|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.15 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$395.25
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$991.16
|
| Rate for Payer: BCN Commercial |
$991.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$399.90
|
| Rate for Payer: Cofinity Commercial |
$325.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$418.50
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.25
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$395.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$292.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.15
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$28,782.00 |
| Rate for Payer: Aetna Commercial |
$210.85
|
| Rate for Payer: Aetna Medicare |
$163.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.58
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS MAPPO |
$157.35
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: BCN Commercial |
$264.65
|
| Rate for Payer: BCN Medicare Advantage |
$157.35
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$226.58
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.35
|
| Rate for Payer: Healthscope Commercial |
$291.10
|
| Rate for Payer: Healthscope Commercial |
$251.76
|
| Rate for Payer: Mclaren Medicaid |
$107.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.22
|
| Rate for Payer: Meridian Medicaid |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,782.00
|
| Rate for Payer: Nomi Health Commercial |
$188.82
|
| Rate for Payer: PACE SWMI |
$157.35
|
| Rate for Payer: PHP Medicare Advantage |
$157.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.41
|
| Rate for Payer: Priority Health Medicare |
$157.35
|
| Rate for Payer: Priority Health Narrow Network |
$224.41
|
| Rate for Payer: Priority Health SBD |
$224.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.35
|
| Rate for Payer: UHC Exchange |
$202.35
|
| Rate for Payer: UHC Medicare Advantage |
$157.35
|
| Rate for Payer: UHCCP Medicaid |
$107.14
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
11406
|
| Min. Negotiated Rate |
$160.82 |
| Max. Negotiated Rate |
$43,630.00 |
| Rate for Payer: Aetna Commercial |
$318.97
|
| Rate for Payer: Aetna Medicare |
$247.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.78
|
| Rate for Payer: BCBS Complete |
$168.86
|
| Rate for Payer: BCBS MAPPO |
$238.04
|
| Rate for Payer: BCBS Trust/PPO |
$201.42
|
| Rate for Payer: BCN Commercial |
$375.00
|
| Rate for Payer: BCN Medicare Advantage |
$238.04
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$342.78
|
| Rate for Payer: Cofinity Commercial |
$318.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.04
|
| Rate for Payer: Healthscope Commercial |
$440.37
|
| Rate for Payer: Healthscope Commercial |
$380.86
|
| Rate for Payer: Mclaren Medicaid |
$160.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.94
|
| Rate for Payer: Meridian Medicaid |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,630.00
|
| Rate for Payer: Nomi Health Commercial |
$285.65
|
| Rate for Payer: PACE SWMI |
$238.04
|
| Rate for Payer: PHP Medicare Advantage |
$238.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.18
|
| Rate for Payer: Priority Health Medicare |
$238.04
|
| Rate for Payer: Priority Health Narrow Network |
$338.18
|
| Rate for Payer: Priority Health SBD |
$338.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.04
|
| Rate for Payer: UHC Exchange |
$284.34
|
| Rate for Payer: UHC Medicare Advantage |
$238.04
|
| Rate for Payer: UHCCP Medicaid |
$160.82
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$413.91 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna Commercial |
$558.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.05
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Commercial |
$565.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Healthscope Commercial |
$591.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: PHP Commercial |
$558.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health SBD |
$413.91
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$160.82 |
| Max. Negotiated Rate |
$43,630.00 |
| Rate for Payer: Aetna Commercial |
$318.97
|
| Rate for Payer: Aetna Medicare |
$247.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.78
|
| Rate for Payer: BCBS Complete |
$168.86
|
| Rate for Payer: BCBS MAPPO |
$238.04
|
| Rate for Payer: BCBS Trust/PPO |
$201.42
|
| Rate for Payer: BCN Commercial |
$375.00
|
| Rate for Payer: BCN Medicare Advantage |
$238.04
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$342.78
|
| Rate for Payer: Cofinity Commercial |
$318.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.04
|
| Rate for Payer: Healthscope Commercial |
$440.37
|
| Rate for Payer: Healthscope Commercial |
$380.86
|
| Rate for Payer: Mclaren Medicaid |
$160.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.94
|
| Rate for Payer: Meridian Medicaid |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,630.00
|
| Rate for Payer: Nomi Health Commercial |
$285.65
|
| Rate for Payer: PACE SWMI |
$238.04
|
| Rate for Payer: PHP Medicare Advantage |
$238.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.18
|
| Rate for Payer: Priority Health Medicare |
$238.04
|
| Rate for Payer: Priority Health Narrow Network |
$338.18
|
