|
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 |
$170.13 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: Aetna Commercial |
$227.97
|
| Rate for Payer: Aetna Medicare |
$176.94
|
| Rate for Payer: BCBS Complete |
$179.60
|
| Rate for Payer: BCBS MAPPO |
$170.13
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.64
|
| 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 Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$171.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.13
|
| Rate for Payer: UHC Exchange |
$170.13
|
| Rate for Payer: UHC Medicare Advantage |
$170.13
|
|
|
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 |
$291.85 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Aetna Commercial |
$381.65
|
| Rate for Payer: BCBS Trust/PPO |
$366.52
|
| Rate for Payer: BCN Commercial |
$346.99
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$386.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.20
|
| Rate for Payer: Healthscope Commercial |
$404.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.65
|
| Rate for Payer: Nomi Health Commercial |
$368.18
|
| Rate for Payer: PHP Commercial |
$381.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO |
$390.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.12
|
| Rate for Payer: UHC Core |
$374.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.75
|
|
|
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 |
$106.64 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: Aetna Commercial |
$381.65
|
| Rate for Payer: Aetna Medicare |
$116.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.31
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$112.25
|
| Rate for Payer: BCBS Trust/PPO |
$369.12
|
| Rate for Payer: BCN Commercial |
$349.10
|
| Rate for Payer: BCN Medicare Advantage |
$112.25
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$386.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.25
|
| Rate for Payer: Healthscope Commercial |
$404.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.75
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.86
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.65
|
| Rate for Payer: Nomi Health Commercial |
$368.18
|
| Rate for Payer: PACE Senior Care Partners |
$106.64
|
| Rate for Payer: PACE SWMI |
$112.25
|
| Rate for Payer: PHP Commercial |
$381.65
|
| Rate for Payer: PHP Medicare Advantage |
$112.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO |
$390.63
|
| Rate for Payer: Priority Health Medicare |
$113.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.83
|
| Rate for Payer: Railroad Medicare Medicare |
$112.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.12
|
| Rate for Payer: UHC Core |
$374.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.25
|
| Rate for Payer: UHC Exchange |
$112.25
|
| Rate for Payer: UHC Medicare Advantage |
$112.25
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$112.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.75
|
|
|
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 |
$170.13 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: Aetna Commercial |
$227.97
|
| Rate for Payer: Aetna Medicare |
$176.94
|
| Rate for Payer: BCBS Complete |
$179.60
|
| Rate for Payer: BCBS MAPPO |
$170.13
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.64
|
| 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 Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$171.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.13
|
| Rate for Payer: UHC Exchange |
$170.13
|
| Rate for Payer: UHC Medicare Advantage |
$170.13
|
|
|
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 |
$216.28 |
| Max. Negotiated Rate |
$375.05 |
| Rate for Payer: Aetna Commercial |
$289.82
|
| Rate for Payer: Aetna Medicare |
$224.93
|
| Rate for Payer: BCBS Complete |
$230.80
|
| Rate for Payer: BCBS MAPPO |
$216.28
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.09
|
| 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 Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health Medicare |
$218.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.28
|
| Rate for Payer: UHC Exchange |
$216.28
|
| Rate for Payer: UHC Medicare Advantage |
$216.28
|
|
|
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 |
$375.05 |
| Max. Negotiated Rate |
$519.30 |
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: BCBS Trust/PPO |
$471.01
|
| Rate for Payer: BCN Commercial |
$445.91
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: Nomi Health Commercial |
$473.14
|
| Rate for Payer: PHP Commercial |
$490.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health HMO/PPO |
$501.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.76
|
| Rate for Payer: UHC Core |
$481.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.75
