66
|
| Rate for Payer: Healthscope Commercial |
$1,964.07
|
| Rate for Payer: Healthscope Commercial |
$1,698.66
|
| Rate for Payer: Mclaren Medicaid |
$670.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,114.74
|
| Rate for Payer: Meridian Medicaid |
$703.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,167.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.83
|
| Rate for Payer: Nomi Health Commercial |
$1,273.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,864.50
|
| Rate for Payer: PACE SWMI |
$1,061.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,061.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$670.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,823.96
|
| Rate for Payer: Priority Health Medicare |
$1,061.66
|
| Rate for Payer: Priority Health SBD |
$1,823.96
|
| Rate for Payer: Priority Health Tiered Network |
$1,823.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,061.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,084.83
|
| Rate for Payer: UHC Core |
$2,084.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,061.66
|
| Rate for Payer: UHC Exchange |
$2,084.83
|
| Rate for Payer: UHC Medicaid |
$670.10
|
| Rate for Payer: UHCCP Medicaid |
$670.10
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT
|
Professional
|
Both
|
$4,016.00
|
|
|
Service Code
|
HCPCS 34708
|
| Min. Negotiated Rate |
$1,051.79 |
| Max. Negotiated Rate |
$3,333.14 |
| Rate for Payer: PHP Medicare Advantage |
$1,675.06
|
| Rate for Payer: Aetna Commercial |
$2,244.58
|
| Rate for Payer: Aetna Medicare |
$1,742.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,244.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,412.09
|
| Rate for Payer: BCBS Complete |
$1,104.38
|
| Rate for Payer: BCBS MAPPO |
$1,675.06
|
| Rate for Payer: BCN Commercial |
$2,652.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,675.06
|
| Rate for Payer: Cash Price |
$3,212.80
|
| Rate for Payer: Cash Price |
$3,212.80
|
| Rate for Payer: Cofinity Commercial |
$2,412.09
|
| Rate for Payer: Cofinity Commercial |
$2,244.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,675.06
|
| Rate for Payer: Healthscope Commercial |
$3,098.86
|
| Rate for Payer: Healthscope Commercial |
$2,680.10
|
| Rate for Payer: Mclaren Medicaid |
$1,051.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,758.81
|
| Rate for Payer: Meridian Medicaid |
$1,104.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,842.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,229.65
|
| Rate for Payer: Nomi Health Commercial |
$2,010.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,012.00
|
| Rate for Payer: PACE SWMI |
$1,675.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,051.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,852.15
|
| Rate for Payer: Priority Health Medicare |
$1,675.06
|
| Rate for Payer: Priority Health SBD |
$2,852.15
|
| Rate for Payer: Priority Health Tiered Network |
$2,852.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,675.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,333.14
|
| Rate for Payer: UHC Core |
$3,333.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,675.06
|
| Rate for Payer: UHC Exchange |
$3,333.14
|
| Rate for Payer: UHC Medicaid |
$1,051.79
|
| Rate for Payer: UHCCP Medicaid |
$1,051.79
|
|
|
PR EVASC RPR ILAC ART BIFUR ENDGRFT CATHJ RS&I UNI
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 0254T
|
| Min. Negotiated Rate |
$395.20 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna Medicare |
$494.00
|
| Rate for Payer: BCBS Complete |
$395.20
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.00
|
|
|
PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
HCPCS 34718
|
| Min. Negotiated Rate |
$709.50 |
| Max. Negotiated Rate |
$2,230.58 |
| Rate for Payer: Aetna Commercial |
$1,509.22
|
| Rate for Payer: Aetna Medicare |
$1,171.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,621.84
|
| Rate for Payer: BCBS Complete |
$744.98
|
| Rate for Payer: BCBS MAPPO |
$1,126.28
|
| Rate for Payer: BCN Commercial |
$1,801.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,126.28
|
| Rate for Payer: Cash Price |
$1,781.60
|
| Rate for Payer: Cash Price |
$1,781.60
|
| Rate for Payer: Cofinity Commercial |
$1,621.84
|
| Rate for Payer: Cofinity Commercial |
$1,509.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,126.28
|
| Rate for Payer: Healthscope Commercial |
$1,802.05
|
| Rate for Payer: Healthscope Commercial |
$2,083.62
|
| Rate for Payer: Mclaren Medicaid |
$709.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,182.59
|
| Rate for Payer: Meridian Medicaid |
