|
PR EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH
|
Professional
|
Both
|
$8,245.00
|
|
|
Service Code
|
HCPCS 33880
|
| Min. Negotiated Rate |
$1,710.21 |
| Max. Negotiated Rate |
$5,359.25 |
| Rate for Payer: Aetna Commercial |
$2,291.68
|
| Rate for Payer: Aetna Medicare |
$1,778.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,462.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,291.68
|
| Rate for Payer: BCBS Complete |
$3,298.00
|
| Rate for Payer: BCBS MAPPO |
$1,710.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,710.21
|
| Rate for Payer: Cash Price |
$6,596.00
|
| Rate for Payer: Cash Price |
$6,596.00
|
| Rate for Payer: Cofinity Commercial |
$2,462.70
|
| Rate for Payer: Cofinity Commercial |
$2,291.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,710.21
|
| Rate for Payer: Healthscope Commercial |
$3,163.89
|
| Rate for Payer: Healthscope Commercial |
$2,736.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,795.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,359.25
|
| Rate for Payer: Nomi Health Commercial |
$2,052.25
|
| Rate for Payer: PACE SWMI |
$1,710.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,710.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,359.25
|
| Rate for Payer: Priority Health Medicare |
$1,710.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,710.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.21
|
|
|
PR EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN
|
Professional
|
Both
|
$5,504.00
|
|
|
Service Code
|
HCPCS 33881
|
| Min. Negotiated Rate |
$1,468.63 |
| Max. Negotiated Rate |
$3,577.60 |
| Rate for Payer: Aetna Commercial |
$1,967.96
|
| Rate for Payer: Aetna Medicare |
$1,527.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,114.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,967.96
|
| Rate for Payer: BCBS Complete |
$2,201.60
|
| Rate for Payer: BCBS MAPPO |
$1,468.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,468.63
|
| Rate for Payer: Cash Price |
$4,403.20
|
| Rate for Payer: Cash Price |
$4,403.20
|
| Rate for Payer: Cofinity Commercial |
$2,114.83
|
| Rate for Payer: Cofinity Commercial |
$1,967.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,468.63
|
| Rate for Payer: Healthscope Commercial |
$2,349.81
|
| Rate for Payer: Healthscope Commercial |
$2,716.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,542.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,577.60
|
| Rate for Payer: Nomi Health Commercial |
$1,762.36
|
| Rate for Payer: PACE SWMI |
$1,468.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,468.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,577.60
|
| Rate for Payer: Priority Health Medicare |
$1,468.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,468.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,468.63
|
|
|
PR EVASC RPR ILAC ART BIFUR ENDGRFT CATHJ RS&I UNI
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
HCPCS 0254T
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$623.35 |
| Rate for Payer: Aetna Medicare |
$479.50
|
| Rate for Payer: BCBS Complete |
$383.60
|
| Rate for Payer: Cash Price |
$767.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.35
|
|
|
PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 34718
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,191.73 |
| Rate for Payer: Aetna Commercial |
$1,587.52
|
| Rate for Payer: Aetna Medicare |
$1,232.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,587.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,706.00
|
| Rate for Payer: BCBS Complete |
$864.80
|
| Rate for Payer: BCBS MAPPO |
$1,184.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.72
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Cofinity Commercial |
$1,706.00
|
| Rate for Payer: Cofinity Commercial |
$1,587.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.72
|
| Rate for Payer: Healthscope Commercial |
$2,191.73
|
| Rate for Payer: Healthscope Commercial |
$1,895.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,405.30
|
| Rate for Payer: Nomi Health Commercial |
$1,421.66
|
| Rate for Payer: PACE SWMI |
$1,184.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.30
|
| Rate for Payer: Priority Health Medicare |
$1,184.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,184.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.72
|
|
|
PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 34717
|
| Min. Negotiated Rate |
$323.60 |
| Max. Negotiated Rate |
$785.05 |
| Rate for Payer: Aetna Commercial |
$568.63
|
| Rate for Payer: Aetna Medicare |
$441.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.06
|
| Rate for Payer: BCBS Complete |
$323.60
|
