|
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 |
$134.68 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna American Axle |
$236.60
|
| Rate for Payer: Aetna Commercial |
$309.40
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$879.35
|
| Rate for Payer: BCN Commercial |
$879.35
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Advantage |
$254.80
|
| 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 |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$327.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.00
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.40
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$309.40
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$229.32
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: UMR Bronson Commercial |
$134.68
|
| Rate for Payer: VA VA |
$705.59
|
| 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 1.1-2.0CM
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna American Axle |
$236.60
|
| Rate for Payer: Aetna Commercial |
$309.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.60
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Advantage |
$254.80
|
| Rate for Payer: Cofinity Commercial |
$313.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.20
|
| Rate for Payer: Healthscope Commercial |
$327.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PHP Commercial |
$309.40
|
| Rate for Payer: Priority Health SBD |
$229.32
|
| Rate for Payer: UMR Bronson Commercial |
$160.16
|
| 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 1.1-2.0CM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$170.27
|
| Rate for Payer: Aetna Medicare |
$132.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.98
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$127.07
|
| Rate for Payer: BCN Commercial |
$175.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.07
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$170.27
|
| Rate for Payer: Cofinity Commercial |
$182.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.42
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.78
|
| Rate for Payer: Nomi Health Commercial |
$152.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE SWMI |
$127.07
|
| Rate for Payer: PHP Commercial |
$177.90
|
| Rate for Payer: PHP Medicare Advantage |
$127.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$203.74
|
| Rate for Payer: Priority Health Medicare |
$127.07
|
| Rate for Payer: Priority Health SBD |
$203.74
|
| Rate for Payer: Priority Health Tiered Network |
$203.74
|
| Rate for Payer: Railroad Medicare Medicare |
$127.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.59
|
| Rate for Payer: UHC Core |
$248.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.07
|
| Rate for Payer: UHC Exchange |
$248.59
|
| Rate for Payer: UHC Medicaid |
$84.14
|
| Rate for Payer: UHCCP Medicaid |
$84.14
|
| Rate for Payer: UMR Bronson Commercial |
$167.44
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$170.27
|
| Rate for Payer: Aetna Medicare |
$132.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.98
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$127.07
|
| Rate for Payer: BCN Commercial |
$175.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.07
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$170.27
|
| Rate for Payer: Cofinity Commercial |
$182.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.42
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.78
|
| Rate for Payer: Nomi Health Commercial |
$152.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE SWMI |
$127.07
|
| Rate for Payer: PHP Commercial |
$177.90
|
| Rate for Payer: PHP Medicare Advantage |
$127.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$203.74
|
| Rate for Payer: Priority Health Medicare |
$127.07
|
| Rate for Payer: Priority Health SBD |
$203.74
|
| Rate for Payer: Priority Health Tiered Network |
$203.74
|
| Rate for Payer: Railroad Medicare Medicare |
$127.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.59
|
| Rate for Payer: UHC Core |
$248.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.07
|
| Rate for Payer: UHC Exchange |
$248.59
|
| Rate for Payer: UHC Medicaid |
$84.14
|
| Rate for Payer: UHCCP Medicaid |
$84.14
|
| Rate for Payer: UMR Bronson Commercial |
$167.44
|
|
|
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 |
$203.28 |
| Max. Negotiated Rate |
$415.80 |
| Rate for Payer: Aetna American Axle |
$300.30
|
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.30
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Advantage |