$744.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,238.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,186.86
|
| Rate for Payer: Nomi Health Commercial |
$1,351.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,670.25
|
| Rate for Payer: PACE SWMI |
$1,126.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,126.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$709.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,937.50
|
| Rate for Payer: Priority Health Medicare |
$1,126.28
|
| Rate for Payer: Priority Health SBD |
$1,937.50
|
| Rate for Payer: Priority Health Tiered Network |
$1,937.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,126.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,230.58
|
| Rate for Payer: UHC Core |
$2,230.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,126.28
|
| Rate for Payer: UHC Exchange |
$2,230.58
|
| Rate for Payer: UHC Medicaid |
$709.50
|
| Rate for Payer: UHCCP Medicaid |
$709.50
|
|
|
PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 34717
|
| Min. Negotiated Rate |
$253.04 |
| Max. Negotiated Rate |
$802.52 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Medicare |
$419.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.39
|
| Rate for Payer: BCBS Complete |
$265.69
|
| Rate for Payer: BCBS MAPPO |
$403.74
|
| Rate for Payer: BCN Commercial |
$642.39
|
| Rate for Payer: BCN Medicare Advantage |
$403.74
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$581.39
|
| Rate for Payer: Cofinity Commercial |
$541.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.74
|
| Rate for Payer: Healthscope Commercial |
$746.92
|
| Rate for Payer: Healthscope Commercial |
$645.98
|
| Rate for Payer: Mclaren Medicaid |
$253.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.93
|
| Rate for Payer: Meridian Medicaid |
$265.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$444.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.72
|
| Rate for Payer: Nomi Health Commercial |
$484.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.75
|
| Rate for Payer: PACE SWMI |
$403.74
|
| Rate for Payer: PHP Medicare Advantage |
$403.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$690.82
|
| Rate for Payer: Priority Health Medicare |
$403.74
|
| Rate for Payer: Priority Health SBD |
$690.82
|
| Rate for Payer: Priority Health Tiered Network |
$690.82
|
| Rate for Payer: Railroad Medicare Medicare |
$403.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$802.52
|
| Rate for Payer: UHC Core |
$802.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$403.74
|
| Rate for Payer: UHC Exchange |
$802.52
|
| Rate for Payer: UHC Medicaid |
$253.04
|
| Rate for Payer: UHCCP Medicaid |
$253.04
|
|
|
PR EVASC RPR TA DPLMNT AORT-ARTC TUBE NDGFT COV LSA
|
Professional
|
Both
|
$8,492.00
|
|
|
Service Code
|
HCPCS 33880
|
| Min. Negotiated Rate |
$820.90 |
| Max. Negotiated Rate |
$6,369.00 |
| Rate for Payer: Aetna Commercial |
$1,741.01
|
| Rate for Payer: Aetna Medicare |
$1,351.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,741.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,870.93
|
| Rate for Payer: BCBS Complete |
$861.95
|
| Rate for Payer: BCBS MAPPO |
$1,299.26
|
| Rate for Payer: BCN Commercial |
$2,603.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,299.26
|
| Rate for Payer: Cash Price |
$6,793.60
|
| Rate for Payer: Cash Price |
$6,793.60
|
| Rate for Payer: Cofinity Commercial |
$1,870.93
|
| Rate for Payer: Cofinity Commercial |
$1,741.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,299.26
|
| Rate for Payer: Healthscope Commercial |
$2,403.63
|
| Rate for Payer: Healthscope Commercial |
$2,078.82
|
| Rate for Payer: Mclaren Medicaid |
$820.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,364.22
|
| Rate for Payer: Meridian Medicaid |
$861.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,429.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,172.34
|
| Rate for Payer: Nomi Health Commercial |
$1,559.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,369.00
|
| Rate for Payer: PACE SWMI |
$1,299.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,299.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,799.68
|
| Rate for Payer: Priority Health Medicare |
$1,299.26
|
| Rate for Payer: Priority Health SBD |
$2,799.68
|
| Rate for Payer: Priority Health Tiered Network |
$2,799.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,299.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,217.36
|
| Rate for Payer: UHC Core |
$3,217.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,299.26
|
| Rate for Payer: UHC Exchange |