| Rate for Payer: BCBS MAPPO |
$424.35
|
| Rate for Payer: BCN Medicare Advantage |
$424.35
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$568.63
|
| Rate for Payer: Cofinity Commercial |
$611.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$424.35
|
| Rate for Payer: Healthscope Commercial |
$678.96
|
| Rate for Payer: Healthscope Commercial |
$785.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.85
|
| Rate for Payer: Nomi Health Commercial |
$509.22
|
| Rate for Payer: PACE SWMI |
$424.35
|
| Rate for Payer: PHP Medicare Advantage |
$424.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health Medicare |
$424.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$424.35
|
| Rate for Payer: UHC Medicare Advantage |
$424.35
|
|
|
PR EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK
|
Professional
|
Both
|
$3,336.00
|
|
|
Service Code
|
HCPCS 61623
|
| Min. Negotiated Rate |
$564.20 |
| Max. Negotiated Rate |
$2,168.40 |
| Rate for Payer: Aetna Commercial |
$756.03
|
| Rate for Payer: Aetna Medicare |
$586.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$756.03
|
| Rate for Payer: BCBS Complete |
$1,334.40
|
| Rate for Payer: BCBS MAPPO |
$564.20
|
| Rate for Payer: BCN Medicare Advantage |
$564.20
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cofinity Commercial |
$812.45
|
| Rate for Payer: Cofinity Commercial |
$756.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.20
|
| Rate for Payer: Healthscope Commercial |
$902.72
|
| Rate for Payer: Healthscope Commercial |
$1,043.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.40
|
| Rate for Payer: Nomi Health Commercial |
$677.04
|
| Rate for Payer: PACE SWMI |
$564.20
|
| Rate for Payer: PHP Medicare Advantage |
$564.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,168.40
|
| Rate for Payer: Priority Health Medicare |
$564.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.20
|
| Rate for Payer: UHC Medicare Advantage |
$564.20
|
|
|
PR EWHO RIGID W/O JNTS CF
|
Professional
|
Both
|
$699.00
|
|
|
Service Code
|
HCPCS L3763
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$1,518.07 |
| Rate for Payer: Aetna Commercial |
$1,099.58
|
| Rate for Payer: Aetna Medicare |
$853.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,181.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.58
|
| Rate for Payer: BCBS Complete |
$279.60
|
| Rate for Payer: BCBS MAPPO |
$820.58
|
| Rate for Payer: BCN Medicare Advantage |
$820.58
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cofinity Commercial |
$1,181.64
|
| Rate for Payer: Cofinity Commercial |
$1,099.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$820.58
|
| Rate for Payer: Healthscope Commercial |
$1,312.93
|
| Rate for Payer: Healthscope Commercial |
$1,518.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$861.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.35
|
| Rate for Payer: Nomi Health Commercial |
$984.70
|
| Rate for Payer: PACE SWMI |
$820.58
|
| Rate for Payer: PHP Medicare Advantage |
$820.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.35
|
| Rate for Payer: Priority Health Medicare |
$820.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$820.58
|
| Rate for Payer: UHC Medicare Advantage |
$820.58
|
|
|
PR EWHO W/JOINT(S) CF
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS L3764
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,588.71 |
| Rate for Payer: Aetna Commercial |
$1,150.74
|
| Rate for Payer: Aetna Medicare |
$893.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.74
|
| Rate for Payer: BCBS Complete |
$292.40
|
| Rate for Payer: BCBS MAPPO |
$858.76
|
| Rate for Payer: BCN Medicare Advantage |
$858.76
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cofinity Commercial |
$1,236.61
|
| Rate for Payer: Cofinity Commercial |
$1,150.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.76
|
| Rate for Payer: Healthscope Commercial |
$1,588.71
|
| Rate for Payer: Healthscope Commercial |
$1,374.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475.15
|
| Rate for Payer: Nomi Health Commercial |
$1,030.51
|
| Rate for Payer: PACE SWMI |
$858.76
|
| Rate for Payer: PHP Medicare Advantage |
$858.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.15
|
| Rate for Payer: Priority Health Medicare |
$858.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.76
|
| Rate for Payer: UHC Medicare Advantage |
$858.76
|
|
|
PR EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM
|
Professional
|
Both
|
$2,379.00
|
|
|
Service Code
|
HCPCS 44110
|
| Min. Negotiated Rate |
$821.23 |
| Max. Negotiated Rate |
$1,546.35 |
| Rate for Payer: Aetna Commercial |
$1,100.45
|
| Rate for Payer: Aetna Medicare |