$323.40
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$323.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PHP Commercial |
$392.70
|
| Rate for Payer: Priority Health SBD |
$291.06
|
| Rate for Payer: UMR Bronson Commercial |
$203.28
|
| 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 |
$206.69
|
| Rate for Payer: Aetna Medicare |
$160.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.12
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS MAPPO |
$154.25
|
| Rate for Payer: BCN Commercial |
$214.02
|
| Rate for Payer: BCN Medicare Advantage |
$154.25
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$206.69
|
| Rate for Payer: Cofinity Commercial |
$222.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.96
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$169.68
|
| Rate for Payer: Nomi Health Commercial |
$185.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PACE SWMI |
$154.25
|
| Rate for Payer: PHP Commercial |
$215.95
|
| Rate for Payer: PHP Medicare Advantage |
$154.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$248.40
|
| Rate for Payer: Priority Health Medicare |
$154.25
|
| Rate for Payer: Priority Health SBD |
$248.40
|
| Rate for Payer: Priority Health Tiered Network |
$248.40
|
| Rate for Payer: Railroad Medicare Medicare |
$154.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.07
|
| Rate for Payer: UHC Core |
$306.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$154.25
|
| Rate for Payer: UHC Exchange |
$306.07
|
| Rate for Payer: UHC Medicaid |
$101.60
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
| Rate for Payer: UMR Bronson Commercial |
$212.52
|
|
|
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 |
$170.94 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna American Axle |
$300.30
|
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.89
|
| Rate for Payer: BCN Commercial |
$2,031.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Advantage |
$323.40
|
| 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 |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$415.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.50
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.70
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$392.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$291.06
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: UMR Bronson Commercial |
$170.94
|
| Rate for Payer: VA VA |
$1,645.66
|
| 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 |
$206.69
|
| Rate for Payer: Aetna Medicare |
$160.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.12
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS MAPPO |
$154.25
|
| Rate for Payer: BCN Commercial |
$214.02
|
| Rate for Payer: BCN Medicare Advantage |
$154.25
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$206.69
|
| Rate for Payer: Cofinity Commercial |
$222.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.96
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$169.68
|
| Rate for Payer: Nomi Health Commercial |
$185.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PACE SWMI |
$154.25
|
| Rate for Payer: PHP Commercial |
$215.95
|
| Rate for Payer: PHP Medicare Advantage |
$154.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$248.40
|
| Rate for Payer: Priority Health Medicare |
$154.25
|
| Rate for Payer: Priority Health SBD |
$248.40
|
| Rate for Payer: Priority Health Tiered Network |
$248.40
|
| Rate for Payer: Railroad Medicare Medicare |
$154.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.07
|
| Rate for Payer: UHC Core |
$306.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$154.25
|
| Rate for Payer: UHC Exchange |
$306.07
|
| Rate for Payer: UHC Medicaid |
$101.60
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
| Rate for Payer: UMR Bronson Commercial |
$212.52
|
|
|
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 |
$219.78 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna American Axle |
$386.10
|
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.50
|
| Rate for Payer: BCN Commercial |
$1,144.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cofinity Advantage |
$415.80
|
| 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 |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$534.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$415.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.50
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.90
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$504.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$374.22