$3,217.36
|
| Rate for Payer: UHC Medicaid |
$820.90
|
| Rate for Payer: UHCCP Medicaid |
$820.90
|
|
|
PR EVASC RPR TA DPLMNT AORT-ARTC TUB NDGFT XCOV LSA
|
Professional
|
Both
|
$5,669.00
|
|
|
Service Code
|
HCPCS 33881
|
| Min. Negotiated Rate |
$689.27 |
| Max. Negotiated Rate |
$4,251.75 |
| Rate for Payer: Aetna Commercial |
$1,460.96
|
| Rate for Payer: Aetna Medicare |
$1,133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,460.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,569.99
|
| Rate for Payer: BCBS Complete |
$723.73
|
| Rate for Payer: BCBS MAPPO |
$1,090.27
|
| Rate for Payer: BCN Commercial |
$2,236.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,090.27
|
| Rate for Payer: Cash Price |
$4,535.20
|
| Rate for Payer: Cash Price |
$4,535.20
|
| Rate for Payer: Cofinity Commercial |
$1,569.99
|
| Rate for Payer: Cofinity Commercial |
$1,460.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,090.27
|
| Rate for Payer: Healthscope Commercial |
$2,017.00
|
| Rate for Payer: Healthscope Commercial |
$1,744.43
|
| Rate for Payer: Mclaren Medicaid |
$689.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,144.78
|
| Rate for Payer: Meridian Medicaid |
$723.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,199.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,717.37
|
| Rate for Payer: Nomi Health Commercial |
$1,308.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,251.75
|
| Rate for Payer: PACE SWMI |
$1,090.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,090.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,405.00
|
| Rate for Payer: Priority Health Medicare |
$1,090.27
|
| Rate for Payer: Priority Health SBD |
$2,405.00
|
| Rate for Payer: Priority Health Tiered Network |
$2,405.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,090.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,761.41
|
| Rate for Payer: UHC Core |
$2,761.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,090.27
|
| Rate for Payer: UHC Exchange |
$2,761.41
|
| Rate for Payer: UHC Medicaid |
$689.27
|
| Rate for Payer: UHCCP Medicaid |
$689.27
|
|
|
PR EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK
|
Professional
|
Both
|
$3,436.00
|
|
|
Service Code
|
HCPCS 61623
|
| Min. Negotiated Rate |
$330.58 |
| Max. Negotiated Rate |
$2,577.00 |
| Rate for Payer: Aetna Commercial |
$700.49
|
| Rate for Payer: Aetna Medicare |
$543.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.76
|
| Rate for Payer: BCBS Complete |
$347.11
|
| Rate for Payer: BCBS MAPPO |
$522.75
|
| Rate for Payer: BCN Commercial |
$861.51
|
| Rate for Payer: BCN Medicare Advantage |
$522.75
|
| Rate for Payer: Cash Price |
$2,748.80
|
| Rate for Payer: Cash Price |
$2,748.80
|
| Rate for Payer: Cofinity Commercial |
$752.76
|
| Rate for Payer: Cofinity Commercial |
$700.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.75
|
| Rate for Payer: Healthscope Commercial |
$967.09
|
| Rate for Payer: Healthscope Commercial |
$836.40
|
| Rate for Payer: Mclaren Medicaid |
$330.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$548.89
|
| Rate for Payer: Meridian Medicaid |
$347.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$575.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.05
|
| Rate for Payer: Nomi Health Commercial |
$627.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,577.00
|
| Rate for Payer: PACE SWMI |
$522.75
|
| Rate for Payer: PHP Medicare Advantage |
$522.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,000.62
|
| Rate for Payer: Priority Health Medicare |
$522.75
|
| Rate for Payer: Priority Health SBD |
$1,000.62
|
| Rate for Payer: Priority Health Tiered Network |
$1,000.62
|
| Rate for Payer: Railroad Medicare Medicare |
$522.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,018.28
|
| Rate for Payer: UHC Core |
$1,018.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$522.75
|
| Rate for Payer: UHC Exchange |
$1,018.28
|
| Rate for Payer: UHC Medicaid |
$330.58
|
| Rate for Payer: UHCCP Medicaid |
$330.58
|
|
|
PR EWHO RIGID W/O JNTS CF
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS L3763
|
| Min. Negotiated Rate |
$272.92 |
| Max. Negotiated Rate |
$1,548.43 |
| Rate for Payer: Aetna Commercial |
$1,121.57
|
| Rate for Payer: Aetna Medicare |
$870.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,121.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.27
|
| Rate for Payer: BCBS Complete |
$288.00
|
| Rate for Payer: BCBS MAPPO |
$836.99
|
| Rate for Payer: BCN Commercial |
$801.35
|
| Rate for Payer: BCN Medicare Advantage |
$836.99
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$1,205.27
