|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna Commercial |
$309.40
|
| Rate for Payer: Aetna Medicare |
$94.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.75
|
| Rate for Payer: BCBS Complete |
$67.38
|
| Rate for Payer: BCBS MAPPO |
$91.00
|
| Rate for Payer: BCBS Trust/PPO |
$299.24
|
| Rate for Payer: BCN Commercial |
$299.24
|
| Rate for Payer: BCN Medicare Advantage |
$91.00
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$313.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$327.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.00
|
| Rate for Payer: Mclaren Medicaid |
$64.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.55
|
| Rate for Payer: Meridian Medicaid |
$67.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.40
|
| Rate for Payer: Nomi Health Commercial |
$298.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE Senior Care Partners |
$86.45
|
| Rate for Payer: PACE SWMI |
$91.00
|
| Rate for Payer: PHP Commercial |
$309.40
|
| Rate for Payer: PHP Medicare Advantage |
$91.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$316.68
|
| Rate for Payer: Priority Health Medicare |
$91.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.34
|
| Rate for Payer: Railroad Medicare Medicare |
$91.00
|
| Rate for Payer: UHC Core |
$303.94
|
| Rate for Payer: UHC Exchange |
$91.00
|
| Rate for Payer: UHC Medicaid |
$64.17
|
| Rate for Payer: UHC Medicare Advantage |
$91.00
|
| Rate for Payer: UHCCP Medicaid |
$64.17
|
| Rate for Payer: VA VA |
$91.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.00
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$321.55 |
| Max. Negotiated Rate |
$415.80 |
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: BCBS Trust/PPO |
$381.57
|
| Rate for Payer: BCN Commercial |
$381.57
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$397.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.60
|
| Rate for Payer: Healthscope Commercial |
$415.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.70
|
| Rate for Payer: Nomi Health Commercial |
$378.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PHP Commercial |
$392.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$401.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.55
|
| Rate for Payer: UHC Core |
$385.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
11443
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna Commercial |
$189.95
|
| Rate for Payer: Aetna Medicare |
$231.00
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCN Commercial |
$214.02
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Mclaren Medicaid |
$101.60
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.40
|
| Rate for Payer: UHC Medicaid |
$101.60
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$415.80 |
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Aetna Medicare |
$120.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$144.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$144.38
|
| Rate for Payer: BCBS Complete |
$85.52
|
| Rate for Payer: BCBS MAPPO |
$115.50
|
| Rate for Payer: BCBS Trust/PPO |
$379.81
|
| Rate for Payer: BCN Commercial |
$379.81
|
| Rate for Payer: BCN Medicare Advantage |
$115.50
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$397.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.50
|
| Rate for Payer: Healthscope Commercial |
$415.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.50
|
| Rate for Payer: Mclaren Medicaid |
$81.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.28
|
| Rate for Payer: Meridian Medicaid |
$85.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.70
|
| Rate for Payer: Nomi Health Commercial |
$378.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PACE Senior Care Partners |
$109.72
|
| Rate for Payer: PACE SWMI |
$115.50
|
| Rate for Payer: PHP Commercial |
$392.70
|
| Rate for Payer: PHP Medicare Advantage |
$115.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$401.94
|
| Rate for Payer: Priority Health Medicare |
$116.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.55
|
| Rate for Payer: Railroad Medicare Medicare |
$115.50
|
| Rate for Payer: UHC Core |
$385.77
|
| Rate for Payer: UHC Exchange |
$115.50
|
| Rate for Payer: UHC Medicaid |
$81.45
|
| Rate for Payer: UHC Medicare Advantage |
$115.50
|
| Rate for Payer: UHCCP Medicaid |
$81.45
|
| Rate for Payer: VA VA |
$115.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 11443
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna Commercial |
$189.95
|
| Rate for Payer: Aetna Medicare |
$231.00
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCN Commercial |
$214.02
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Mclaren Medicaid |
$101.60
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.40
|
| Rate for Payer: UHC Medicaid |
$101.60
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$413.42 |
| Max. Negotiated Rate |
$534.60 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: BCBS Trust/PPO |
$490.58
|
| Rate for Payer: BCN Commercial |
$490.58
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cofinity Commercial |
$510.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.20
|
| Rate for Payer: Healthscope Commercial |
$534.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.90
|
| Rate for Payer: Nomi Health Commercial |
