|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.02 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.10
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Advantage |
$177.80
|
| Rate for Payer: Cofinity Commercial |
$218.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.20
|
| Rate for Payer: Healthscope Commercial |
$228.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
| Rate for Payer: PHP Commercial |
$215.90
|
| Rate for Payer: Priority Health SBD |
$160.02
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
11402
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna Medicare |
$102.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.59
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCBS MAPPO |
$99.02
|
| Rate for Payer: BCN Commercial |
$137.84
|
| Rate for Payer: BCN Medicare Advantage |
$99.02
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.02
|
| Rate for Payer: Healthscope Commercial |
$183.19
|
| Rate for Payer: Healthscope Commercial |
$158.43
|
| Rate for Payer: Mclaren Medicaid |
$65.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.97
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$108.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.49
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PACE SWMI |
$99.02
|
| Rate for Payer: PHP Medicare Advantage |
$99.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$159.98
|
| Rate for Payer: Priority Health Medicare |
$99.02
|
| Rate for Payer: Priority Health SBD |
$159.98
|
| Rate for Payer: Priority Health Tiered Network |
$159.98
|
| Rate for Payer: Railroad Medicare Medicare |
$99.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.64
|
| Rate for Payer: UHC Core |
$196.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$99.02
|
| Rate for Payer: UHC Exchange |
$196.64
|
| Rate for Payer: UHC Medicaid |
$65.39
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$177.66 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health SBD |
$177.66
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna Medicare |
$102.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.59
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCBS MAPPO |
$99.02
|
| Rate for Payer: BCN Commercial |
$137.84
|
| Rate for Payer: BCN Medicare Advantage |
$99.02
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.02
|
| Rate for Payer: Healthscope Commercial |
$183.19
|
| Rate for Payer: Healthscope Commercial |
$158.43
|
| Rate for Payer: Mclaren Medicaid |
$65.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.97
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$108.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.49
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PACE SWMI |
$99.02
|
| Rate for Payer: PHP Medicare Advantage |
$99.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$159.98
|
| Rate for Payer: Priority Health Medicare |
$99.02
|
| Rate for Payer: Priority Health SBD |
$159.98
|
| Rate for Payer: Priority Health Tiered Network |
$159.98
|
| Rate for Payer: Railroad Medicare Medicare |
$99.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.64
|
| Rate for Payer: UHC Core |
$196.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$99.02
|
| Rate for Payer: UHC Exchange |
$196.64
|
| Rate for Payer: UHC Medicaid |
$65.39
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$177.66 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| 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 |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| 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 |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$239.70
|
| 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 |
$177.66
|
| 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 T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$259.99 |
| Rate for Payer: Aetna Commercial |
$175.29
|
| Rate for Payer: Aetna Medicare |
$136.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.37
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$130.81
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: BCN Medicare Advantage |
$130.81
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$188.37
|
| Rate for Payer: Cofinity Commercial |
$175.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.81
|
| Rate for Payer: Healthscope Commercial |
$242.00
|
| Rate for Payer: Healthscope Commercial |
$209.30
|
| Rate for Payer: Mclaren Medicaid |
$86.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.35
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.99
|
| Rate for Payer: Nomi Health Commercial |
$156.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PACE SWMI |
$130.81
|
| Rate for Payer: PHP Medicare Advantage |
$130.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$208.29
|
| Rate for Payer: Priority Health Medicare |
$130.81
|
| Rate for Payer: Priority Health SBD |
$208.29
|
| Rate for Payer: Priority Health Tiered Network |
$208.29
|
| Rate for Payer: Railroad Medicare Medicare |
$130.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.35
|
| Rate for Payer: UHC Core |
$254.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$130.81
|
| Rate for Payer: UHC Exchange |
$254.35
|
| Rate for Payer: UHC Medicaid |
$86.48
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$259.99 |
| Rate for Payer: Aetna Commercial |
$175.29
|
| Rate for Payer: Aetna Medicare |
$136.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.37
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$130.81
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: BCN Medicare Advantage |
$130.81
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$188.37
|
| Rate for Payer: Cofinity Commercial |
$175.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.81
|
| Rate for Payer: Healthscope Commercial |
$242.00
|
| Rate for Payer: Healthscope Commercial |
$209.30
|
| Rate for Payer: Mclaren Medicaid |
$86.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.35
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.99
|
| Rate for Payer: Nomi Health Commercial |
$156.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PACE SWMI |
$130.81
|