| Rate for Payer: Priority Health SBD |
$338.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.04
|
| Rate for Payer: UHC Exchange |
$284.34
|
| Rate for Payer: UHC Medicare Advantage |
$238.04
|
| Rate for Payer: UHCCP Medicaid |
$160.82
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$263.28 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$558.45
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,436.45
|
| Rate for Payer: BCN Commercial |
$1,436.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$565.02
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$591.30
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$558.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$413.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.28
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.03 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$236.30
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$239.08
|
| Rate for Payer: Cofinity Commercial |
$194.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$250.20
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$236.30
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$175.14
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.03
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Aetna Commercial |
$236.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.70
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$194.60
|
| Rate for Payer: Cofinity Commercial |
$239.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Healthscope Commercial |
$250.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: PHP Commercial |
$236.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health SBD |
$175.14
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$23,083.00 |
| Rate for Payer: Aetna Commercial |
$167.47
|
| Rate for Payer: Aetna Medicare |
$129.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS MAPPO |
$124.98
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$205.36
|
| Rate for Payer: BCN Medicare Advantage |
$124.98
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$179.97
|
| Rate for Payer: Cofinity Commercial |
$167.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.98
|
| Rate for Payer: Healthscope Commercial |
$231.21
|
| Rate for Payer: Healthscope Commercial |
$199.97
|
| Rate for Payer: Mclaren Medicaid |
$86.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.23
|
| Rate for Payer: Meridian Medicaid |
$90.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,083.00
|
| Rate for Payer: Nomi Health Commercial |
$149.98
|
| Rate for Payer: PACE SWMI |
$124.98
|
| Rate for Payer: PHP Medicare Advantage |
$124.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.96
|
| Rate for Payer: Priority Health Medicare |
$124.98
|
| Rate for Payer: Priority Health Narrow Network |
$181.96
|
| Rate for Payer: Priority Health SBD |
$181.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.98
|
| Rate for Payer: UHC Exchange |
$158.70
|
| Rate for Payer: UHC Medicare Advantage |
$124.98
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
11441
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$23,083.00 |
| Rate for Payer: Aetna Commercial |
$167.47
|
| Rate for Payer: Aetna Medicare |
$129.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS MAPPO |
$124.98
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$205.36
|
| Rate for Payer: BCN Medicare Advantage |
$124.98
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$179.97
|
| Rate for Payer: Cofinity Commercial |
$167.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.98
|
| Rate for Payer: Healthscope Commercial |
$231.21
|
| Rate for Payer: Healthscope Commercial |
$199.97
|
| Rate for Payer: Mclaren Medicaid |
$86.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.23
|
| Rate for Payer: Meridian Medicaid |
$90.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,083.00
|
| Rate for Payer: Nomi Health Commercial |
$149.98
|
| Rate for Payer: PACE SWMI |
$124.98
|
| Rate for Payer: PHP Medicare Advantage |
$124.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.96
|
| Rate for Payer: Priority Health Medicare |
$124.98
|
| Rate for Payer: Priority Health Narrow Network |
$181.96
|
| Rate for Payer: Priority Health SBD |
$181.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.98
|
| Rate for Payer: UHC Exchange |
$158.70
|
| Rate for Payer: UHC Medicare Advantage |
$124.98
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$222.39 |
| Max. Negotiated Rate |
$317.70 |
| Rate for Payer: Aetna Commercial |
$300.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.45
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$303.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.40
|
| Rate for Payer: Healthscope Commercial |
$317.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.05
|
| Rate for Payer: PHP Commercial |
$300.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health SBD |
$222.39
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$25,531.00 |
| Rate for Payer: Aetna Commercial |
$185.95
|
| Rate for Payer: Aetna Medicare |
$144.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.83
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$138.77
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| Rate for Payer: BCN Medicare Advantage |
$138.77