|
|
|
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 |
$216.28 |
| Max. Negotiated Rate |
$375.05 |
| Rate for Payer: Aetna Commercial |
$289.82
|
| Rate for Payer: Aetna Medicare |
$224.93
|
| Rate for Payer: BCBS Complete |
$230.80
|
| Rate for Payer: BCBS MAPPO |
$216.28
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.09
|
| 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 Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health Medicare |
$218.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.28
|
| Rate for Payer: UHC Exchange |
$216.28
|
| Rate for Payer: UHC Medicare Advantage |
$216.28
|
|
|
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 |
$137.04 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna Medicare |
$150.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.31
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$144.25
|
| Rate for Payer: BCBS Trust/PPO |
$474.35
|
| Rate for Payer: BCN Commercial |
$448.62
|
| Rate for Payer: BCN Medicare Advantage |
$144.25
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.25
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.75
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.46
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: Nomi Health Commercial |
$473.14
|
| Rate for Payer: PACE Senior Care Partners |
$137.04
|
| Rate for Payer: PACE SWMI |
$144.25
|
| Rate for Payer: PHP Commercial |
$490.45
|
| Rate for Payer: PHP Medicare Advantage |
$144.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health HMO/PPO |
$501.99
|
| Rate for Payer: Priority Health Medicare |
$145.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.59
|
| Rate for Payer: Railroad Medicare Medicare |
$144.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.76
|
| Rate for Payer: UHC Core |
$481.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.25
|
| Rate for Payer: UHC Exchange |
$144.25
|
| Rate for Payer: UHC Medicare Advantage |
$144.25
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$144.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.75
|
|
|
PR EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN
|
Professional
|
Both
|
$7,984.00
|
|
|
Service Code
|
HCPCS 61563
|
| Min. Negotiated Rate |
$1,967.57 |
| Max. Negotiated Rate |
$5,189.60 |
| Rate for Payer: Aetna Commercial |
$2,636.54
|
| Rate for Payer: Aetna Medicare |
$2,046.27
|
| Rate for Payer: BCBS Complete |
$3,193.60
|
| Rate for Payer: BCBS MAPPO |
$1,967.57
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,065.95
|
| 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 Cigna Priority Health |
$5,189.60
|
| Rate for Payer: Priority Health Medicare |
$1,987.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,967.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,967.57
|
| Rate for Payer: UHC Exchange |
$1,967.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,967.57
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT
|
Professional
|
Both
|
$2,311.00
|
|
|
Service Code
|
HCPCS 21048
|
| Min. Negotiated Rate |
$924.40 |
| Max. Negotiated Rate |
$1,502.15 |
| Rate for Payer: Aetna Commercial |
$1,265.09
|
| Rate for Payer: Aetna Medicare |
$981.86
|
| Rate for Payer: BCBS Complete |
$924.40
|
| Rate for Payer: BCBS MAPPO |
$944.10
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$991.30
|
| 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 Cigna Priority Health |
$1,502.15
|
| Rate for Payer: Priority Health Medicare |
$953.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$944.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$944.10
|
| Rate for Payer: UHC Exchange |
$944.10
|
| Rate for Payer: UHC Medicare Advantage |
$944.10
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
HCPCS 21030
|
| Min. Negotiated Rate |
$343.11 |
| Max. Negotiated Rate |
$665.60 |
| Rate for Payer: Aetna Commercial |
$459.77
|
| Rate for Payer: Aetna Medicare |
$356.83
|
| Rate for Payer: BCBS Complete |
$409.60
|
| Rate for Payer: BCBS MAPPO |
$343.11
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.27
|
| 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 Cigna Priority Health |
$665.60
|
| Rate for Payer: Priority Health Medicare |
$346.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.11
|
| Rate for Payer: UHC Exchange |
$343.11
|
| Rate for Payer: UHC Medicare Advantage |
$343.11
|
|
|
PR EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42815
|
| Min. Negotiated Rate |
$510.56 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Commercial |
$684.15
|
| Rate for Payer: Aetna Medicare |
$530.98
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$510.56
|
| Rate for Payer: BCN Medicare Advantage |
$510.56
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$735.21
|