$854.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.45
|
| Rate for Payer: BCBS Complete |
$951.60
|
| Rate for Payer: BCBS MAPPO |
$821.23
|
| Rate for Payer: BCN Medicare Advantage |
$821.23
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cofinity Commercial |
$1,182.57
|
| Rate for Payer: Cofinity Commercial |
$1,100.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.23
|
| Rate for Payer: Healthscope Commercial |
$1,313.97
|
| Rate for Payer: Healthscope Commercial |
$1,519.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,546.35
|
| Rate for Payer: Nomi Health Commercial |
$985.48
|
| Rate for Payer: PACE SWMI |
$821.23
|
| Rate for Payer: PHP Medicare Advantage |
$821.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,546.35
|
| Rate for Payer: Priority Health Medicare |
$821.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.23
|
| Rate for Payer: UHC Medicare Advantage |
$821.23
|
|
|
PR EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE
|
Professional
|
Both
|
$3,605.00
|
|
|
Service Code
|
HCPCS 44111
|
| Min. Negotiated Rate |
$945.42 |
| Max. Negotiated Rate |
$2,343.25 |
| Rate for Payer: Aetna Commercial |
$1,266.86
|
| Rate for Payer: Aetna Medicare |
$983.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,361.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.86
|
| Rate for Payer: BCBS Complete |
$1,442.00
|
| Rate for Payer: BCBS MAPPO |
$945.42
|
| Rate for Payer: BCN Medicare Advantage |
$945.42
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cofinity Commercial |
$1,361.40
|
| Rate for Payer: Cofinity Commercial |
$1,266.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.42
|
| Rate for Payer: Healthscope Commercial |
$1,749.03
|
| Rate for Payer: Healthscope Commercial |
$1,512.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,343.25
|
| Rate for Payer: Nomi Health Commercial |
$1,134.50
|
| Rate for Payer: PACE SWMI |
$945.42
|
| Rate for Payer: PHP Medicare Advantage |
$945.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,343.25
|
| Rate for Payer: Priority Health Medicare |
$945.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.42
|
| Rate for Payer: UHC Medicare Advantage |
$945.42
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$141.12 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Cofinity Commercial |
$156.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$141.12
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 11440
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$185.19 |
| Rate for Payer: Aetna Commercial |
$134.13
|
| Rate for Payer: Aetna Medicare |
$104.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.13
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$100.10
|
| Rate for Payer: BCN Medicare Advantage |
$100.10
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$144.14
|
| Rate for Payer: Cofinity Commercial |
$134.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.10
|
| Rate for Payer: Healthscope Commercial |
$160.16
|
| Rate for Payer: Healthscope Commercial |
$185.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.60
|
| Rate for Payer: Nomi Health Commercial |
$120.12
|
| Rate for Payer: PACE SWMI |
$100.10
|
| Rate for Payer: PHP Medicare Advantage |
$100.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$100.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.10
|
| Rate for Payer: UHC Medicare Advantage |
$100.10
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
11440
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$185.19 |
| Rate for Payer: Aetna Commercial |
$134.13
|
| Rate for Payer: Aetna Medicare |
$104.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.14
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$100.10
|
| Rate for Payer: BCN Medicare Advantage |
$100.10
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$134.13
|
| Rate for Payer: Cofinity Commercial |
$144.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.10
|
| Rate for Payer: Healthscope Commercial |
$185.19
|
| Rate for Payer: Healthscope Commercial |
$160.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.60
|
| Rate for Payer: Nomi Health Commercial |
$120.12
|
| Rate for Payer: PACE SWMI |
$100.10
|
| Rate for Payer: PHP Medicare Advantage |
$100.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$100.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.10
|
| Rate for Payer: UHC Medicare Advantage |
$100.10
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$141.12 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$141.12
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
HCPCS 11446
|
| Min. Negotiated Rate |
$304.03 |
| Max. Negotiated Rate |
$562.46 |