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$199.83
|
| Rate for Payer: Cofinity Commercial |
$185.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.77
|
| Rate for Payer: Healthscope Commercial |
$256.72
|
| Rate for Payer: Healthscope Commercial |
$222.03
|
| Rate for Payer: Mclaren Medicaid |
$95.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.71
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,531.00
|
| Rate for Payer: Nomi Health Commercial |
$166.52
|
| Rate for Payer: PACE SWMI |
$138.77
|
| Rate for Payer: PHP Medicare Advantage |
$138.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.48
|
| Rate for Payer: Priority Health Medicare |
$138.77
|
| Rate for Payer: Priority Health Narrow Network |
$200.48
|
| Rate for Payer: Priority Health SBD |
$200.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.77
|
| Rate for Payer: UHC Exchange |
$177.31
|
| Rate for Payer: UHC Medicare Advantage |
$138.77
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$153.63 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$300.05
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$303.58
|
| Rate for Payer: Cofinity Commercial |
$247.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$317.70
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.05
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$300.05
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$222.39
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.63
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$25,531.00 |
| Rate for Payer: Aetna Commercial |
$185.95
|
| Rate for Payer: Aetna Medicare |
$144.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.83
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$138.77
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| Rate for Payer: BCN Medicare Advantage |
$138.77
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$199.83
|
| Rate for Payer: Cofinity Commercial |
$185.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.77
|
| Rate for Payer: Healthscope Commercial |
$256.72
|
| Rate for Payer: Healthscope Commercial |
$222.03
|
| Rate for Payer: Mclaren Medicaid |
$95.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.71
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,531.00
|
| Rate for Payer: Nomi Health Commercial |
$166.52
|
| Rate for Payer: PACE SWMI |
$138.77
|
| Rate for Payer: PHP Medicare Advantage |
$138.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.48
|
| Rate for Payer: Priority Health Medicare |
$138.77
|
| Rate for Payer: Priority Health Narrow Network |
$200.48
|
| Rate for Payer: Priority Health SBD |
$200.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.77
|
| Rate for Payer: UHC Exchange |
$177.31
|
| Rate for Payer: UHC Medicare Advantage |
$138.77
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$187.72 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$381.65
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$965.26
|
| Rate for Payer: BCN Commercial |
$965.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$386.14
|
| Rate for Payer: Cofinity Commercial |
$314.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$404.10
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.65
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$381.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$282.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.72
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
11443
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$31,199.00 |
| Rate for Payer: Aetna Commercial |
$227.97
|
| Rate for Payer: Aetna Medicare |
$176.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.99
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS MAPPO |
$170.13
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$268.97
|
| Rate for Payer: BCN Medicare Advantage |
$170.13
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$244.99
|
| Rate for Payer: Cofinity Commercial |
$227.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.13
|
| Rate for Payer: Healthscope Commercial |
$314.74
|
| Rate for Payer: Healthscope Commercial |
$272.21
|
| Rate for Payer: Mclaren Medicaid |
$116.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.64
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,199.00
|
| Rate for Payer: Nomi Health Commercial |
$204.16
|
| Rate for Payer: PACE SWMI |
$170.13
|
| Rate for Payer: PHP Medicare Advantage |
$170.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.82
|
| Rate for Payer: Priority Health Medicare |
$170.13
|
| Rate for Payer: Priority Health Narrow Network |
$243.82
|
| Rate for Payer: Priority Health SBD |
$243.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.13
|
| Rate for Payer: UHC Exchange |
$216.89
|
| Rate for Payer: UHC Medicare Advantage |
$170.13
|
| Rate for Payer: UHCCP Medicaid |
$116.09
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 11443
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$31,199.00 |
| Rate for Payer: Aetna Commercial |
$227.97
|
| Rate for Payer: Aetna Medicare |
$176.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.99
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS MAPPO |
$170.13
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$268.97
|
| Rate for Payer: BCN Medicare Advantage |
$170.13