|
| Rate for Payer: Cofinity Commercial |
$1,121.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$836.99
|
| Rate for Payer: Healthscope Commercial |
$1,339.18
|
| Rate for Payer: Healthscope Commercial |
$1,548.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$878.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$920.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.04
|
| Rate for Payer: Nomi Health Commercial |
$1,004.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$540.00
|
| Rate for Payer: PACE SWMI |
$836.99
|
| Rate for Payer: PHP Medicare Advantage |
$836.99
|
| Rate for Payer: Priority Health Medicare |
$836.99
|
| Rate for Payer: Railroad Medicare Medicare |
$836.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.92
|
| Rate for Payer: UHC Core |
$272.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$836.99
|
| Rate for Payer: UHC Exchange |
$272.92
|
|
|
PR EWHO W/JOINT(S) CF
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS L3764
|
| Min. Negotiated Rate |
$285.62 |
| Max. Negotiated Rate |
$1,620.49 |
| Rate for Payer: Aetna Commercial |
$1,173.76
|
| Rate for Payer: Aetna Medicare |
$910.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,173.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,261.35
|
| Rate for Payer: BCBS Complete |
$301.20
|
| Rate for Payer: BCBS MAPPO |
$875.94
|
| Rate for Payer: BCN Commercial |
$838.63
|
| Rate for Payer: BCN Medicare Advantage |
$875.94
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cofinity Commercial |
$1,261.35
|
| Rate for Payer: Cofinity Commercial |
$1,173.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$875.94
|
| Rate for Payer: Healthscope Commercial |
$1,401.50
|
| Rate for Payer: Healthscope Commercial |
$1,620.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$919.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$963.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$817.38
|
| Rate for Payer: Nomi Health Commercial |
$1,051.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.75
|
| Rate for Payer: PACE SWMI |
$875.94
|
| Rate for Payer: PHP Medicare Advantage |
$875.94
|
| Rate for Payer: Priority Health Medicare |
$875.94
|
| Rate for Payer: Railroad Medicare Medicare |
$875.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.62
|
| Rate for Payer: UHC Core |
$285.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$875.94
|
| Rate for Payer: UHC Exchange |
$285.62
|
|
|
PR EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 44110
|
| Min. Negotiated Rate |
$508.43 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna Commercial |
$1,059.46
|
| Rate for Payer: Aetna Medicare |
$822.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.52
|
| Rate for Payer: BCBS Complete |
$533.85
|
| Rate for Payer: BCBS MAPPO |
$790.64
|
| Rate for Payer: BCN Commercial |
$1,275.83
|
| Rate for Payer: BCN Medicare Advantage |
$790.64
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cofinity Commercial |
$1,138.52
|
| Rate for Payer: Cofinity Commercial |
$1,059.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.64
|
| Rate for Payer: Healthscope Commercial |
$1,462.68
|
| Rate for Payer: Healthscope Commercial |
$1,265.02
|
| Rate for Payer: Mclaren Medicaid |
$508.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$830.17
|
| Rate for Payer: Meridian Medicaid |
$533.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$869.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,509.71
|
| Rate for Payer: Nomi Health Commercial |
$948.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,837.50
|
| Rate for Payer: PACE SWMI |
$790.64
|
| Rate for Payer: PHP Medicare Advantage |
$790.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,554.52
|
| Rate for Payer: Priority Health Medicare |
$790.64
|
| Rate for Payer: Priority Health SBD |
$1,554.52
|
| Rate for Payer: Priority Health Tiered Network |
$1,554.52
|
| Rate for Payer: Railroad Medicare Medicare |
$790.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,499.95
|
| Rate for Payer: UHC Core |
$1,499.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$790.64
|
| Rate for Payer: UHC Exchange |
$1,499.95
|
| Rate for Payer: UHC Medicaid |
$508.43
|
| Rate for Payer: UHCCP Medicaid |
$508.43
|
|
|
PR EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE
|
Professional
|
Both
|
$3,713.00
|
|
|
Service Code
|
HCPCS 44111
|
| Min. Negotiated Rate |
$577.44 |
| Max. Negotiated Rate |
$2,784.75 |
| Rate for Payer: Aetna Commercial |
$1,203.70
|
| Rate for Payer: Aetna Medicare |
$934.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,293.52
|