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: UMR Bronson Commercial |
$219.78
|
| Rate for Payer: VA VA |
$1,645.66
|
| 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
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$534.60 |
| Rate for Payer: Aetna American Axle |
$386.10
|
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.10
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cofinity Advantage |
$415.80
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$415.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: PHP Commercial |
$504.90
|
| Rate for Payer: Priority Health SBD |
$374.22
|
| Rate for Payer: UMR Bronson Commercial |
$261.36
|
| 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 |
$261.03
|
| Rate for Payer: Aetna Medicare |
$202.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.51
|
| Rate for Payer: BCBS Complete |
$133.97
|
| Rate for Payer: BCBS MAPPO |
$194.80
|
| Rate for Payer: BCN Commercial |
$270.57
|
| Rate for Payer: BCN Medicare Advantage |
$194.80
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cofinity Commercial |
$261.03
|
| Rate for Payer: Cofinity Commercial |
$280.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.54
|
| Rate for Payer: Meridian Medicaid |
$133.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.28
|
| Rate for Payer: Nomi Health Commercial |
$233.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: PACE SWMI |
$194.80
|
| Rate for Payer: PHP Commercial |
$272.72
|
| Rate for Payer: PHP Medicare Advantage |
$194.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$314.04
|
| Rate for Payer: Priority Health Medicare |
$194.80
|
| Rate for Payer: Priority Health SBD |
$314.04
|
| Rate for Payer: Priority Health Tiered Network |
$314.04
|
| Rate for Payer: Railroad Medicare Medicare |
$194.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.35
|
| Rate for Payer: UHC Core |
$392.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$194.80
|
| Rate for Payer: UHC Exchange |
$392.35
|
| Rate for Payer: UHC Medicaid |
$127.59
|
| Rate for Payer: UHCCP Medicaid |
$127.59
|
| Rate for Payer: UMR Bronson Commercial |
$273.24
|
|
|
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 |
$261.03
|
| Rate for Payer: Aetna Medicare |
$202.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.51
|
| Rate for Payer: BCBS Complete |
$133.97
|
| Rate for Payer: BCBS MAPPO |
$194.80
|
| Rate for Payer: BCN Commercial |
$270.57
|
| Rate for Payer: BCN Medicare Advantage |
$194.80
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cofinity Commercial |
$261.03
|
| Rate for Payer: Cofinity Commercial |
$280.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.54
|
| Rate for Payer: Meridian Medicaid |
$133.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.28
|
| Rate for Payer: Nomi Health Commercial |
$233.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: PACE SWMI |
$194.80
|
| Rate for Payer: PHP Commercial |
$272.72
|
| Rate for Payer: PHP Medicare Advantage |
$194.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$314.04
|
| Rate for Payer: Priority Health Medicare |
$194.80
|
| Rate for Payer: Priority Health SBD |
$314.04
|
| Rate for Payer: Priority Health Tiered Network |
$314.04
|
| Rate for Payer: Railroad Medicare Medicare |
$194.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.35
|
| Rate for Payer: UHC Core |
$392.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$194.80
|
| Rate for Payer: UHC Exchange |
$392.35
|
| Rate for Payer: UHC Medicaid |
$127.59
|
| Rate for Payer: UHCCP Medicaid |
$127.59
|
| Rate for Payer: UMR Bronson Commercial |
$273.24
|
|
|
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 |
$2,581.55
|
| Rate for Payer: Aetna Medicare |
$2,003.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,581.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,774.20
|
| Rate for Payer: BCBS Complete |
$1,291.80
|
| Rate for Payer: BCBS MAPPO |
$1,926.53
|
| Rate for Payer: BCN Commercial |
$4,171.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,926.53
|
| Rate for Payer: Cash Price |
$6,579.20
|
| Rate for Payer: Cash Price |
$6,579.20
|
| Rate for Payer: Cofinity Commercial |
$2,581.55
|
| Rate for Payer: Cofinity Commercial |
$2,774.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,926.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,022.86
|
| Rate for Payer: Meridian Medicaid |
$1,291.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,119.18
|
| Rate for Payer: Nomi Health Commercial |