| Rate for Payer: Aetna Commercial |
$407.40
|
| Rate for Payer: Aetna Medicare |
$316.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.40
|
| Rate for Payer: BCBS Complete |
$330.40
|
| Rate for Payer: BCBS MAPPO |
$304.03
|
| Rate for Payer: BCN Medicare Advantage |
$304.03
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cofinity Commercial |
$437.80
|
| Rate for Payer: Cofinity Commercial |
$407.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.03
|
| Rate for Payer: Healthscope Commercial |
$562.46
|
| Rate for Payer: Healthscope Commercial |
$486.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.90
|
| Rate for Payer: Nomi Health Commercial |
$364.84
|
| Rate for Payer: PACE SWMI |
$304.03
|
| Rate for Payer: PHP Medicare Advantage |
$304.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.90
|
| Rate for Payer: Priority Health Medicare |
$304.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$304.03
|
| Rate for Payer: UHC Medicare Advantage |
$304.03
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 11420
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$144.21 |
| Rate for Payer: Aetna Commercial |
$104.45
|
| Rate for Payer: Aetna Medicare |
$81.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.45
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$77.95
|
| Rate for Payer: BCN Medicare Advantage |
$77.95
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$112.25
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$124.72
|
| Rate for Payer: Healthscope Commercial |
$144.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.95
|
| Rate for Payer: Nomi Health Commercial |
$93.54
|
| Rate for Payer: PACE SWMI |
$77.95
|
| Rate for Payer: PHP Medicare Advantage |
$77.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health Medicare |
$77.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.95
|
| Rate for Payer: UHC Medicare Advantage |
$77.95
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 11421
|
| Min. Negotiated Rate |
$103.13 |
| Max. Negotiated Rate |
$190.79 |
| Rate for Payer: Aetna Commercial |
$138.19
|
| Rate for Payer: Aetna Medicare |
$107.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.19
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: BCBS MAPPO |
$103.13
|
| Rate for Payer: BCN Medicare Advantage |
$103.13
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$138.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.13
|
| Rate for Payer: Healthscope Commercial |
$190.79
|
| Rate for Payer: Healthscope Commercial |
$165.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.65
|
| Rate for Payer: Nomi Health Commercial |
$123.76
|
| Rate for Payer: PACE SWMI |
$103.13
|
| Rate for Payer: PHP Medicare Advantage |
$103.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health Medicare |
$103.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.13
|
| Rate for Payer: UHC Medicare Advantage |
$103.13
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.43 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Aetna Commercial |
$221.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.65
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$182.70
|
| Rate for Payer: Cofinity Commercial |
$224.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.80
|
| Rate for Payer: Healthscope Commercial |
$234.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.85
|
| Rate for Payer: PHP Commercial |
$221.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health SBD |
$164.43
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
11421
|
| Min. Negotiated Rate |
$103.13 |
| Max. Negotiated Rate |
$190.79 |
| Rate for Payer: Aetna Commercial |
$138.19
|
| Rate for Payer: Aetna Medicare |
$107.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.51
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: BCBS MAPPO |
$103.13
|
| Rate for Payer: BCN Medicare Advantage |
$103.13
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$138.19
|
| Rate for Payer: Cofinity Commercial |
$148.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.13
|
| Rate for Payer: Healthscope Commercial |
$190.79
|
| Rate for Payer: Healthscope Commercial |
$165.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.65
|
| Rate for Payer: Nomi Health Commercial |
$123.76
|
| Rate for Payer: PACE SWMI |
$103.13
|
| Rate for Payer: PHP Medicare Advantage |
$103.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health Medicare |
$103.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.13
|
| Rate for Payer: UHC Medicare Advantage |
$103.13
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.43 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$221.85
