|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
11424
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna American Axle |
$333.45
|
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.45
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$359.10
|
| Rate for Payer: Cofinity Commercial |
$441.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.40
|
| Rate for Payer: Healthscope Commercial |
$461.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.05
|
| Rate for Payer: PHP Commercial |
$436.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health SBD |
$323.19
|
| Rate for Payer: UMR Bronson Commercial |
$225.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
11424
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$189.81 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna American Axle |
$333.45
|
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$359.10
|
| Rate for Payer: Cofinity Commercial |
$441.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$461.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.75
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.05
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$436.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$323.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: UMR Bronson Commercial |
$189.81
|
| Rate for Payer: VA VA |
$1,580.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 11424
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$232.36
|
| Rate for Payer: Aetna Medicare |
$180.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.36
|
| Rate for Payer: BCBS Complete |
$205.20
|
| Rate for Payer: BCBS MAPPO |
$173.40
|
| Rate for Payer: BCN Medicare Advantage |
$173.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$232.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.07
|
| Rate for Payer: Nomi Health Commercial |
$208.08
|
| Rate for Payer: PACE SWMI |
$173.40
|
| Rate for Payer: PHP Commercial |
$242.76
|
| Rate for Payer: PHP Medicare Advantage |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health Medicare |
$173.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.40
|
| Rate for Payer: UHC Medicare Advantage |
$173.40
|
| Rate for Payer: UMR Bronson Commercial |
$235.98
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
HCPCS 11426
|
| Min. Negotiated Rate |
$257.95 |
| Max. Negotiated Rate |
$458.90 |
| Rate for Payer: Aetna Commercial |
$345.65
|
| Rate for Payer: Aetna Medicare |
$268.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.65
|
| Rate for Payer: BCBS Complete |
$282.40
|
| Rate for Payer: BCBS MAPPO |
$257.95
|
| Rate for Payer: BCN Medicare Advantage |
$257.95
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cofinity Commercial |
$371.45
|
| Rate for Payer: Cofinity Commercial |
$345.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.85
|
| Rate for Payer: Nomi Health Commercial |
$309.54
|
| Rate for Payer: PACE SWMI |
$257.95
|
| Rate for Payer: PHP Commercial |
$361.13
|
| Rate for Payer: PHP Medicare Advantage |
$257.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.90
|
| Rate for Payer: Priority Health Medicare |
$257.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.95
|
| Rate for Payer: UHC Medicare Advantage |
$257.95
|
| Rate for Payer: UMR Bronson Commercial |
$324.76
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$261.22 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna American Axle |
$458.90
|
| Rate for Payer: Aetna Commercial |
$600.10
|
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cofinity Commercial |
$494.20
|
| Rate for Payer: Cofinity Commercial |
$607.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$494.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$635.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.50
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$600.10
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$600.10
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.90
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health SBD |
$444.78
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: UMR Bronson Commercial |
$261.22
|
| Rate for Payer: VA VA |
$2,791.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$310.64 |
| Max. Negotiated Rate |
$635.40 |
| Rate for Payer: Aetna American Axle |
$458.90
|
| Rate for Payer: Aetna Commercial |
$600.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.90
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cofinity Commercial |
$494.20
|
| Rate for Payer: Cofinity Commercial |
$607.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$494.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.80
|
| Rate for Payer: Healthscope Commercial |
$635.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$600.10
|
| Rate for Payer: PHP Commercial |
$600.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.90
|
| Rate for Payer: Priority Health SBD |
$444.78
|
| Rate for Payer: UMR Bronson Commercial |
$310.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
11426
|
| Min. Negotiated Rate |
$257.95 |
| Max. Negotiated Rate |
$458.90 |
| Rate for Payer: Aetna Commercial |
$345.65
|
| Rate for Payer: Aetna Medicare |
$268.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.65
|
| Rate for Payer: BCBS Complete |
$282.40
|
| Rate for Payer: BCBS MAPPO |
$257.95
|
| Rate for Payer: BCN Medicare Advantage |
$257.95
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cofinity Commercial |
$345.65
|
| Rate for Payer: Cofinity Commercial |
$371.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.85
|
| Rate for Payer: Nomi Health Commercial |
$309.54
|
| Rate for Payer: PACE SWMI |
$257.95
|
| Rate for Payer: PHP Commercial |
$361.13
|
| Rate for Payer: PHP Medicare Advantage |
$257.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.90
|
| Rate for Payer: Priority Health Medicare |
$257.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.95
|
| Rate for Payer: UHC Medicare Advantage |
$257.95
|
| Rate for Payer: UMR Bronson Commercial |
$324.76
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
11400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna American Axle |
$132.60
|
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: UMR Bronson Commercial |
$75.48
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 11400
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$106.42
|
| Rate for Payer: Aetna Medicare |
$82.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.42
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$79.42
|
| Rate for Payer: BCN Medicare Advantage |
$79.42
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$114.36
|
| Rate for Payer: Cofinity Commercial |
$106.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.39
|
| Rate for Payer: Nomi Health Commercial |
$95.30
|
| Rate for Payer: PACE SWMI |
$79.42
|
| Rate for Payer: PHP Commercial |
$111.19
|
| Rate for Payer: PHP Medicare Advantage |
$79.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$79.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.42
|
| Rate for Payer: UHC Medicare Advantage |
$79.42
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
11400
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$106.42
|
| Rate for Payer: Aetna Medicare |
$82.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.42
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$79.42
|
| Rate for Payer: BCN Medicare Advantage |
$79.42
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$106.42
|
| Rate for Payer: Cofinity Commercial |
$114.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.39
|
| Rate for Payer: Nomi Health Commercial |
$95.30
|
| Rate for Payer: PACE SWMI |
$79.42
|
| Rate for Payer: PHP Commercial |
$111.19
|
| Rate for Payer: PHP Medicare Advantage |
$79.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$79.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.42
|
| Rate for Payer: UHC Medicare Advantage |
$79.42
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