$2,311.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,168.00
|
| Rate for Payer: PACE SWMI |
$1,926.53
|
| Rate for Payer: PHP Commercial |
$2,697.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,926.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,230.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,506.82
|
| Rate for Payer: Priority Health Medicare |
$1,926.53
|
| Rate for Payer: Priority Health SBD |
$3,506.82
|
| Rate for Payer: Priority Health Tiered Network |
$3,506.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,926.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,496.83
|
| Rate for Payer: UHC Core |
$3,496.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,926.53
|
| Rate for Payer: UHC Exchange |
$3,496.83
|
| Rate for Payer: UHC Medicaid |
$1,230.29
|
| Rate for Payer: UHCCP Medicaid |
$1,230.29
|
| Rate for Payer: UMR Bronson Commercial |
$3,783.04
|
|
|
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 |
$1,838.22 |
| Rate for Payer: Aetna Commercial |
$1,182.30
|
| Rate for Payer: Aetna Medicare |
$917.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,270.53
|
| Rate for Payer: BCBS Complete |
$607.22
|
| Rate for Payer: BCBS MAPPO |
$882.31
|
| Rate for Payer: BCN Commercial |
$1,502.40
|
| Rate for Payer: BCN Medicare Advantage |
$882.31
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cofinity Commercial |
$1,182.30
|
| Rate for Payer: Cofinity Commercial |
$1,270.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$926.43
|
| Rate for Payer: Meridian Medicaid |
$607.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$970.54
|
| Rate for Payer: Nomi Health Commercial |
$1,058.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,785.00
|
| Rate for Payer: PACE SWMI |
$882.31
|
| Rate for Payer: PHP Commercial |
$1,235.23
|
| Rate for Payer: PHP Medicare Advantage |
$882.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,606.03
|
| Rate for Payer: Priority Health Medicare |
$882.31
|
| Rate for Payer: Priority Health SBD |
$1,606.03
|
| Rate for Payer: Priority Health Tiered Network |
$1,606.03
|
| Rate for Payer: Railroad Medicare Medicare |
$882.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,838.22
|
| Rate for Payer: UHC Core |
$1,838.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$882.31
|
| Rate for Payer: UHC Exchange |
$1,838.22
|
| Rate for Payer: UHC Medicaid |
$578.30
|
| Rate for Payer: UHCCP Medicaid |
$578.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,094.80
|
|
|
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 |
$436.26
|
| Rate for Payer: Aetna Medicare |
$338.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.82
|
| Rate for Payer: BCBS Complete |
$225.44
|
| Rate for Payer: BCBS MAPPO |
$325.57
|
| Rate for Payer: BCN Commercial |
$548.78
|
| Rate for Payer: BCN Medicare Advantage |
$325.57
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cofinity Commercial |
$436.26
|
| Rate for Payer: Cofinity Commercial |
$468.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.85
|
| Rate for Payer: Meridian Medicaid |
$225.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$358.13
|
| Rate for Payer: Nomi Health Commercial |
$390.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$791.25
|
| Rate for Payer: PACE SWMI |
$325.57
|
| Rate for Payer: PHP Commercial |
$455.80
|
| Rate for Payer: PHP Medicare Advantage |
$325.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$586.63
|
| Rate for Payer: Priority Health Medicare |
$325.57
|
| Rate for Payer: Priority Health SBD |
$586.63
|
| Rate for Payer: Priority Health Tiered Network |
$586.63
|
| Rate for Payer: Railroad Medicare Medicare |
$325.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.57
|
| Rate for Payer: UHC Core |
$667.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$325.57
|
| Rate for Payer: UHC Exchange |
$667.57
|
| Rate for Payer: UHC Medicaid |
$214.70
|
| Rate for Payer: UHCCP Medicaid |
$214.70
|
| Rate for Payer: UMR Bronson Commercial |
$485.30
|
|
|
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 |
$623.07
|
| Rate for Payer: Aetna Medicare |
$483.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$669.57
|
| Rate for Payer: BCBS Complete |
$320.27
|
| Rate for Payer: BCBS MAPPO |
$464.98
|
| Rate for Payer: BCN Commercial |
$811.22
|
| Rate for Payer: BCN Medicare Advantage |
$464.98
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cofinity Commercial |
$623.07
|
| Rate for Payer: Cofinity Commercial |
$669.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.23
|
