|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$64.84 |
| Max. Negotiated Rate |
$484.61 |
| Rate for Payer: Aetna Commercial |
$232.05
|
| Rate for Payer: Aetna Medicare |
$70.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.31
|
| Rate for Payer: BCBS Complete |
$484.61
|
| Rate for Payer: BCBS MAPPO |
$68.25
|
| Rate for Payer: BCBS Trust/PPO |
$212.26
|
| Rate for Payer: BCN Commercial |
$212.26
|
| Rate for Payer: BCN Medicare Advantage |
$68.25
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$234.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.25
|
| Rate for Payer: Healthscope Commercial |
$245.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.75
|
| Rate for Payer: Mclaren Medicaid |
$461.54
|
| Rate for Payer: Meridian Medicaid |
$484.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.05
|
| Rate for Payer: PACE Senior Care Partners |
$64.84
|
| Rate for Payer: PACE SWMI |
$68.25
|
| Rate for Payer: PHP Commercial |
$232.05
|
| Rate for Payer: PHP Medicare Advantage |
$68.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.51
|
| Rate for Payer: Priority Health Medicare |
$68.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.50
|
| Rate for Payer: Railroad Medicare Medicare |
$68.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.24
|
| Rate for Payer: UHC Core |
$227.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.25
|
| Rate for Payer: UHC Medicare Advantage |
$70.30
|
| Rate for Payer: VA VA |
$68.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.75
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Aetna Commercial |
$232.05
|
| Rate for Payer: BCBS Trust/PPO |
$210.97
|
| Rate for Payer: BCN Commercial |
$210.97
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$234.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
| Rate for Payer: Healthscope Commercial |
$245.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.05
|
| Rate for Payer: PHP Commercial |
$232.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.24
|
| Rate for Payer: UHC Core |
$227.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.75
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$242.20 |
| Rate for Payer: Aetna Commercial |
$190.07
|
| Rate for Payer: Aetna Medicare |
$147.51
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: BCBS MAPPO |
$141.84
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| Rate for Payer: BCN Medicare Advantage |
$141.84
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Cofinity Commercial |
$190.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.84
|
| Rate for Payer: Mclaren Medicaid |
$94.57
|
| Rate for Payer: Meridian Medicaid |
$99.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.93
|
| Rate for Payer: PACE SWMI |
$141.84
|
| Rate for Payer: PHP Medicare Advantage |
$141.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.04
|
| Rate for Payer: Priority Health Medicare |
$141.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.84
|
| Rate for Payer: UHC Medicare Advantage |
$146.10
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$82.18 |
| Max. Negotiated Rate |
$484.61 |
| Rate for Payer: Aetna Commercial |
$294.10
|
| Rate for Payer: Aetna Medicare |
$89.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.12
|
| Rate for Payer: BCBS Complete |
$484.61
|
| Rate for Payer: BCBS MAPPO |
$86.50
|
| Rate for Payer: BCBS Trust/PPO |
$269.02
|
| Rate for Payer: BCN Commercial |
$269.02
|
| Rate for Payer: BCN Medicare Advantage |
$86.50
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$297.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.50
|
| Rate for Payer: Healthscope Commercial |
$311.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.50
|
| Rate for Payer: Mclaren Medicaid |
$461.54
|
| Rate for Payer: Meridian Medicaid |
$484.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.10
|
| Rate for Payer: PACE Senior Care Partners |
$82.18
|
| Rate for Payer: PACE SWMI |
$86.50
|
| Rate for Payer: PHP Commercial |
$294.10
|
| Rate for Payer: PHP Medicare Advantage |
$86.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.02
|
| Rate for Payer: Priority Health Medicare |
$86.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.03
|
| Rate for Payer: Railroad Medicare Medicare |
$86.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.48
|
| Rate for Payer: UHC Core |
$288.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.50
|
| Rate for Payer: UHC Medicare Advantage |
$89.10
|
| Rate for Payer: VA VA |
$86.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$242.20 |
| Rate for Payer: Aetna Commercial |
$190.07
|
| Rate for Payer: Aetna Medicare |
$147.51
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: BCBS MAPPO |
$141.84
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| Rate for Payer: BCN Medicare Advantage |
$141.84
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$190.07
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.84
|
| Rate for Payer: Mclaren Medicaid |
$94.57
|
| Rate for Payer: Meridian Medicaid |
$99.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.93
|
| Rate for Payer: PACE SWMI |
$141.84
|
| Rate for Payer: PHP Medicare Advantage |
$141.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.04
|
| Rate for Payer: Priority Health Medicare |
$141.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.84
|
| Rate for Payer: UHC Medicare Advantage |
$146.10