$487.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: PHP Commercial |
$504.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$516.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.42
|
| Rate for Payer: UHC Core |
$495.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 11444
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$242.15
|
| Rate for Payer: Aetna Medicare |
$297.00
|
| Rate for Payer: BCBS Complete |
$133.97
|
| Rate for Payer: BCN Commercial |
$270.57
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Mclaren Medicaid |
$127.59
|
| Rate for Payer: Meridian Medicaid |
$133.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.04
|
| Rate for Payer: UHC Medicaid |
$127.59
|
| Rate for Payer: UHCCP Medicaid |
$127.59
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
11444
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$242.15
|
| Rate for Payer: Aetna Medicare |
$297.00
|
| Rate for Payer: BCBS Complete |
$133.97
|
| Rate for Payer: BCN Commercial |
$270.57
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Mclaren Medicaid |
$127.59
|
| Rate for Payer: Meridian Medicaid |
$133.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.04
|
| Rate for Payer: UHC Medicaid |
$127.59
|
| Rate for Payer: UHCCP Medicaid |
$127.59
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$534.60 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Medicare |
$154.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$185.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$185.62
|
| Rate for Payer: BCBS Complete |
$109.95
|
| Rate for Payer: BCBS MAPPO |
$148.50
|
| Rate for Payer: BCBS Trust/PPO |
$488.33
|
| Rate for Payer: BCN Commercial |
$488.33
|
| Rate for Payer: BCN Medicare Advantage |
$148.50
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cofinity Commercial |
$510.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.50
|
| Rate for Payer: Healthscope Commercial |
$534.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.50
|
| Rate for Payer: Mclaren Medicaid |
$104.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.93
|
| Rate for Payer: Meridian Medicaid |
$109.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$163.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.90
|
| Rate for Payer: Nomi Health Commercial |
$487.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: PACE Senior Care Partners |
$141.07
|
| Rate for Payer: PACE SWMI |
$148.50
|
| Rate for Payer: PHP Commercial |
$504.90
|
| Rate for Payer: PHP Medicare Advantage |
$148.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$516.78
|
| Rate for Payer: Priority Health Medicare |
$149.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.42
|
| Rate for Payer: Railroad Medicare Medicare |
$148.50
|
| Rate for Payer: UHC Core |
$495.99
|
| Rate for Payer: UHC Exchange |
$148.50
|
| Rate for Payer: UHC Medicaid |
$104.72
|
| Rate for Payer: UHC Medicare Advantage |
$148.50
|
| Rate for Payer: UHCCP Medicaid |
$104.72
|
| Rate for Payer: VA VA |
$148.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.50
|
|
|
PR EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN
|
Professional
|
Both
|
$8,224.00
|
|
|
Service Code
|
HCPCS 61563
|
| Min. Negotiated Rate |
$1,230.29 |
| Max. Negotiated Rate |
$6,168.00 |
| Rate for Payer: Aetna Commercial |
$2,563.18
|
| Rate for Payer: Aetna Medicare |
$4,112.00
|
| Rate for Payer: BCBS Complete |
$1,291.80
|
| Rate for Payer: BCN Commercial |
$4,171.18
|
| Rate for Payer: Cash Price |
$6,579.20
|
| Rate for Payer: Cash Price |
$6,579.20
|
| Rate for Payer: Mclaren Medicaid |
$1,230.29
|
| Rate for Payer: Meridian Medicaid |
$1,291.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,168.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,230.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,506.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,506.82
|
| Rate for Payer: UHC Medicaid |
$1,230.29
|
| Rate for Payer: UHCCP Medicaid |
$1,230.29
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 21048
|
| Min. Negotiated Rate |
$578.30 |
| Max. Negotiated Rate |
$1,785.00 |
| Rate for Payer: Aetna Commercial |
$1,361.18
|
| Rate for Payer: Aetna Medicare |
$1,190.00
|
| Rate for Payer: BCBS Complete |
$607.22
|
| Rate for Payer: BCN Commercial |
$1,502.40
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Mclaren Medicaid |
$578.30
|
| Rate for Payer: Meridian Medicaid |
$607.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,785.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,606.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,606.03
|
| Rate for Payer: UHC Medicaid |
$578.30
|
| Rate for Payer: UHCCP Medicaid |
$578.30
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG
|
Professional
|
Both
|
$1,055.00
|
|
|
Service Code
|
HCPCS 21030
|
| Min. Negotiated Rate |
$214.70 |
| Max. Negotiated Rate |
$791.25 |
| Rate for Payer: Aetna Commercial |
$488.49
|
| Rate for Payer: Aetna Medicare |
$527.50
|
| Rate for Payer: BCBS Complete |
$225.44
|
| Rate for Payer: BCN Commercial |
$548.78
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Mclaren Medicaid |
$214.70
|
| Rate for Payer: Meridian Medicaid |
$225.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$791.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$586.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.63