| Rate for Payer: BCBS Complete |
$606.31
|
| Rate for Payer: BCBS MAPPO |
$898.28
|
| Rate for Payer: BCN Commercial |
$1,468.04
|
| Rate for Payer: BCN Medicare Advantage |
$898.28
|
| Rate for Payer: Cash Price |
$2,970.40
|
| Rate for Payer: Cash Price |
$2,970.40
|
| Rate for Payer: Cofinity Commercial |
$1,293.52
|
| Rate for Payer: Cofinity Commercial |
$1,203.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.28
|
| Rate for Payer: Healthscope Commercial |
$1,661.82
|
| Rate for Payer: Healthscope Commercial |
$1,437.25
|
| Rate for Payer: Mclaren Medicaid |
$577.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$943.19
|
| Rate for Payer: Meridian Medicaid |
$606.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$988.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.25
|
| Rate for Payer: Nomi Health Commercial |
$1,077.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,784.75
|
| Rate for Payer: PACE SWMI |
$898.28
|
| Rate for Payer: PHP Medicare Advantage |
$898.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$577.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,788.71
|
| Rate for Payer: Priority Health Medicare |
$898.28
|
| Rate for Payer: Priority Health SBD |
$1,788.71
|
| Rate for Payer: Priority Health Tiered Network |
$1,788.71
|
| Rate for Payer: Railroad Medicare Medicare |
$898.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,740.23
|
| Rate for Payer: UHC Core |
$1,740.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$898.28
|
| Rate for Payer: UHC Exchange |
$1,740.23
|
| Rate for Payer: UHC Medicaid |
$577.44
|
| Rate for Payer: UHCCP Medicaid |
$577.44
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
11440
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$182.95 |
| Rate for Payer: Aetna Commercial |
$124.77
|
| Rate for Payer: Aetna Medicare |
$96.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.08
|
| Rate for Payer: BCBS Complete |
$65.53
|
| Rate for Payer: BCBS MAPPO |
$93.11
|
| Rate for Payer: BCN Commercial |
$128.02
|
| Rate for Payer: BCN Medicare Advantage |
$93.11
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$134.08
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.11
|
| Rate for Payer: Healthscope Commercial |
$172.25
|
| Rate for Payer: Healthscope Commercial |
$148.98
|
| Rate for Payer: Mclaren Medicaid |
$62.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.77
|
| Rate for Payer: Meridian Medicaid |
$65.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.95
|
| Rate for Payer: Nomi Health Commercial |
$111.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.25
|
| Rate for Payer: PACE SWMI |
$93.11
|
| Rate for Payer: PHP Medicare Advantage |
$93.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$148.59
|
| Rate for Payer: Priority Health Medicare |
$93.11
|
| Rate for Payer: Priority Health SBD |
$148.59
|
| Rate for Payer: Priority Health Tiered Network |
$148.59
|
| Rate for Payer: Railroad Medicare Medicare |
$93.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.11
|
| Rate for Payer: UHC Core |
$175.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$93.11
|
| Rate for Payer: UHC Exchange |
$175.11
|
| Rate for Payer: UHC Medicaid |
$62.41
|
| Rate for Payer: UHCCP Medicaid |
$62.41
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$535.08
|
| Rate for Payer: BCN Commercial |
$535.08
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Advantage |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.35
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.25
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Advantage |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.25
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: Priority Health SBD |
$145.53
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 11440
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$182.95 |
| Rate for Payer: Aetna Commercial |
$124.77
|
| Rate for Payer: Aetna Medicare |
$96.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.08
|
| Rate for Payer: BCBS Complete |
$65.53
|
| Rate for Payer: BCBS MAPPO |
$93.11
|
| Rate for Payer: BCN Commercial |
$128.02
|
| Rate for Payer: BCN Medicare Advantage |
$93.11
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$134.08
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.11
|
| Rate for Payer: Healthscope Commercial |
$172.25
|
| Rate for Payer: Healthscope Commercial |
$148.98
|
| Rate for Payer: Mclaren Medicaid |
$62.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.77
|
| Rate for Payer: Meridian Medicaid |
$65.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.95
|