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.03 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna Commercial |
$294.10
|
| Rate for Payer: BCBS Trust/PPO |
$267.39
|
| Rate for Payer: BCN Commercial |
$267.39
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$297.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.80
|
| Rate for Payer: Healthscope Commercial |
$311.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.10
|
| Rate for Payer: PHP Commercial |
$294.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.48
|
| Rate for Payer: UHC Core |
$288.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
11443
|
| Min. Negotiated Rate |
$115.02 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$232.26
|
| Rate for Payer: Aetna Medicare |
$180.26
|
| Rate for Payer: BCBS Complete |
$120.77
|
| Rate for Payer: BCBS MAPPO |
$173.33
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$268.97
|
| Rate for Payer: BCN Medicare Advantage |
$173.33
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$232.26
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.33
|
| Rate for Payer: Mclaren Medicaid |
$115.02
|
| Rate for Payer: Meridian Medicaid |
$120.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$182.00
|
| Rate for Payer: PACE SWMI |
$173.33
|
| Rate for Payer: PHP Medicare Advantage |
$173.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.09
|
| Rate for Payer: Priority Health Medicare |
$173.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.33
|
| Rate for Payer: UHC Medicare Advantage |
$178.53
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$268.36 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna Commercial |
$374.00
|
| Rate for Payer: BCBS Trust/PPO |
$340.03
|
| Rate for Payer: BCN Commercial |
$340.03
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$378.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.00
|
| Rate for Payer: Healthscope Commercial |
$396.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.00
|
| Rate for Payer: PHP Commercial |
$374.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.20
|
| Rate for Payer: UHC Core |
$367.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.00
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$1,116.73 |
| Rate for Payer: Aetna Commercial |
$374.00
|
| Rate for Payer: Aetna Medicare |
$114.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.50
|
| Rate for Payer: BCBS Complete |
$1,116.73
|
| Rate for Payer: BCBS MAPPO |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$342.10
|
| Rate for Payer: BCN Commercial |
$342.10
|
| Rate for Payer: BCN Medicare Advantage |
$110.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$378.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.00
|
| Rate for Payer: Healthscope Commercial |
$396.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.00
|
| Rate for Payer: Mclaren Medicaid |
$1,063.55
|
| Rate for Payer: Meridian Medicaid |
$1,116.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.00
|
| Rate for Payer: PACE Senior Care Partners |
$104.50
|
| Rate for Payer: PACE SWMI |
$110.00
|
| Rate for Payer: PHP Commercial |
$374.00
|
| Rate for Payer: PHP Medicare Advantage |
$110.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,063.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.80
|
| Rate for Payer: Priority Health Medicare |
$110.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.36
|
| Rate for Payer: Railroad Medicare Medicare |
$110.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.20
|
| Rate for Payer: UHC Core |
$367.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.00
|
| Rate for Payer: UHC Medicare Advantage |
$113.30
|
| Rate for Payer: VA VA |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.00
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 11443
|
| Min. Negotiated Rate |
$115.02 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$232.26
|
| Rate for Payer: Aetna Medicare |
$180.26
|
| Rate for Payer: BCBS Complete |
$120.77
|
| Rate for Payer: BCBS MAPPO |
$173.33
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$268.97
|
| Rate for Payer: BCN Medicare Advantage |
$173.33
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$232.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.33
|
| Rate for Payer: Mclaren Medicaid |
$115.02
|
| Rate for Payer: Meridian Medicaid |
$120.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$182.00
|
| Rate for Payer: PACE SWMI |
$173.33
|
| Rate for Payer: PHP Medicare Advantage |
$173.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.09
|
| Rate for Payer: Priority Health Medicare |
$173.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.33
|
| Rate for Payer: UHC Medicare Advantage |
$178.53
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
11444
|
| Min. Negotiated Rate |
$144.63 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$294.18
|
| Rate for Payer: Aetna Medicare |
$228.32
|
| Rate for Payer: BCBS Complete |
$151.86
|
| Rate for Payer: BCBS MAPPO |
$219.54
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$333.37
|
| Rate for Payer: BCN Medicare Advantage |
$219.54
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$316.14
|
| Rate for Payer: Cofinity Commercial |
$294.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.54
|
| Rate for Payer: Mclaren Medicaid |
$144.63
|
| Rate for Payer: Meridian Medicaid |
$151.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.52