| Rate for Payer: PHP Medicare Advantage |
$130.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$208.29
|
| Rate for Payer: Priority Health Medicare |
$130.81
|
| Rate for Payer: Priority Health SBD |
$208.29
|
| Rate for Payer: Priority Health Tiered Network |
$208.29
|
| Rate for Payer: Railroad Medicare Medicare |
$130.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.35
|
| Rate for Payer: UHC Core |
$254.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$130.81
|
| Rate for Payer: UHC Exchange |
$254.35
|
| Rate for Payer: UHC Medicaid |
$86.48
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$287.30
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.70
|
| 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 |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Advantage |
$236.60
|
| Rate for Payer: Cofinity Commercial |
$290.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$304.20
|
| 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 |
$287.30
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$287.30
|
| 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 |
$212.94
|
| 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 T/A/L 2.1-3.0 CM
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna Commercial |
$287.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.70
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Advantage |
$236.60
|
| Rate for Payer: Cofinity Commercial |
$290.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Healthscope Commercial |
$304.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PHP Commercial |
$287.30
|
| Rate for Payer: Priority Health SBD |
$212.94
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$301.77 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.35
|
| 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 |
$1,269.55
|
| Rate for Payer: BCN Commercial |
$1,269.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Advantage |
$335.30
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$431.10
|
| 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 |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$407.15
|
| 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 |
$301.77
|
| 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 T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$197.44
|
| Rate for Payer: Aetna Medicare |
$153.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.17
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$147.34
|
| Rate for Payer: BCN Commercial |
$197.53
|
| Rate for Payer: BCN Medicare Advantage |
$147.34
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$212.17
|
| Rate for Payer: Cofinity Commercial |
$197.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.34
|
| Rate for Payer: Healthscope Commercial |
$272.58
|
| Rate for Payer: Healthscope Commercial |
$235.74
|
| Rate for Payer: Mclaren Medicaid |
$96.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.71
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.82
|
| Rate for Payer: Nomi Health Commercial |
$176.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PACE SWMI |
$147.34
|
| Rate for Payer: PHP Medicare Advantage |
$147.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$229.25
|
| Rate for Payer: Priority Health Medicare |
$147.34
|
| Rate for Payer: Priority Health SBD |
$229.25
|
| Rate for Payer: Priority Health Tiered Network |
$229.25
|
| Rate for Payer: Railroad Medicare Medicare |
$147.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.87
|
| Rate for Payer: UHC Core |
$280.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$147.34
|
| Rate for Payer: UHC Exchange |
$280.87
|
| Rate for Payer: UHC Medicaid |
$96.92
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$301.77 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.35
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Advantage |
$335.30
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Healthscope Commercial |
$431.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PHP Commercial |
$407.15
|
| Rate for Payer: Priority Health SBD |
$301.77
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$197.44
|
| Rate for Payer: Aetna Medicare |
$153.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.17
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$147.34
|
| Rate for Payer: BCN Commercial |
$197.53
|
| Rate for Payer: BCN Medicare Advantage |
$147.34
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$212.17
|
| Rate for Payer: Cofinity Commercial |
$197.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.34
|
| Rate for Payer: Healthscope Commercial |
$272.58
|
| Rate for Payer: Healthscope Commercial |
$235.74
|
| Rate for Payer: Mclaren Medicaid |
$96.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.71
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.82
|
| Rate for Payer: Nomi Health Commercial |
$176.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PACE SWMI |
$147.34
|
| Rate for Payer: PHP Medicare Advantage |
$147.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$229.25
|
| Rate for Payer: Priority Health Medicare |
$147.34
|
| Rate for Payer: Priority Health SBD |
$229.25
|
| Rate for Payer: Priority Health Tiered Network |
$229.25
|
| Rate for Payer: Railroad Medicare Medicare |
$147.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.87
|
| Rate for Payer: UHC Core |
$280.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$147.34
|
| Rate for Payer: UHC Exchange |
$280.87
|
| Rate for Payer: UHC Medicaid |
$96.92
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$507.75 |
| Rate for Payer: Aetna Commercial |
$298.23
|
| Rate for Payer: Aetna Medicare |
$231.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.49
|
| Rate for Payer: BCBS Complete |
$152.53
|
| Rate for Payer: BCBS MAPPO |
$222.56
|
| Rate for Payer: BCN Commercial |
$296.49
|
| Rate for Payer: BCN Medicare Advantage |
$222.56
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$320.49
|
| Rate for Payer: Cofinity Commercial |
$298.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.56
|
| Rate for Payer: Healthscope Commercial |
$411.74
|
| Rate for Payer: Healthscope Commercial |