|
| Rate for Payer: UHC Medicaid |
$214.70
|
| Rate for Payer: UHCCP Medicaid |
$214.70
|
|
|
PR EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
HCPCS 42815
|
| Min. Negotiated Rate |
$305.02 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$718.44
|
| Rate for Payer: Aetna Medicare |
$852.50
|
| Rate for Payer: BCBS Complete |
$320.27
|
| Rate for Payer: BCN Commercial |
$811.22
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Mclaren Medicaid |
$305.02
|
| Rate for Payer: Meridian Medicaid |
$320.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,278.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$988.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$988.40
|
| Rate for Payer: UHC Medicaid |
$305.02
|
| Rate for Payer: UHCCP Medicaid |
$305.02
|
|
|
PR EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 42810
|
| Min. Negotiated Rate |
$164.44 |
| Max. Negotiated Rate |
$669.75 |
| Rate for Payer: Aetna Commercial |
$370.11
|
| Rate for Payer: Aetna Medicare |
$446.50
|
| Rate for Payer: BCBS Complete |
$172.66
|
| Rate for Payer: BCN Commercial |
$429.75
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Mclaren Medicaid |
$164.44
|
| Rate for Payer: Meridian Medicaid |
$172.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$523.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.63
|
| Rate for Payer: UHC Medicaid |
$164.44
|
| Rate for Payer: UHCCP Medicaid |
$164.44
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 19125
|
| Min. Negotiated Rate |
$288.62 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Aetna Commercial |
$503.32
|
| Rate for Payer: Aetna Medicare |
$650.50
|
| Rate for Payer: BCBS Complete |
$303.05
|
| Rate for Payer: BCN Commercial |
$702.65
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Mclaren Medicaid |
$288.62
|
| Rate for Payer: Meridian Medicaid |
$303.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$643.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$643.11
|
| Rate for Payer: UHC Medicaid |
$288.62
|
| Rate for Payer: UHCCP Medicaid |
$288.62
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$905.50 |
| Max. Negotiated Rate |
$1,170.90 |
| Rate for Payer: Aetna Commercial |
$1,105.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,074.50
|
| Rate for Payer: BCN Commercial |
$1,074.50
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$1,118.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.80
|
| Rate for Payer: Healthscope Commercial |
$1,170.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,105.85
|
| Rate for Payer: Nomi Health Commercial |
$1,066.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: PHP Commercial |
$1,105.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,131.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$905.50
|
| Rate for Payer: UHC Core |
$1,086.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.75
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$229.37 |
| Max. Negotiated Rate |
$1,170.90 |
| Rate for Payer: Aetna Commercial |
$1,105.85
|
| Rate for Payer: Aetna Medicare |
$338.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.56
|
| Rate for Payer: BCBS Complete |
$240.82
|
| Rate for Payer: BCBS MAPPO |
$325.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.55
|
| Rate for Payer: BCCCP Commercial |
$569.78
|
| Rate for Payer: BCN Commercial |
$1,069.55
|
| Rate for Payer: BCN Medicare Advantage |
$325.25
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$1,118.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.25
|
| Rate for Payer: Healthscope Commercial |
$1,170.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.75
|
| Rate for Payer: Mclaren Medicaid |
$229.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.51
|
| Rate for Payer: Meridian Medicaid |
$240.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$357.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,105.85
|
| Rate for Payer: Nomi Health Commercial |
$1,066.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: PACE Senior Care Partners |
$308.99
|
| Rate for Payer: PACE SWMI |
$325.25
|
| Rate for Payer: PHP Commercial |
$1,105.85
|
| Rate for Payer: PHP Medicare Advantage |
$325.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,131.87
|
| Rate for Payer: Priority Health Medicare |
$328.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$905.50
|
| Rate for Payer: Railroad Medicare Medicare |
$325.25
|
| Rate for Payer: UHC Core |
$1,086.34
|
| Rate for Payer: UHC Exchange |
$325.25
|
| Rate for Payer: UHC Medicaid |
$229.37
|
| Rate for Payer: UHC Medicare Advantage |
$325.25
|
| Rate for Payer: UHCCP Medicaid |
$229.37
|
| Rate for Payer: VA VA |
$325.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.75
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
19125
|
| Min. Negotiated Rate |
$288.62 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Aetna Commercial |
$503.32
|
| Rate for Payer: Aetna Medicare |
$650.50
|
| Rate for Payer: BCBS Complete |
$303.05
|
| Rate for Payer: BCN Commercial |
$702.65
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Mclaren Medicaid |
$288.62
|
| Rate for Payer: Meridian Medicaid |
$303.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$643.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$643.11