|
| Rate for Payer: PACE SWMI |
$219.54
|
| Rate for Payer: PHP Medicare Advantage |
$219.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.22
|
| Rate for Payer: Priority Health Medicare |
$219.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.54
|
| Rate for Payer: UHC Medicare Advantage |
$226.13
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 11444
|
| Min. Negotiated Rate |
$144.63 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$294.18
|
| Rate for Payer: Aetna Medicare |
$228.32
|
| Rate for Payer: BCBS Complete |
$151.86
|
| Rate for Payer: BCBS MAPPO |
$219.54
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$333.37
|
| Rate for Payer: BCN Medicare Advantage |
$219.54
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$294.18
|
| Rate for Payer: Cofinity Commercial |
$316.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.54
|
| Rate for Payer: Mclaren Medicaid |
$144.63
|
| Rate for Payer: Meridian Medicaid |
$151.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.52
|
| Rate for Payer: PACE SWMI |
$219.54
|
| Rate for Payer: PHP Medicare Advantage |
$219.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.22
|
| Rate for Payer: Priority Health Medicare |
$219.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.54
|
| Rate for Payer: UHC Medicare Advantage |
$226.13
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$1,116.73 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Medicare |
$147.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.88
|
| Rate for Payer: BCBS Complete |
$1,116.73
|
| Rate for Payer: BCBS MAPPO |
$141.50
|
| Rate for Payer: BCBS Trust/PPO |
$440.06
|
| Rate for Payer: BCN Commercial |
$440.06
|
| Rate for Payer: BCN Medicare Advantage |
$141.50
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$486.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.50
|
| Rate for Payer: Healthscope Commercial |
$509.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.50
|
| Rate for Payer: Mclaren Medicaid |
$1,063.55
|
| Rate for Payer: Meridian Medicaid |
$1,116.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$481.10
|
| Rate for Payer: PACE Senior Care Partners |
$134.42
|
| Rate for Payer: PACE SWMI |
$141.50
|
| Rate for Payer: PHP Commercial |
$481.10
|
| Rate for Payer: PHP Medicare Advantage |
$141.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,063.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.42
|
| Rate for Payer: Priority Health Medicare |
$141.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.20
|
| Rate for Payer: Railroad Medicare Medicare |
$141.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.08
|
| Rate for Payer: UHC Core |
$472.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.50
|
| Rate for Payer: UHC Medicare Advantage |
$145.74
|
| Rate for Payer: VA VA |
$141.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$345.20 |
| Max. Negotiated Rate |
$509.40 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: BCBS Trust/PPO |
$437.40
|
| Rate for Payer: BCN Commercial |
$437.40
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$486.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.80
|
| Rate for Payer: Healthscope Commercial |
$509.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$481.10
|
| Rate for Payer: PHP Commercial |
$481.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.08
|
| Rate for Payer: UHC Core |
$472.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.50
|
|
|
PR EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 56740
|
| Min. Negotiated Rate |
$202.78 |
| Max. Negotiated Rate |
$1,879.16 |
| Rate for Payer: Aetna Commercial |
$418.03
|
| Rate for Payer: Aetna Medicare |
$324.44
|
| Rate for Payer: BCBS Complete |
$212.92
|
| Rate for Payer: BCBS MAPPO |
$311.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.16
|
| Rate for Payer: BCN Commercial |
$463.27
|
| Rate for Payer: BCN Medicare Advantage |
$311.96
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$449.22
|
| Rate for Payer: Cofinity Commercial |
$418.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.96
|
| Rate for Payer: Mclaren Medicaid |
$202.78
|
| Rate for Payer: Meridian Medicaid |
$212.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$327.56
|
| Rate for Payer: PACE SWMI |
$311.96
|
| Rate for Payer: PHP Medicare Advantage |
$311.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$448.81
|
| Rate for Payer: Priority Health Medicare |
$311.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.96
|
| Rate for Payer: UHC Medicare Advantage |
$321.32
|
|
|
PR EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN
|
Professional
|
Both
|
$7,827.00
|
|
|
Service Code
|
HCPCS 61563
|
| Min. Negotiated Rate |
$382.49 |
| Max. Negotiated Rate |
$5,478.90 |
| Rate for Payer: Aetna Commercial |
$2,676.94
|
| Rate for Payer: Aetna Medicare |
$2,077.63
|
| Rate for Payer: BCBS Complete |
$1,350.63
|
| Rate for Payer: BCBS MAPPO |
$1,997.72
|
| Rate for Payer: BCBS Trust/PPO |
$382.49
|
| Rate for Payer: BCN Commercial |
$4,057.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.72
|
| Rate for Payer: Cash Price |
$6,261.60
|
| Rate for Payer: Cash Price |
$6,261.60
|
| Rate for Payer: Cofinity Commercial |
$2,876.72
|
| Rate for Payer: Cofinity Commercial |
$2,676.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.72
|
| Rate for Payer: Mclaren Medicaid |
$1,286.31