| Rate for Payer: Cofinity Commercial |
$684.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.09
|
| Rate for Payer: Nomi Health Commercial |
$612.67
|
| Rate for Payer: PACE SWMI |
$510.56
|
| Rate for Payer: PHP Medicare Advantage |
$510.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$515.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.56
|
| Rate for Payer: UHC Exchange |
$510.56
|
| Rate for Payer: UHC Medicare Advantage |
$510.56
|
|
|
PR EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 42810
|
| Min. Negotiated Rate |
$268.27 |
| Max. Negotiated Rate |
$563.55 |
| Rate for Payer: Aetna Commercial |
$359.48
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: BCBS Complete |
$346.80
|
| Rate for Payer: BCBS MAPPO |
$268.27
|
| Rate for Payer: BCN Medicare Advantage |
$268.27
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$386.31
|
| Rate for Payer: Cofinity Commercial |
$359.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.68
|
| Rate for Payer: Nomi Health Commercial |
$321.92
|
| Rate for Payer: PACE SWMI |
$268.27
|
| Rate for Payer: PHP Medicare Advantage |
$268.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health Medicare |
$270.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$268.27
|
| Rate for Payer: UHC Exchange |
$268.27
|
| Rate for Payer: UHC Medicare Advantage |
$268.27
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,263.00
|
|
|
Service Code
|
HCPCS 19125
|
| Min. Negotiated Rate |
$449.37 |
| Max. Negotiated Rate |
$820.95 |
| Rate for Payer: Aetna Commercial |
$602.16
|
| Rate for Payer: Aetna Medicare |
$467.34
|
| Rate for Payer: BCBS Complete |
$505.20
|
| Rate for Payer: BCBS MAPPO |
$449.37
|
| Rate for Payer: BCN Medicare Advantage |
$449.37
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cofinity Commercial |
$647.09
|
| Rate for Payer: Cofinity Commercial |
$602.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.84
|
| Rate for Payer: Nomi Health Commercial |
$539.24
|
| Rate for Payer: PACE SWMI |
$449.37
|
| Rate for Payer: PHP Medicare Advantage |
$449.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health Medicare |
$453.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.37
|
| Rate for Payer: UHC Exchange |
$449.37
|
| Rate for Payer: UHC Medicare Advantage |
$449.37
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$820.95 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Aetna Commercial |
$1,073.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.99
|
| Rate for Payer: BCN Commercial |
$976.05
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cofinity Commercial |
$1,086.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.40
|
| Rate for Payer: Healthscope Commercial |
$1,136.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.55
|
| Rate for Payer: Nomi Health Commercial |
$1,035.66
|
| Rate for Payer: PHP Commercial |
$1,073.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,098.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$846.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,111.44
|
| Rate for Payer: UHC Core |
$1,054.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.25
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$299.96 |
| Max. Negotiated Rate |
$2,907.19 |
| Rate for Payer: Aetna Commercial |
$1,073.55
|
| Rate for Payer: Aetna Medicare |
$328.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$394.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$394.69
|
| Rate for Payer: BCBS Complete |
$2,907.19
|
| Rate for Payer: BCBS MAPPO |
$315.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.31
|
| Rate for Payer: BCN Commercial |
$981.98
|
| Rate for Payer: BCN Medicare Advantage |
$315.75
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cofinity Commercial |
$1,086.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.75
|
| Rate for Payer: Healthscope Commercial |
$1,136.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.25
|
| Rate for Payer: Mclaren Medicaid |
$2,768.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.54
|
| Rate for Payer: Meridian Medicaid |
$2,907.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.55
|
| Rate for Payer: Nomi Health Commercial |
$1,035.66
|
| Rate for Payer: PACE Senior Care Partners |
$299.96
|
| Rate for Payer: PACE SWMI |
$315.75
|
| Rate for Payer: PHP Commercial |
$1,073.55
|
| Rate for Payer: PHP Medicare Advantage |
$315.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,768.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,098.81
|
| Rate for Payer: Priority Health Medicare |
$318.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$846.21
|
| Rate for Payer: Railroad Medicare Medicare |
$315.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,111.44
|
| Rate for Payer: UHC Core |