$356.10
|
| Rate for Payer: Mclaren Medicaid |
$145.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.69
|
| Rate for Payer: Meridian Medicaid |
$152.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$244.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.30
|
| Rate for Payer: Nomi Health Commercial |
$267.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: PACE SWMI |
$222.56
|
| Rate for Payer: PHP Medicare Advantage |
$222.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$344.12
|
| Rate for Payer: Priority Health Medicare |
$222.56
|
| Rate for Payer: Priority Health SBD |
$344.12
|
| Rate for Payer: Priority Health Tiered Network |
$344.12
|
| Rate for Payer: Railroad Medicare Medicare |
$222.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.54
|
| Rate for Payer: UHC Core |
$429.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$222.56
|
| Rate for Payer: UHC Exchange |
$429.54
|
| Rate for Payer: UHC Medicaid |
$145.27
|
| Rate for Payer: UHCCP Medicaid |
$145.27
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$426.51 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$575.45
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.05
|
| 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 |
$1,839.91
|
| Rate for Payer: BCN Commercial |
$1,839.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Advantage |
$473.90
|
| Rate for Payer: Cofinity Commercial |
$582.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$609.30
|
| 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 |
$575.45
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$575.45
|
| 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 |
$426.51
|
| 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 T/A/L >4.0 CM
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
11406
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$507.75 |
| Rate for Payer: Aetna Commercial |
$298.23
|
| Rate for Payer: Aetna Medicare |
$231.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.49
|
| Rate for Payer: BCBS Complete |
$152.53
|
| Rate for Payer: BCBS MAPPO |
$222.56
|
| Rate for Payer: BCN Commercial |
$296.49
|
| Rate for Payer: BCN Medicare Advantage |
$222.56
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$320.49
|
| Rate for Payer: Cofinity Commercial |
$298.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.56
|
| Rate for Payer: Healthscope Commercial |
$411.74
|
| Rate for Payer: Healthscope Commercial |
$356.10
|
| Rate for Payer: Mclaren Medicaid |
$145.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.69
|
| Rate for Payer: Meridian Medicaid |
$152.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$244.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.30
|
| Rate for Payer: Nomi Health Commercial |
$267.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: PACE SWMI |
$222.56
|
| Rate for Payer: PHP Medicare Advantage |
$222.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$344.12
|
| Rate for Payer: Priority Health Medicare |
$222.56
|
| Rate for Payer: Priority Health SBD |
$344.12
|
| Rate for Payer: Priority Health Tiered Network |
$344.12
|
| Rate for Payer: Railroad Medicare Medicare |
$222.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.54
|
| Rate for Payer: UHC Core |
$429.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$222.56
|
| Rate for Payer: UHC Exchange |
$429.54
|
| Rate for Payer: UHC Medicaid |
$145.27
|
| Rate for Payer: UHCCP Medicaid |
$145.27
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$426.51 |
| Max. Negotiated Rate |
$609.30 |
| Rate for Payer: Aetna Commercial |
$575.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.05
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Advantage |
$473.90
|
| Rate for Payer: Cofinity Commercial |
$582.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.60
|
| Rate for Payer: Healthscope Commercial |
$609.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: PHP Commercial |
$575.45
|
| Rate for Payer: Priority Health SBD |
$426.51
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
11441
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$230.83 |
| Rate for Payer: Aetna Commercial |
$154.74
|
| Rate for Payer: Aetna Medicare |
$120.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.29
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCBS MAPPO |
$115.48
|
| Rate for Payer: BCN Commercial |
$158.65
|
| Rate for Payer: BCN Medicare Advantage |
$115.48
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$166.29
|
| Rate for Payer: Cofinity Commercial |
$154.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.48
|
| Rate for Payer: Healthscope Commercial |
$213.64
|
| Rate for Payer: Healthscope Commercial |
$184.77
|
| Rate for Payer: Mclaren Medicaid |
$76.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.25
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.83
|
| Rate for Payer: Nomi Health Commercial |
$138.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PACE SWMI |
$115.48
|
| Rate for Payer: PHP Medicare Advantage |
$115.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$184.14
|
| Rate for Payer: Priority Health Medicare |
$115.48
|
| Rate for Payer: Priority Health SBD |
$184.14
|
| Rate for Payer: Priority Health Tiered Network |
$184.14
|
| Rate for Payer: Railroad Medicare Medicare |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.49
|
| Rate for Payer: UHC Core |
$223.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.48
|
| Rate for Payer: UHC Exchange |
$223.49
|
| Rate for Payer: UHC Medicaid |
$76.68
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$180.18 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna Commercial |
$243.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.90
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Advantage |
$200.20
|
| Rate for Payer: Cofinity Commercial |
$245.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.80
|
| Rate for Payer: Healthscope Commercial |
$257.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PHP Commercial |
$243.10
|
| Rate for Payer: Priority Health SBD |
$180.18
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$230.83 |