| Rate for Payer: Meridian Medicaid |
$320.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$511.48
|
| Rate for Payer: Nomi Health Commercial |
$557.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,278.75
|
| Rate for Payer: PACE SWMI |
$464.98
|
| Rate for Payer: PHP Commercial |
$650.97
|
| Rate for Payer: PHP Medicare Advantage |
$464.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$988.40
|
| Rate for Payer: Priority Health Medicare |
$464.98
|
| Rate for Payer: Priority Health SBD |
$988.40
|
| Rate for Payer: Priority Health Tiered Network |
$988.40
|
| Rate for Payer: Railroad Medicare Medicare |
$464.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.00
|
| Rate for Payer: UHC Core |
$942.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$464.98
|
| Rate for Payer: UHC Exchange |
$942.00
|
| Rate for Payer: UHC Medicaid |
$305.02
|
| Rate for Payer: UHCCP Medicaid |
$305.02
|
| Rate for Payer: UMR Bronson Commercial |
$784.30
|
|
|
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 |
$332.86
|
| Rate for Payer: Aetna Medicare |
$258.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.70
|
| Rate for Payer: BCBS Complete |
$172.66
|
| Rate for Payer: BCBS MAPPO |
$248.40
|
| Rate for Payer: BCN Commercial |
$429.75
|
| Rate for Payer: BCN Medicare Advantage |
$248.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$332.86
|
| Rate for Payer: Cofinity Commercial |
$357.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.82
|
| Rate for Payer: Meridian Medicaid |
$172.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.24
|
| Rate for Payer: Nomi Health Commercial |
$298.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.75
|
| Rate for Payer: PACE SWMI |
$248.40
|
| Rate for Payer: PHP Commercial |
$347.76
|
| Rate for Payer: PHP Medicare Advantage |
$248.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$523.63
|
| Rate for Payer: Priority Health Medicare |
$248.40
|
| Rate for Payer: Priority Health SBD |
$523.63
|
| Rate for Payer: Priority Health Tiered Network |
$523.63
|
| Rate for Payer: Railroad Medicare Medicare |
$248.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.93
|
| Rate for Payer: UHC Core |
$485.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.40
|
| Rate for Payer: UHC Exchange |
$485.93
|
| Rate for Payer: UHC Medicaid |
$164.44
|
| Rate for Payer: UHCCP Medicaid |
$164.44
|
| Rate for Payer: UMR Bronson Commercial |
$410.78
|
|
|
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 |
$595.32
|
| Rate for Payer: Aetna Medicare |
$462.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.75
|
| Rate for Payer: BCBS Complete |
$303.05
|
| Rate for Payer: BCBS MAPPO |
$444.27
|
| Rate for Payer: BCN Commercial |
$702.65
|
| Rate for Payer: BCN Medicare Advantage |
$444.27
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$595.32
|
| Rate for Payer: Cofinity Commercial |
$639.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.48
|
| Rate for Payer: Meridian Medicaid |
$303.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$488.70
|
| Rate for Payer: Nomi Health Commercial |
$533.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: PACE SWMI |
$444.27
|
| Rate for Payer: PHP Commercial |
$621.98
|
| Rate for Payer: PHP Medicare Advantage |
$444.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.11
|
| Rate for Payer: Priority Health Medicare |
$444.27
|
| Rate for Payer: Priority Health SBD |
$643.11
|
| Rate for Payer: Priority Health Tiered Network |
$643.11
|
| Rate for Payer: Railroad Medicare Medicare |
$444.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.13
|
| Rate for Payer: UHC Core |
$810.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$444.27
|
| Rate for Payer: UHC Exchange |
$810.13
|
| Rate for Payer: UHC Medicaid |
$288.62
|
| Rate for Payer: UHCCP Medicaid |
$288.62
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
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 |
$595.32
|
| Rate for Payer: Aetna Medicare |
$462.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.75
|
| Rate for Payer: BCBS Complete |
$303.05
|
| Rate for Payer: BCBS MAPPO |
$444.27
|
| Rate for Payer: BCN Commercial |
$702.65
|
| Rate for Payer: BCN Medicare Advantage |
$444.27
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$595.32
|
| Rate for Payer: Cofinity Commercial |
$639.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.48
|
| Rate for Payer: Meridian Medicaid |
$303.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$488.70
|
| Rate for Payer: Nomi Health Commercial |