|
| Rate for Payer: UHC Medicaid |
$288.62
|
| Rate for Payer: UHCCP Medicaid |
$288.62
|
|
|
PR EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 19126
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$238.03 |
| Rate for Payer: Aetna Commercial |
$177.60
|
| Rate for Payer: Aetna Medicare |
$140.00
|
| Rate for Payer: BCBS Complete |
$96.39
|
| Rate for Payer: BCN Commercial |
$238.03
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Mclaren Medicaid |
$91.80
|
| Rate for Payer: Meridian Medicaid |
$96.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$217.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.87
|
| Rate for Payer: UHC Medicaid |
$91.80
|
| Rate for Payer: UHCCP Medicaid |
$91.80
|
|
|
PR EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY
|
Professional
|
Both
|
$2,848.00
|
|
|
Service Code
|
HCPCS 60600
|
| Min. Negotiated Rate |
$780.65 |
| Max. Negotiated Rate |
$2,178.82 |
| Rate for Payer: Aetna Commercial |
$1,763.47
|
| Rate for Payer: Aetna Medicare |
$1,424.00
|
| Rate for Payer: BCBS Complete |
$819.68
|
| Rate for Payer: BCN Commercial |
$2,009.35
|
| Rate for Payer: Cash Price |
$2,278.40
|
| Rate for Payer: Cash Price |
$2,278.40
|
| Rate for Payer: Mclaren Medicaid |
$780.65
|
| Rate for Payer: Meridian Medicaid |
$819.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,136.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$780.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,178.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,178.82
|
| Rate for Payer: UHC Medicaid |
$780.65
|
| Rate for Payer: UHCCP Medicaid |
$780.65
|
|
|
PR EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS 26596
|
| Min. Negotiated Rate |
$505.45 |
| Max. Negotiated Rate |
$1,324.96 |
| Rate for Payer: Aetna Commercial |
$1,076.67
|
| Rate for Payer: Aetna Medicare |
$683.50
|
| Rate for Payer: BCBS Complete |
$530.72
|
| Rate for Payer: BCN Commercial |
$1,239.47
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Mclaren Medicaid |
$505.45
|
| Rate for Payer: Meridian Medicaid |
$530.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,025.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,324.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,324.96
|
| Rate for Payer: UHC Medicaid |
$505.45
|
| Rate for Payer: UHCCP Medicaid |
$505.45
|
|
|
PR EXC CRV STUMP VAG APPR W/RPR NTRCL
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 57556
|
| Min. Negotiated Rate |
$333.35 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna Commercial |
$698.98
|
| Rate for Payer: Aetna Medicare |
$660.00
|
| Rate for Payer: BCBS Complete |
$350.02
|
| Rate for Payer: BCN Commercial |
$882.42
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Mclaren Medicaid |
$333.35
|
| Rate for Payer: Meridian Medicaid |
$350.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$990.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$893.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$893.70
|
| Rate for Payer: UHC Medicaid |
$333.35
|
| Rate for Payer: UHCCP Medicaid |
$333.35
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ
|
Professional
|
Both
|
$4,331.00
|
|
|
Service Code
|
HCPCS 38555
|
| Min. Negotiated Rate |
$627.07 |
| Max. Negotiated Rate |
$3,248.25 |
| Rate for Payer: Aetna Commercial |
$1,274.21
|
| Rate for Payer: Aetna Medicare |
$2,165.50
|
| Rate for Payer: BCBS Complete |
$658.42
|
| Rate for Payer: BCN Commercial |
$1,549.22
|
| Rate for Payer: Cash Price |
$3,464.80
|
| Rate for Payer: Cash Price |
$3,464.80
|
| Rate for Payer: Mclaren Medicaid |
$627.07
|
| Rate for Payer: Meridian Medicaid |
$658.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,248.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,061.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,061.36
|
| Rate for Payer: UHC Medicaid |
$627.07
|
| Rate for Payer: UHCCP Medicaid |
$627.07
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 38550
|
| Min. Negotiated Rate |
$330.15 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$643.88
|
| Rate for Payer: Aetna Medicare |
$812.00
|
| Rate for Payer: BCBS Complete |
$346.66
|
| Rate for Payer: BCN Commercial |
$794.78
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Mclaren Medicaid |
$330.15
|
| Rate for Payer: Meridian Medicaid |
$346.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,057.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,057.52
|
| Rate for Payer: UHC Medicaid |
$330.15
|
| Rate for Payer: UHCCP Medicaid |
$330.15
|
|
|
PR EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT
|
Professional
|
Both
|
$2,432.00
|
|
|
Service Code
|
HCPCS 26205
|
| Min. Negotiated Rate |
$367.43 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$808.63
|
| Rate for Payer: Aetna Medicare |
$1,216.00
|
| Rate for Payer: BCBS Complete |
$385.80
|
| Rate for Payer: BCN Commercial |
$929.23
|
| Rate for Payer: Cash Price |
$1,945.60
|
| Rate for Payer: Cash Price |
$1,945.60
|
| Rate for Payer: Mclaren Medicaid |
$367.43
|
| Rate for Payer: Meridian Medicaid |
$385.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,824.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$993.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$993.33
|
| Rate for Payer: UHC Medicaid |
$367.43
|
| Rate for Payer: UHCCP Medicaid |
$367.43
|
|