| Rate for Payer: Nomi Health Commercial |
$111.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.25
|
| Rate for Payer: PACE SWMI |
$93.11
|
| Rate for Payer: PHP Medicare Advantage |
$93.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$148.59
|
| Rate for Payer: Priority Health Medicare |
$93.11
|
| Rate for Payer: Priority Health SBD |
$148.59
|
| Rate for Payer: Priority Health Tiered Network |
$148.59
|
| Rate for Payer: Railroad Medicare Medicare |
$93.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.11
|
| Rate for Payer: UHC Core |
$175.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$93.11
|
| Rate for Payer: UHC Exchange |
$175.11
|
| Rate for Payer: UHC Medicaid |
$62.41
|
| Rate for Payer: UHCCP Medicaid |
$62.41
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 11446
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$638.25 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare |
$287.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.15
|
| Rate for Payer: BCBS Complete |
$189.21
|
| Rate for Payer: BCBS MAPPO |
$276.49
|
| Rate for Payer: BCN Commercial |
$378.96
|
| Rate for Payer: BCN Medicare Advantage |
$276.49
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$398.15
|
| Rate for Payer: Cofinity Commercial |
$370.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.49
|
| Rate for Payer: Healthscope Commercial |
$511.51
|
| Rate for Payer: Healthscope Commercial |
$442.38
|
| Rate for Payer: Mclaren Medicaid |
$180.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.31
|
| Rate for Payer: Meridian Medicaid |
$189.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$304.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$555.50
|
| Rate for Payer: Nomi Health Commercial |
$331.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.25
|
| Rate for Payer: PACE SWMI |
$276.49
|
| Rate for Payer: PHP Medicare Advantage |
$276.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.82
|
| Rate for Payer: Priority Health Medicare |
$276.49
|
| Rate for Payer: Priority Health SBD |
$439.82
|
| Rate for Payer: Priority Health Tiered Network |
$439.82
|
| Rate for Payer: Railroad Medicare Medicare |
$276.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.27
|
| Rate for Payer: UHC Core |
$561.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$276.49
|
| Rate for Payer: UHC Exchange |
$561.27
|
| Rate for Payer: UHC Medicaid |
$180.20
|
| Rate for Payer: UHCCP Medicaid |
$180.20
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
11420
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Advantage |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 11420
|
| Min. Negotiated Rate |
$48.56 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Aetna Commercial |
$98.13
|
| Rate for Payer: Aetna Medicare |
$76.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.13
|
| Rate for Payer: BCBS Complete |
$50.99
|
| Rate for Payer: BCBS MAPPO |
$73.23
|
| Rate for Payer: BCN Commercial |
$98.57
|
| Rate for Payer: BCN Medicare Advantage |
$73.23
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.13
|
| Rate for Payer: Cofinity Commercial |
$105.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.23
|
| Rate for Payer: Healthscope Commercial |
$135.48
|
| Rate for Payer: Healthscope Commercial |
$117.17
|
| Rate for Payer: Mclaren Medicaid |
$48.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.89
|
| Rate for Payer: Meridian Medicaid |
$50.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.85
|
| Rate for Payer: Nomi Health Commercial |
$87.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PACE SWMI |
$73.23
|
| Rate for Payer: PHP Medicare Advantage |
$73.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$114.40
|
| Rate for Payer: Priority Health Medicare |
$73.23
|
| Rate for Payer: Priority Health SBD |
$114.40
|
| Rate for Payer: Priority Health Tiered Network |
$114.40
|
| Rate for Payer: Railroad Medicare Medicare |
$73.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.52
|
| Rate for Payer: UHC Core |
$140.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.23
|
| Rate for Payer: UHC Exchange |
$140.52
|
| Rate for Payer: UHC Medicaid |
$48.56
|
| Rate for Payer: UHCCP Medicaid |
$48.56
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
11420
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.38
|
| Rate for Payer: BCN Commercial |
$1,236.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Advantage |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
11420
|
| Min. Negotiated Rate |
$48.56 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Aetna Commercial |
$98.13
|