$533.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: PACE SWMI |
$444.27
|
| Rate for Payer: PHP Commercial |
$621.98
|
| Rate for Payer: PHP Medicare Advantage |
$444.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.11
|
| Rate for Payer: Priority Health Medicare |
$444.27
|
| Rate for Payer: Priority Health SBD |
$643.11
|
| Rate for Payer: Priority Health Tiered Network |
$643.11
|
| Rate for Payer: Railroad Medicare Medicare |
$444.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.13
|
| Rate for Payer: UHC Core |
$810.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$444.27
|
| Rate for Payer: UHC Exchange |
$810.13
|
| Rate for Payer: UHC Medicaid |
$288.62
|
| Rate for Payer: UHCCP Medicaid |
$288.62
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
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 |
$481.37 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna American Axle |
$845.65
|
| Rate for Payer: Aetna Commercial |
$1,105.85
|
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,278.15
|
| Rate for Payer: BCCCP Commercial |
$569.78
|
| Rate for Payer: BCN Commercial |
$3,278.15
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Advantage |
$910.70
|
| 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 |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$1,170.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$910.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.75
|
| Rate for Payer: Mclaren Medicaid |
$3,901.35
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,105.85
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$1,105.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health SBD |
$819.63
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: UMR Bronson Commercial |
$481.37
|
| Rate for Payer: VA VA |
$3,901.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.75
|
|
|
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 |
$572.44 |
| Max. Negotiated Rate |
$1,170.90 |
| Rate for Payer: Aetna American Axle |
$845.65
|
| Rate for Payer: Aetna Commercial |
$1,105.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.65
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Advantage |
$910.70
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$910.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,105.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: PHP Commercial |
$1,105.85
|
| Rate for Payer: Priority Health SBD |
$819.63
|
| Rate for Payer: UMR Bronson Commercial |
$572.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.75
|
|
|
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 |
$288.13 |
| Rate for Payer: Aetna Commercial |
$194.31
|
| Rate for Payer: Aetna Medicare |
$150.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.81
|
| Rate for Payer: BCBS Complete |
$96.39
|
| Rate for Payer: BCBS MAPPO |
$145.01
|
| Rate for Payer: BCN Commercial |
$238.03
|
| Rate for Payer: BCN Medicare Advantage |
$145.01
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Cofinity Commercial |
$208.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.26
|
| Rate for Payer: Meridian Medicaid |
$96.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.51
|
| Rate for Payer: Nomi Health Commercial |
$174.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.00
|
| Rate for Payer: PACE SWMI |
$145.01
|
| Rate for Payer: PHP Commercial |
$203.01
|
| Rate for Payer: PHP Medicare Advantage |
$145.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$217.87
|
| Rate for Payer: Priority Health Medicare |
$145.01
|
| Rate for Payer: Priority Health SBD |
$217.87
|
| Rate for Payer: Priority Health Tiered Network |
$217.87
|
| Rate for Payer: Railroad Medicare Medicare |
$145.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.13
|
| Rate for Payer: UHC Core |
$288.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.01
|
| Rate for Payer: UHC Exchange |
$288.13
|
| Rate for Payer: UHC Medicaid |
$91.80
|
| Rate for Payer: UHCCP Medicaid |
$91.80
|
| Rate for Payer: UMR Bronson Commercial |
$128.80
|
|
|
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 |
$2,443.71 |
| Rate for Payer: Aetna Commercial |
$1,647.02
|
| Rate for Payer: Aetna Medicare |
$1,278.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,647.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,769.93
|
| Rate for Payer: BCBS Complete |
$819.68
|
| Rate for Payer: BCBS MAPPO |
$1,229.12
|
| Rate for Payer: BCN Commercial |
$2,009.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,229.12
|
| Rate for Payer: Cash Price |
$2,278.40
|