|
| Rate for Payer: Meridian Medicaid |
$1,350.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,097.61
|
| Rate for Payer: PACE SWMI |
$1,997.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,286.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,478.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,388.85
|
| Rate for Payer: Priority Health Medicare |
$1,997.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,388.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,997.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.72
|
| Rate for Payer: UHC Medicare Advantage |
$2,057.65
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 21048
|
| Min. Negotiated Rate |
$635.38 |
| Max. Negotiated Rate |
$3,701.02 |
| Rate for Payer: Aetna Commercial |
$1,299.97
|
| Rate for Payer: Aetna Medicare |
$1,008.94
|
| Rate for Payer: BCBS Complete |
$667.15
|
| Rate for Payer: BCBS MAPPO |
$970.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,701.02
|
| Rate for Payer: BCN Commercial |
$1,452.35
|
| Rate for Payer: BCN Medicare Advantage |
$970.13
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cofinity Commercial |
$1,396.99
|
| Rate for Payer: Cofinity Commercial |
$1,299.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$970.13
|
| Rate for Payer: Mclaren Medicaid |
$635.38
|
| Rate for Payer: Meridian Medicaid |
$667.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,018.64
|
| Rate for Payer: PACE SWMI |
$970.13
|
| Rate for Payer: PHP Medicare Advantage |
$970.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$635.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,586.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.66
|
| Rate for Payer: Priority Health Medicare |
$970.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,517.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$970.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$970.13
|
| Rate for Payer: UHC Medicare Advantage |
$999.23
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG
|
Professional
|
Both
|
$1,004.00
|
|
|
Service Code
|
HCPCS 21030
|
| Min. Negotiated Rate |
$230.89 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$468.89
|
| Rate for Payer: Aetna Medicare |
$363.92
|
| Rate for Payer: BCBS Complete |
$242.43
|
| Rate for Payer: BCBS MAPPO |
$349.92
|
| Rate for Payer: BCBS Trust/PPO |
$998.90
|
| Rate for Payer: BCN Commercial |
$672.42
|
| Rate for Payer: BCN Medicare Advantage |
$349.92
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cofinity Commercial |
$468.89
|
| Rate for Payer: Cofinity Commercial |
$503.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.92
|
| Rate for Payer: Mclaren Medicaid |
$230.89
|
| Rate for Payer: Meridian Medicaid |
$242.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$367.42
|
| Rate for Payer: PACE SWMI |
$349.92
|
| Rate for Payer: PHP Medicare Advantage |
$349.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.98
|
| Rate for Payer: Priority Health Medicare |
$349.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$549.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.92
|
| Rate for Payer: UHC Medicare Advantage |
$360.42
|
|
|
PR EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 42815
|
| Min. Negotiated Rate |
$278.41 |
| Max. Negotiated Rate |
$1,136.10 |
| Rate for Payer: Aetna Commercial |
$712.30
|
| Rate for Payer: Aetna Medicare |
$552.83
|
| Rate for Payer: BCBS Complete |
$364.33
|
| Rate for Payer: BCBS MAPPO |
$531.57
|
| Rate for Payer: BCBS Trust/PPO |
$278.41
|
| Rate for Payer: BCN Commercial |
$796.55
|
| Rate for Payer: BCN Medicare Advantage |
$531.57
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$765.46
|
| Rate for Payer: Cofinity Commercial |
$712.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.57
|
| Rate for Payer: Mclaren Medicaid |
$346.98
|
| Rate for Payer: Meridian Medicaid |
$364.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$558.15
|
| Rate for Payer: PACE SWMI |
$531.57
|
| Rate for Payer: PHP Medicare Advantage |
$531.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.39
|
| Rate for Payer: Priority Health Medicare |
$531.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$958.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.57
|
| Rate for Payer: UHC Medicare Advantage |
$547.52
|
|
|
PR EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 42810
|
| Min. Negotiated Rate |
$183.18 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Aetna Commercial |
$369.22
|
| Rate for Payer: Aetna Medicare |
$286.56
|
| Rate for Payer: BCBS Complete |
$192.34
|
| Rate for Payer: BCBS MAPPO |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$196.53
|
| Rate for Payer: BCN Commercial |
$575.66
|
| Rate for Payer: BCN Medicare Advantage |
$275.54
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$396.78
|
| Rate for Payer: Cofinity Commercial |
$369.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.54
|
| Rate for Payer: Mclaren Medicaid |
$183.18
|
| Rate for Payer: Meridian Medicaid |
$192.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$289.32
|
| Rate for Payer: PACE SWMI |
$275.54
|
| Rate for Payer: PHP Medicare Advantage |
$275.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$500.36
|
| Rate for Payer: Priority Health Medicare |
$275.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$500.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.54
|