| Rate for Payer: Aetna Medicare |
$76.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.13
|
| Rate for Payer: BCBS Complete |
$50.99
|
| Rate for Payer: BCBS MAPPO |
$73.23
|
| Rate for Payer: BCN Commercial |
$98.57
|
| Rate for Payer: BCN Medicare Advantage |
$73.23
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.13
|
| Rate for Payer: Cofinity Commercial |
$105.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.23
|
| Rate for Payer: Healthscope Commercial |
$135.48
|
| Rate for Payer: Healthscope Commercial |
$117.17
|
| Rate for Payer: Mclaren Medicaid |
$48.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.89
|
| Rate for Payer: Meridian Medicaid |
$50.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.85
|
| Rate for Payer: Nomi Health Commercial |
$87.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PACE SWMI |
$73.23
|
| Rate for Payer: PHP Medicare Advantage |
$73.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$114.40
|
| Rate for Payer: Priority Health Medicare |
$73.23
|
| Rate for Payer: Priority Health SBD |
$114.40
|
| Rate for Payer: Priority Health Tiered Network |
$114.40
|
| Rate for Payer: Railroad Medicare Medicare |
$73.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.52
|
| Rate for Payer: UHC Core |
$140.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.23
|
| Rate for Payer: UHC Exchange |
$140.52
|
| Rate for Payer: UHC Medicaid |
$48.56
|
| Rate for Payer: UHCCP Medicaid |
$48.56
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 11421
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Aetna Commercial |
$128.17
|
| Rate for Payer: Aetna Medicare |
$99.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.74
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS MAPPO |
$95.65
|
| Rate for Payer: BCN Commercial |
$129.98
|
| Rate for Payer: BCN Medicare Advantage |
$95.65
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$137.74
|
| Rate for Payer: Cofinity Commercial |
$128.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.65
|
| Rate for Payer: Healthscope Commercial |
$176.95
|
| Rate for Payer: Healthscope Commercial |
$153.04
|
| Rate for Payer: Mclaren Medicaid |
$63.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.43
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.50
|
| Rate for Payer: Nomi Health Commercial |
$114.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.75
|
| Rate for Payer: PACE SWMI |
$95.65
|
| Rate for Payer: PHP Medicare Advantage |
$95.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.87
|
| Rate for Payer: Priority Health Medicare |
$95.65
|
| Rate for Payer: Priority Health SBD |
$150.87
|
| Rate for Payer: Priority Health Tiered Network |
$150.87
|
| Rate for Payer: Railroad Medicare Medicare |
$95.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.63
|
| Rate for Payer: UHC Core |
$188.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.65
|
| Rate for Payer: UHC Exchange |
$188.63
|
| Rate for Payer: UHC Medicaid |
$63.05
|
| Rate for Payer: UHCCP Medicaid |
$63.05
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
11421
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Aetna Commercial |
$128.17
|
| Rate for Payer: Aetna Medicare |
$99.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.74
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS MAPPO |
$95.65
|
| Rate for Payer: BCN Commercial |
$129.98
|
| Rate for Payer: BCN Medicare Advantage |
$95.65
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$137.74
|
| Rate for Payer: Cofinity Commercial |
$128.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.65
|
| Rate for Payer: Healthscope Commercial |
$176.95
|
| Rate for Payer: Healthscope Commercial |
$153.04
|
| Rate for Payer: Mclaren Medicaid |
$63.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.43
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.50
|
| Rate for Payer: Nomi Health Commercial |
$114.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.75
|
| Rate for Payer: PACE SWMI |
$95.65
|
| Rate for Payer: PHP Medicare Advantage |
$95.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.87
|
| Rate for Payer: Priority Health Medicare |
$95.65
|
| Rate for Payer: Priority Health SBD |
$150.87
|
| Rate for Payer: Priority Health Tiered Network |
$150.87
|
| Rate for Payer: Railroad Medicare Medicare |
$95.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.63
|
| Rate for Payer: UHC Core |
$188.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.65
|
| Rate for Payer: UHC Exchange |
$188.63
|
| Rate for Payer: UHC Medicaid |
$63.05
|
| Rate for Payer: UHCCP Medicaid |
$63.05
|
|