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$224.46
|
| Rate for Payer: Cofinity Commercial |
$182.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$234.90
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.85
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$221.85
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$164.43
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 11422
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$238.48 |
| Rate for Payer: Aetna Commercial |
$172.74
|
| Rate for Payer: Aetna Medicare |
$134.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.74
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$128.91
|
| Rate for Payer: BCN Medicare Advantage |
$128.91
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$185.63
|
| Rate for Payer: Cofinity Commercial |
$172.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.91
|
| Rate for Payer: Healthscope Commercial |
$206.26
|
| Rate for Payer: Healthscope Commercial |
$238.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.15
|
| Rate for Payer: Nomi Health Commercial |
$154.69
|
| Rate for Payer: PACE SWMI |
$128.91
|
| Rate for Payer: PHP Medicare Advantage |
$128.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health Medicare |
$128.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.91
|
| Rate for Payer: UHC Medicare Advantage |
$128.91
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
11422
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$183.33 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Aetna Commercial |
$247.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.15
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$203.70
|
| Rate for Payer: Cofinity Commercial |
$250.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.80
|
| Rate for Payer: Healthscope Commercial |
$261.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.35
|
| Rate for Payer: PHP Commercial |
$247.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health SBD |
$183.33
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
11422
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$238.48 |
| Rate for Payer: Aetna Commercial |
$172.74
|
| Rate for Payer: Aetna Medicare |
$134.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.63
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$128.91
|
| Rate for Payer: BCN Medicare Advantage |
$128.91
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$172.74
|
| Rate for Payer: Cofinity Commercial |
$185.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.91
|
| Rate for Payer: Healthscope Commercial |
$238.48
|
| Rate for Payer: Healthscope Commercial |
$206.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.15
|
| Rate for Payer: Nomi Health Commercial |
$154.69
|
| Rate for Payer: PACE SWMI |
$128.91
|
| Rate for Payer: PHP Medicare Advantage |
$128.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health Medicare |
$128.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.91
|
| Rate for Payer: UHC Medicare Advantage |
$128.91
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
11422
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$183.33 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$247.35
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$250.26
|
| Rate for Payer: Cofinity Commercial |
$203.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$261.90
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.35
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$247.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$183.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
11423
|
| Min. Negotiated Rate |
$150.04 |
| Max. Negotiated Rate |
$277.57 |
| Rate for Payer: Aetna Commercial |
$201.05
|
| Rate for Payer: Aetna Medicare |
$156.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.06
|
| Rate for Payer: BCBS Complete |
$160.40
|
| Rate for Payer: BCBS MAPPO |
$150.04
|
| Rate for Payer: BCN Medicare Advantage |
$150.04
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cofinity Commercial |
$216.06
|
| Rate for Payer: Cofinity Commercial |
$201.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.04
|
| Rate for Payer: Healthscope Commercial |
$240.06
|
| Rate for Payer: Healthscope Commercial |
$277.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.65
|
| Rate for Payer: Nomi Health Commercial |
$180.05
|
| Rate for Payer: PACE SWMI |
$150.04
|
| Rate for Payer: PHP Medicare Advantage |
$150.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.65
|
| Rate for Payer: Priority Health Medicare |
$150.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.04
|
| Rate for Payer: UHC Medicare Advantage |
$150.04
|
|