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$244.99
|
| Rate for Payer: Cofinity Commercial |
$227.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.13
|
| Rate for Payer: Healthscope Commercial |
$314.74
|
| Rate for Payer: Healthscope Commercial |
$272.21
|
| Rate for Payer: Mclaren Medicaid |
$116.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.64
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,199.00
|
| Rate for Payer: Nomi Health Commercial |
$204.16
|
| Rate for Payer: PACE SWMI |
$170.13
|
| Rate for Payer: PHP Medicare Advantage |
$170.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.82
|
| Rate for Payer: Priority Health Medicare |
$170.13
|
| Rate for Payer: Priority Health Narrow Network |
$243.82
|
| Rate for Payer: Priority Health SBD |
$243.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.13
|
| Rate for Payer: UHC Exchange |
$216.89
|
| Rate for Payer: UHC Medicare Advantage |
$170.13
|
| Rate for Payer: UHCCP Medicaid |
$116.09
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$282.87 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Aetna Commercial |
$381.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.85
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$314.30
|
| Rate for Payer: Cofinity Commercial |
$386.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.20
|
| Rate for Payer: Healthscope Commercial |
$404.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.65
|
| Rate for Payer: PHP Commercial |
$381.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health SBD |
$282.87
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$237.18 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$543.70
|
| Rate for Payer: BCN Commercial |
$543.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Cofinity Commercial |
$403.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$490.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$363.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.18
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
HCPCS 11444
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$39,517.00 |
| Rate for Payer: Aetna Commercial |
$289.82
|
| Rate for Payer: Aetna Medicare |
$224.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.44
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCBS MAPPO |
$216.28
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$333.37
|
| Rate for Payer: BCN Medicare Advantage |
$216.28
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$311.44
|
| Rate for Payer: Cofinity Commercial |
$289.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.28
|
| Rate for Payer: Healthscope Commercial |
$400.12
|
| Rate for Payer: Healthscope Commercial |
$346.05
|
| Rate for Payer: Mclaren Medicaid |
$146.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.09
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,517.00
|
| Rate for Payer: Nomi Health Commercial |
$259.54
|
| Rate for Payer: PACE SWMI |
$216.28
|
| Rate for Payer: PHP Medicare Advantage |
$216.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.58
|
| Rate for Payer: Priority Health Medicare |
$216.28
|
| Rate for Payer: Priority Health Narrow Network |
$306.58
|
| Rate for Payer: Priority Health SBD |
$306.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.28
|
| Rate for Payer: UHC Exchange |
$276.26
|
| Rate for Payer: UHC Medicare Advantage |
$216.28
|
| Rate for Payer: UHCCP Medicaid |
$146.76
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$363.51 |
| Max. Negotiated Rate |
$519.30 |
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.05
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$403.90
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: PHP Commercial |
$490.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health SBD |
$363.51
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
11444
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$39,517.00 |
| Rate for Payer: Aetna Commercial |
$289.82
|
| Rate for Payer: Aetna Medicare |
$224.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.44
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCBS MAPPO |
$216.28
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$333.37
|
| Rate for Payer: BCN Medicare Advantage |
$216.28
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$311.44
|
| Rate for Payer: Cofinity Commercial |
$289.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.28
|
| Rate for Payer: Healthscope Commercial |
$400.12
|
| Rate for Payer: Healthscope Commercial |
$346.05
|
| Rate for Payer: Mclaren Medicaid |
$146.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.09
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,517.00
|
| Rate for Payer: Nomi Health Commercial |
$259.54
|
| Rate for Payer: PACE SWMI |
$216.28
|
| Rate for Payer: PHP Medicare Advantage |
$216.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.58
|
| Rate for Payer: Priority Health Medicare |
$216.28
|
| Rate for Payer: Priority Health Narrow Network |
$306.58
|
| Rate for Payer: Priority Health SBD |
$306.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.28
|
| Rate for Payer: UHC Exchange |
$276.26
|
| Rate for Payer: UHC Medicare Advantage |
$216.28
|
| Rate for Payer: UHCCP Medicaid |
$146.76
|
|
|
PR EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN
|
Professional
|
Both