| Rate for Payer: UHC Medicare Advantage |
$283.81
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 19125
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$866.60 |
| Rate for Payer: Aetna Commercial |
$613.24
|
| Rate for Payer: Aetna Medicare |
$475.95
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS MAPPO |
$457.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$840.53
|
| Rate for Payer: BCN Medicare Advantage |
$457.64
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$613.24
|
| Rate for Payer: Cofinity Commercial |
$659.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.64
|
| Rate for Payer: Mclaren Medicaid |
$298.20
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$480.52
|
| Rate for Payer: PACE SWMI |
$457.64
|
| Rate for Payer: PHP Medicare Advantage |
$457.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.12
|
| Rate for Payer: Priority Health Medicare |
$457.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$457.64
|
| Rate for Payer: UHC Medicare Advantage |
$471.37
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
19125
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$866.60 |
| Rate for Payer: Aetna Commercial |
$613.24
|
| Rate for Payer: Aetna Medicare |
$475.95
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS MAPPO |
$457.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$840.53
|
| Rate for Payer: BCN Medicare Advantage |
$457.64
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$659.00
|
| Rate for Payer: Cofinity Commercial |
$613.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.64
|
| Rate for Payer: Mclaren Medicaid |
$298.20
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$480.52
|
| Rate for Payer: PACE SWMI |
$457.64
|
| Rate for Payer: PHP Medicare Advantage |
$457.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.12
|
| Rate for Payer: Priority Health Medicare |
$457.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$457.64
|
| Rate for Payer: UHC Medicare Advantage |
$471.37
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$755.06 |
| Max. Negotiated Rate |
$1,114.20 |
| Rate for Payer: Aetna Commercial |
$1,052.30
|
| Rate for Payer: BCBS Trust/PPO |
$956.73
|
| Rate for Payer: BCN Commercial |
$956.73
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$1,064.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.40
|
| Rate for Payer: Healthscope Commercial |
$1,114.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.30
|
| Rate for Payer: PHP Commercial |
$1,052.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,077.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$755.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,089.44
|
| Rate for Payer: UHC Core |
$1,033.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.50
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$294.02 |
| Max. Negotiated Rate |
$2,625.49 |
| Rate for Payer: Aetna Commercial |
$1,052.30
|
| Rate for Payer: Aetna Medicare |
$321.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$386.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$386.88
|
| Rate for Payer: BCBS Complete |
$2,625.49
|
| Rate for Payer: BCBS MAPPO |
$309.50
|
| Rate for Payer: BCBS Trust/PPO |
$962.54
|
| Rate for Payer: BCCCP Commercial |
$618.15
|
| Rate for Payer: BCN Commercial |
$962.54
|
| Rate for Payer: BCN Medicare Advantage |
$309.50
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$1,064.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$1,114.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.50
|
| Rate for Payer: Mclaren Medicaid |
$2,500.47
|
| Rate for Payer: Meridian Medicaid |
$2,625.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.30
|
| Rate for Payer: PACE Senior Care Partners |
$294.02
|
| Rate for Payer: PACE SWMI |
$309.50
|
| Rate for Payer: PHP Commercial |
$1,052.30
|
| Rate for Payer: PHP Medicare Advantage |
$309.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,500.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,077.06
|
| Rate for Payer: Priority Health Medicare |
$309.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$755.06
|
| Rate for Payer: Railroad Medicare Medicare |
$309.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,089.44
|
| Rate for Payer: UHC Core |
$1,033.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.50
|
| Rate for Payer: UHC Medicare Advantage |
$318.78
|
| Rate for Payer: VA VA |
$309.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.50
|
|
|
PR EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 19126
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$232.12 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$165.88
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS MAPPO |
$159.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$232.12
|
| Rate for Payer: BCN Medicare Advantage |
$159.50
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$229.68
|
| Rate for Payer: Cofinity Commercial |
$213.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.50
|
| Rate for Payer: Mclaren Medicaid |
$101.60
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$167.48
|
| Rate for Payer: PACE SWMI |
$159.50
|
| Rate for Payer: PHP Medicare Advantage |
$159.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.24
|
| Rate for Payer: Priority Health Medicare |
$159.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.50
|
| Rate for Payer: UHC Medicare Advantage |
$164.28
|
|