$1,054.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.75
|
| Rate for Payer: UHC Exchange |
$315.75
|
| Rate for Payer: UHC Medicare Advantage |
$315.75
|
| Rate for Payer: UHCCP Medicaid |
$2,768.57
|
| Rate for Payer: VA VA |
$315.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.25
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,263.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
19125
|
| Min. Negotiated Rate |
$449.37 |
| Max. Negotiated Rate |
$820.95 |
| Rate for Payer: Aetna Commercial |
$602.16
|
| Rate for Payer: Aetna Medicare |
$467.34
|
| Rate for Payer: BCBS Complete |
$505.20
|
| Rate for Payer: BCBS MAPPO |
$449.37
|
| Rate for Payer: BCN Medicare Advantage |
$449.37
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cofinity Commercial |
$647.09
|
| Rate for Payer: Cofinity Commercial |
$602.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.84
|
| Rate for Payer: Nomi Health Commercial |
$539.24
|
| Rate for Payer: PACE SWMI |
$449.37
|
| Rate for Payer: PHP Medicare Advantage |
$449.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health Medicare |
$453.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.37
|
| Rate for Payer: UHC Exchange |
$449.37
|
| Rate for Payer: UHC Medicare Advantage |
$449.37
|
|
|
PR EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 19126
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$223.76 |
| Rate for Payer: Aetna Commercial |
$208.22
|
| Rate for Payer: Aetna Medicare |
$161.61
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$155.39
|
| Rate for Payer: BCN Medicare Advantage |
$155.39
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$223.76
|
| Rate for Payer: Cofinity Commercial |
$208.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.16
|
| Rate for Payer: Nomi Health Commercial |
$186.47
|
| Rate for Payer: PACE SWMI |
$155.39
|
| Rate for Payer: PHP Medicare Advantage |
$155.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$156.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.39
|
| Rate for Payer: UHC Exchange |
$155.39
|
| Rate for Payer: UHC Medicare Advantage |
$155.39
|
|
|
PR EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY
|
Professional
|
Both
|
$2,765.00
|
|
|
Service Code
|
HCPCS 60600
|
| Min. Negotiated Rate |
$1,106.00 |
| Max. Negotiated Rate |
$1,885.28 |
| Rate for Payer: Aetna Commercial |
$1,754.35
|
| Rate for Payer: Aetna Medicare |
$1,361.59
|
| Rate for Payer: BCBS Complete |
$1,106.00
|
| Rate for Payer: BCBS MAPPO |
$1,309.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,309.22
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cofinity Commercial |
$1,885.28
|
| Rate for Payer: Cofinity Commercial |
$1,754.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,309.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,374.68
|
| Rate for Payer: Nomi Health Commercial |
$1,571.06
|
| Rate for Payer: PACE SWMI |
$1,309.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,309.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.25
|
| Rate for Payer: Priority Health Medicare |
$1,322.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,309.22
|
| Rate for Payer: UHC Exchange |
$1,309.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,309.22
|
|
|
PR EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 26596
|
| Min. Negotiated Rate |
$530.80 |
| Max. Negotiated Rate |
$1,117.12 |
| Rate for Payer: Aetna Commercial |
$1,039.55
|
| Rate for Payer: Aetna Medicare |
$806.81
|
| Rate for Payer: BCBS Complete |
$530.80
|
| Rate for Payer: BCBS MAPPO |
$775.78
|
| Rate for Payer: BCN Medicare Advantage |
$775.78
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,117.12
|
| Rate for Payer: Cofinity Commercial |
$1,039.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$775.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.57
|
| Rate for Payer: Nomi Health Commercial |
$930.94
|
| Rate for Payer: PACE SWMI |
$775.78
|
| Rate for Payer: PHP Medicare Advantage |
$775.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.55
|
| Rate for Payer: Priority Health Medicare |
$783.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$775.78
|
| Rate for Payer: UHC Exchange |
$775.78
|
| Rate for Payer: UHC Medicare Advantage |
$775.78
|
|
|
PR EXC CRV STUMP VAG APPR W/RPR NTRCL
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 57556
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$833.30 |
| Rate for Payer: Aetna Commercial |
$753.64
|
| Rate for Payer: Aetna Medicare |
$584.92
|
| Rate for Payer: BCBS Complete |
$512.80
|
| Rate for Payer: BCBS MAPPO |
$562.42
|
| Rate for Payer: BCN Medicare Advantage |
$562.42
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cofinity Commercial |
$809.88
|
| Rate for Payer: Cofinity Commercial |