| Rate for Payer: Aetna Commercial |
$154.74
|
| Rate for Payer: Aetna Medicare |
$120.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.29
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCBS MAPPO |
$115.48
|
| Rate for Payer: BCN Commercial |
$158.65
|
| Rate for Payer: BCN Medicare Advantage |
$115.48
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$166.29
|
| Rate for Payer: Cofinity Commercial |
$154.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.48
|
| Rate for Payer: Healthscope Commercial |
$213.64
|
| Rate for Payer: Healthscope Commercial |
$184.77
|
| Rate for Payer: Mclaren Medicaid |
$76.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.25
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.83
|
| Rate for Payer: Nomi Health Commercial |
$138.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PACE SWMI |
$115.48
|
| Rate for Payer: PHP Medicare Advantage |
$115.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$184.14
|
| Rate for Payer: Priority Health Medicare |
$115.48
|
| Rate for Payer: Priority Health SBD |
$184.14
|
| Rate for Payer: Priority Health Tiered Network |
$184.14
|
| Rate for Payer: Railroad Medicare Medicare |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.49
|
| Rate for Payer: UHC Core |
$223.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.48
|
| Rate for Payer: UHC Exchange |
$223.49
|
| Rate for Payer: UHC Medicaid |
$76.68
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$180.18 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$243.10
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.90
|
| 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 |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Advantage |
$200.20
|
| Rate for Payer: Cofinity Commercial |
$245.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$257.40
|
| 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 |
$243.10
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$243.10
|
| 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 |
$180.18
|
| 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 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$170.27
|
| Rate for Payer: Aetna Medicare |
$132.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.98
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$127.07
|
| Rate for Payer: BCN Commercial |
$175.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.07
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$170.27
|
| Rate for Payer: Cofinity Commercial |
$182.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.07
|
| Rate for Payer: Healthscope Commercial |
$235.08
|
| Rate for Payer: Healthscope Commercial |
$203.31
|
| Rate for Payer: Mclaren Medicaid |
$84.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.42
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.31
|
| Rate for Payer: Nomi Health Commercial |
$152.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE SWMI |
$127.07
|
| Rate for Payer: PHP Medicare Advantage |
$127.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$203.74
|
| Rate for Payer: Priority Health Medicare |
$127.07
|
| Rate for Payer: Priority Health SBD |
$203.74
|
| Rate for Payer: Priority Health Tiered Network |
$203.74
|
| Rate for Payer: Railroad Medicare Medicare |
$127.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.59
|
| Rate for Payer: UHC Core |
$248.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.07
|
| Rate for Payer: UHC Exchange |
$248.59
|
| Rate for Payer: UHC Medicaid |
$84.14
|
| Rate for Payer: UHCCP Medicaid |
$84.14
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna Commercial |
$309.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.60
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Advantage |
$254.80
|
| Rate for Payer: Cofinity Commercial |
$313.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.20
|
| Rate for Payer: Healthscope Commercial |
$327.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PHP Commercial |
$309.40
|
| Rate for Payer: Priority Health SBD |
$229.32
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$170.27
|
| Rate for Payer: Aetna Medicare |
$132.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.98
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$127.07
|
| Rate for Payer: BCN Commercial |
$175.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.07
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$182.98
|
| Rate for Payer: Cofinity Commercial |
$170.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.07
|
| Rate for Payer: Healthscope Commercial |
$235.08
|
| Rate for Payer: Healthscope Commercial |
$203.31
|
| Rate for Payer: Mclaren Medicaid |
$84.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.42
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.31
|
| Rate for Payer: Nomi Health Commercial |
$152.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE SWMI |
$127.07
|
| Rate for Payer: PHP Medicare Advantage |
$127.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$203.74
|
| Rate for Payer: Priority Health Medicare |
$127.07
|
| Rate for Payer: Priority Health SBD |
$203.74
|
| Rate for Payer: Priority Health Tiered Network |
$203.74
|
| Rate for Payer: Railroad Medicare Medicare |
$127.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.59
|
| Rate for Payer: UHC Core |
$248.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.07
|
| Rate for Payer: UHC Exchange |
$248.59
|
| Rate for Payer: UHC Medicaid |
$84.14
|
| Rate for Payer: UHCCP Medicaid |
$84.14
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$309.40
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.60
|
| 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 |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Advantage |
$254.80
|
| Rate for Payer: Cofinity Commercial |
$313.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$327.60
|
| 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 |
$309.40
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$309.40
|
| 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 |
$229.32
|
| 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
|
|