|
$7,984.00
|
|
|
Service Code
|
HCPCS 61563
|
| Min. Negotiated Rate |
$382.49 |
| Max. Negotiated Rate |
$359,590.00 |
| Rate for Payer: Aetna Commercial |
$2,636.54
|
| Rate for Payer: Aetna Medicare |
$2,046.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,636.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,833.30
|
| Rate for Payer: BCBS Complete |
$1,355.99
|
| Rate for Payer: BCBS MAPPO |
$1,967.57
|
| Rate for Payer: BCBS Trust/PPO |
$382.49
|
| Rate for Payer: BCN Commercial |
$4,057.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,967.57
|
| Rate for Payer: Cash Price |
$6,387.20
|
| Rate for Payer: Cash Price |
$6,387.20
|
| Rate for Payer: Cofinity Commercial |
$2,833.30
|
| Rate for Payer: Cofinity Commercial |
$2,636.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,967.57
|
| Rate for Payer: Healthscope Commercial |
$3,640.00
|
| Rate for Payer: Healthscope Commercial |
$3,148.11
|
| Rate for Payer: Mclaren Medicaid |
$1,291.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,065.95
|
| Rate for Payer: Meridian Medicaid |
$1,355.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359,590.00
|
| Rate for Payer: Nomi Health Commercial |
$2,361.08
|
| Rate for Payer: PACE SWMI |
$1,967.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,967.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,291.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,189.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,434.47
|
| Rate for Payer: Priority Health Medicare |
$1,967.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,434.47
|
| Rate for Payer: Priority Health SBD |
$3,434.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,342.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,967.57
|
| Rate for Payer: UHC Exchange |
$2,342.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,967.57
|
| Rate for Payer: UHCCP Medicaid |
$1,291.42
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT
|
Professional
|
Both
|
$2,311.00
|
|
|
Service Code
|
HCPCS 21048
|
| Min. Negotiated Rate |
$642.62 |
| Max. Negotiated Rate |
$174,623.00 |
| Rate for Payer: Aetna Commercial |
$1,265.09
|
| Rate for Payer: Aetna Medicare |
$981.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.50
|
| Rate for Payer: BCBS Complete |
$674.75
|
| Rate for Payer: BCBS MAPPO |
$944.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,701.02
|
| Rate for Payer: BCN Commercial |
$1,452.35
|
| Rate for Payer: BCN Medicare Advantage |
$944.10
|
| Rate for Payer: Cash Price |
$1,848.80
|
| Rate for Payer: Cash Price |
$1,848.80
|
| Rate for Payer: Cofinity Commercial |
$1,359.50
|
| Rate for Payer: Cofinity Commercial |
$1,265.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$944.10
|
| Rate for Payer: Healthscope Commercial |
$1,746.58
|
| Rate for Payer: Healthscope Commercial |
$1,510.56
|
| Rate for Payer: Mclaren Medicaid |
$642.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$991.30
|
| Rate for Payer: Meridian Medicaid |
$674.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174,623.00
|
| Rate for Payer: Nomi Health Commercial |
$1,132.92
|
| Rate for Payer: PACE SWMI |
$944.10
|
| Rate for Payer: PHP Medicare Advantage |
$944.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,502.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.94
|
| Rate for Payer: Priority Health Medicare |
$944.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,517.94
|
| Rate for Payer: Priority Health SBD |
$1,517.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,095.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$944.10
|
| Rate for Payer: UHC Exchange |
$1,095.12
|
| Rate for Payer: UHC Medicare Advantage |
$944.10
|
| Rate for Payer: UHCCP Medicaid |
$642.62
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
HCPCS 21030
|
| Min. Negotiated Rate |
$234.73 |
| Max. Negotiated Rate |
$62,986.00 |
| Rate for Payer: Aetna Commercial |
$459.77
|
| Rate for Payer: Aetna Medicare |
$356.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.08
|
| Rate for Payer: BCBS Complete |
$246.47
|
| Rate for Payer: BCBS MAPPO |
$343.11
|
| Rate for Payer: BCBS Trust/PPO |
$998.90
|
| Rate for Payer: BCN Commercial |
$672.42
|
| Rate for Payer: BCN Medicare Advantage |
$343.11
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cofinity Commercial |
$494.08
|
| Rate for Payer: Cofinity Commercial |
$459.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.11
|
| Rate for Payer: Healthscope Commercial |
$634.75
|
| Rate for Payer: Healthscope Commercial |
$548.98
|
| Rate for Payer: Mclaren Medicaid |
$234.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.27
|
| Rate for Payer: Meridian Medicaid |
$246.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62,986.00
|
| Rate for Payer: Nomi Health Commercial |
$411.73
|
| Rate for Payer: PACE SWMI |
$343.11
|
| Rate for Payer: PHP Medicare Advantage |
$343.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$551.61
|
| Rate for Payer: Priority Health Medicare |
$343.11
|
| Rate for Payer: Priority Health Narrow Network |
$551.61
|
| Rate for Payer: Priority Health SBD |
$551.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.11
|
| Rate for Payer: UHC Exchange |
$476.92
|
| Rate for Payer: UHC Medicare Advantage |
$343.11
|
| Rate for Payer: UHCCP Medicaid |
$234.73
|
|