$753.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$590.54
|
| Rate for Payer: Nomi Health Commercial |
$674.90
|
| Rate for Payer: PACE SWMI |
$562.42
|
| Rate for Payer: PHP Medicare Advantage |
$562.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.30
|
| Rate for Payer: Priority Health Medicare |
$568.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$562.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$562.42
|
| Rate for Payer: UHC Exchange |
$562.42
|
| Rate for Payer: UHC Medicare Advantage |
$562.42
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ
|
Professional
|
Both
|
$4,205.00
|
|
|
Service Code
|
HCPCS 38555
|
| Min. Negotiated Rate |
$995.35 |
| Max. Negotiated Rate |
$2,733.25 |
| Rate for Payer: Aetna Commercial |
$1,333.77
|
| Rate for Payer: Aetna Medicare |
$1,035.16
|
| Rate for Payer: BCBS Complete |
$1,682.00
|
| Rate for Payer: BCBS MAPPO |
$995.35
|
| Rate for Payer: BCN Medicare Advantage |
$995.35
|
| Rate for Payer: Cash Price |
$3,364.00
|
| Rate for Payer: Cash Price |
$3,364.00
|
| Rate for Payer: Cofinity Commercial |
$1,433.30
|
| Rate for Payer: Cofinity Commercial |
$1,333.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$995.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,045.12
|
| Rate for Payer: Nomi Health Commercial |
$1,194.42
|
| Rate for Payer: PACE SWMI |
$995.35
|
| Rate for Payer: PHP Medicare Advantage |
$995.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,733.25
|
| Rate for Payer: Priority Health Medicare |
$1,005.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$995.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$995.35
|
| Rate for Payer: UHC Exchange |
$995.35
|
| Rate for Payer: UHC Medicare Advantage |
$995.35
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38550
|
| Min. Negotiated Rate |
$506.03 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$678.08
|
| Rate for Payer: Aetna Medicare |
$526.27
|
| Rate for Payer: BCBS Complete |
$630.80
|
| Rate for Payer: BCBS MAPPO |
$506.03
|
| Rate for Payer: BCN Medicare Advantage |
$506.03
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$728.68
|
| Rate for Payer: Cofinity Commercial |
$678.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.33
|
| Rate for Payer: Nomi Health Commercial |
$607.24
|
| Rate for Payer: PACE SWMI |
$506.03
|
| Rate for Payer: PHP Medicare Advantage |
$506.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health Medicare |
$511.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.03
|
| Rate for Payer: UHC Exchange |
$506.03
|
| Rate for Payer: UHC Medicare Advantage |
$506.03
|
|
|
PR EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT
|
Professional
|
Both
|
$2,361.00
|
|
|
Service Code
|
HCPCS 26205
|
| Min. Negotiated Rate |
$586.51 |
| Max. Negotiated Rate |
$1,534.65 |
| Rate for Payer: Aetna Commercial |
$785.92
|
| Rate for Payer: Aetna Medicare |
$609.97
|
| Rate for Payer: BCBS Complete |
$944.40
|
| Rate for Payer: BCBS MAPPO |
$586.51
|
| Rate for Payer: BCN Medicare Advantage |
$586.51
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cofinity Commercial |
$844.57
|
| Rate for Payer: Cofinity Commercial |
$785.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.84
|
| Rate for Payer: Nomi Health Commercial |
$703.81
|
| Rate for Payer: PACE SWMI |
$586.51
|
| Rate for Payer: PHP Medicare Advantage |
$586.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.65
|
| Rate for Payer: Priority Health Medicare |
$592.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$586.51
|
| Rate for Payer: UHC Exchange |
$586.51
|
| Rate for Payer: UHC Medicare Advantage |
$586.51
|
|
|
PR EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT
|
Professional
|
Both
|
$1,782.00
|
|
|
Service Code
|
HCPCS 26215
|
| Min. Negotiated Rate |
$548.78 |
| Max. Negotiated Rate |
$1,158.30 |
| Rate for Payer: Aetna Commercial |
$735.37
|
| Rate for Payer: Aetna Medicare |
$570.73
|
| Rate for Payer: BCBS Complete |
$712.80
|
| Rate for Payer: BCBS MAPPO |
$548.78
|
| Rate for Payer: BCN Medicare Advantage |
$548.78
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cofinity Commercial |
$790.24
|
| Rate for Payer: Cofinity Commercial |
$735.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$548.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$576.22
|
| Rate for Payer: Nomi Health Commercial |
$658.54
|
| Rate for Payer: PACE SWMI |
$548.78
|
| Rate for Payer: PHP Medicare Advantage |
$548.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.30
|
| Rate for Payer: Priority Health Medicare |
$554.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$548.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$548.78
|
| Rate for Payer: UHC Exchange |
$548.78
|
| Rate for Payer: UHC Medicare Advantage |
$548.78
|
|