| Rate for Payer: Cash Price |
$2,278.40
|
| Rate for Payer: Cofinity Commercial |
$1,647.02
|
| Rate for Payer: Cofinity Commercial |
$1,769.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,229.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,290.58
|
| Rate for Payer: Meridian Medicaid |
$819.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,352.03
|
| Rate for Payer: Nomi Health Commercial |
$1,474.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,136.00
|
| Rate for Payer: PACE SWMI |
$1,229.12
|
| Rate for Payer: PHP Commercial |
$1,720.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,229.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$780.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,178.82
|
| Rate for Payer: Priority Health Medicare |
$1,229.12
|
| Rate for Payer: Priority Health SBD |
$2,178.82
|
| Rate for Payer: Priority Health Tiered Network |
$2,178.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,229.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,443.71
|
| Rate for Payer: UHC Core |
$2,443.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,229.12
|
| Rate for Payer: UHC Exchange |
$2,443.71
|
| Rate for Payer: UHC Medicaid |
$780.65
|
| Rate for Payer: UHCCP Medicaid |
$780.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,310.08
|
|
|
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 |
$1,351.14 |
| Rate for Payer: Aetna Commercial |
$1,022.85
|
| Rate for Payer: Aetna Medicare |
$793.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.18
|
| Rate for Payer: BCBS Complete |
$530.72
|
| Rate for Payer: BCBS MAPPO |
$763.32
|
| Rate for Payer: BCN Commercial |
$1,239.47
|
| Rate for Payer: BCN Medicare Advantage |
$763.32
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cofinity Commercial |
$1,022.85
|
| Rate for Payer: Cofinity Commercial |
$1,099.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$801.49
|
| Rate for Payer: Meridian Medicaid |
$530.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$839.65
|
| Rate for Payer: Nomi Health Commercial |
$915.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,025.25
|
| Rate for Payer: PACE SWMI |
$763.32
|
| Rate for Payer: PHP Commercial |
$1,068.65
|
| Rate for Payer: PHP Medicare Advantage |
$763.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,324.96
|
| Rate for Payer: Priority Health Medicare |
$763.32
|
| Rate for Payer: Priority Health SBD |
$1,324.96
|
| Rate for Payer: Priority Health Tiered Network |
$1,324.96
|
| Rate for Payer: Railroad Medicare Medicare |
$763.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,351.14
|
| Rate for Payer: UHC Core |
$1,351.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$763.32
|
| Rate for Payer: UHC Exchange |
$1,351.14
|
| Rate for Payer: UHC Medicaid |
$505.45
|
| Rate for Payer: UHCCP Medicaid |
$505.45
|
| Rate for Payer: UMR Bronson Commercial |
$628.82
|
|
|
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 |
$1,023.54 |
| Rate for Payer: Aetna Commercial |
$690.62
|
| Rate for Payer: Aetna Medicare |
$536.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$690.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$742.16
|
| Rate for Payer: BCBS Complete |
$350.02
|
| Rate for Payer: BCBS MAPPO |
$515.39
|
| Rate for Payer: BCN Commercial |
$882.42
|
| Rate for Payer: BCN Medicare Advantage |
$515.39
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$690.62
|
| Rate for Payer: Cofinity Commercial |
$742.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$515.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$541.16
|
| Rate for Payer: Meridian Medicaid |
$350.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$566.93
|
| Rate for Payer: Nomi Health Commercial |
$618.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$990.00
|
| Rate for Payer: PACE SWMI |
$515.39
|
| Rate for Payer: PHP Commercial |
$721.55
|
| Rate for Payer: PHP Medicare Advantage |
$515.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$893.70
|
| Rate for Payer: Priority Health Medicare |
$515.39
|
| Rate for Payer: Priority Health SBD |
$893.70
|
| Rate for Payer: Priority Health Tiered Network |
$893.70
|
| Rate for Payer: Railroad Medicare Medicare |
$515.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,023.54
|
| Rate for Payer: UHC Core |
$1,023.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$515.39
|
| Rate for Payer: UHC Exchange |
$1,023.54
|
| Rate for Payer: UHC Medicaid |
$333.35
|
| Rate for Payer: UHCCP Medicaid |
$333.35
|
| Rate for Payer: UMR Bronson Commercial |
$607.20
|
|