11400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna American Axle |
$132.60
|
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: UMR Bronson Commercial |
$89.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 11401
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Commercial |
$133.50
|
| Rate for Payer: Aetna Medicare |
$103.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$99.63
|
| Rate for Payer: BCN Medicare Advantage |
$99.63
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$133.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.61
|
| Rate for Payer: Nomi Health Commercial |
$119.56
|
| Rate for Payer: PACE SWMI |
$99.63
|
| Rate for Payer: PHP Commercial |
$139.48
|
| Rate for Payer: PHP Medicare Advantage |
$99.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.63
|
| Rate for Payer: UHC Medicare Advantage |
$99.63
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna American Axle |
$160.55
|
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.55
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health SBD |
$155.61
|
| Rate for Payer: UMR Bronson Commercial |
$108.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$91.39 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna American Axle |
$160.55
|
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$155.61
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: UMR Bronson Commercial |
$91.39
|
| Rate for Payer: VA VA |
$389.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
11401
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Commercial |
$133.50
|
| Rate for Payer: Aetna Medicare |
$103.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$99.63
|
| Rate for Payer: BCN Medicare Advantage |
$99.63
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$133.50
|
| Rate for Payer: Cofinity Commercial |
$143.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.61
|
| Rate for Payer: Nomi Health Commercial |
$119.56
|
| Rate for Payer: PACE SWMI |
$99.63
|
| Rate for Payer: PHP Commercial |
$139.48
|
| Rate for Payer: PHP Medicare Advantage |
$99.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.63
|
| Rate for Payer: UHC Medicare Advantage |
$99.63
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
11402
|
| Min. Negotiated Rate |
$109.13 |
| Max. Negotiated Rate |
$178.10 |
| Rate for Payer: Aetna Commercial |
$146.23
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.23
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS MAPPO |
$109.13
|
| Rate for Payer: BCN Medicare Advantage |
$109.13
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$146.23
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.59
|
| Rate for Payer: Nomi Health Commercial |
$130.96
|
| Rate for Payer: PACE SWMI |
$109.13
|
| Rate for Payer: PHP Commercial |
$152.78
|
| Rate for Payer: PHP Medicare Advantage |
$109.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health Medicare |
$109.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.13
|
| Rate for Payer: UHC Medicare Advantage |
$109.13
|
| Rate for Payer: UMR Bronson Commercial |
$126.04
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$109.13 |
| Max. Negotiated Rate |
$178.10 |
| Rate for Payer: Aetna Commercial |
$146.23
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.23
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS MAPPO |
$109.13
|
| Rate for Payer: BCN Medicare Advantage |
$109.13
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Cofinity Commercial |
$146.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.59
|
| Rate for Payer: Nomi Health Commercial |
$130.96
|
| Rate for Payer: PACE SWMI |
$109.13
|
| Rate for Payer: PHP Commercial |
$152.78
|
| Rate for Payer: PHP Medicare Advantage |
$109.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health Medicare |
$109.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.13
|
| Rate for Payer: UHC Medicare Advantage |
$109.13
|
| Rate for Payer: UMR Bronson Commercial |
$126.04
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna American Axle |
$178.10
|
| Rate for Payer: Aetna Commercial |
$232.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.10
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$235.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Healthscope Commercial |
$246.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: PHP Commercial |
$232.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health SBD |
$172.62
|
| Rate for Payer: UMR Bronson Commercial |
$120.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$101.38 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna American Axle |
$178.10
|
| Rate for Payer: Aetna Commercial |
$232.90
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$235.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$246.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.50
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$232.90
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$172.62
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: UMR Bronson Commercial |
$101.38
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$148.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$142.34
|
| Rate for Payer: BCN Medicare Advantage |
$142.34
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Cofinity Commercial |
$204.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.46
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: PACE SWMI |
$142.34
|
| Rate for Payer: PHP Commercial |
$199.28
|
| Rate for Payer: PHP Medicare Advantage |
$142.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$142.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.34
|
| Rate for Payer: UHC Medicare Advantage |
$142.34
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Aetna American Axle |
$213.20
|
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| Rate for Payer: UMR Bronson Commercial |
$144.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$148.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$142.34
|
| Rate for Payer: BCN Medicare Advantage |
$142.34
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$204.97
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.46
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: PACE SWMI |
$142.34
|
| Rate for Payer: PHP Commercial |
$199.28
|
| Rate for Payer: PHP Medicare Advantage |
$142.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$142.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.34
|
| Rate for Payer: UHC Medicare Advantage |
$142.34
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna American Axle |
$213.20
|
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.00
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: UMR Bronson Commercial |
$121.36
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$204.60 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna American Axle |
$302.25
|
| Rate for Payer: Aetna Commercial |
$395.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.25
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$325.50
|
| Rate for Payer: Cofinity Commercial |
$399.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.00
|
| Rate for Payer: Healthscope Commercial |
$418.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.25
|
| Rate for Payer: PHP Commercial |
$395.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health SBD |
$292.95
|
| Rate for Payer: UMR Bronson Commercial |
$204.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$157.35 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$210.85
|
| Rate for Payer: Aetna Medicare |
$163.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.85
|
| Rate for Payer: BCBS Complete |
$186.00
|
| Rate for Payer: BCBS MAPPO |
$157.35
|
| Rate for Payer: BCN Medicare Advantage |
$157.35
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| Rate for Payer: Cofinity Commercial |
$226.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.22
|
| Rate for Payer: Nomi Health Commercial |
$188.82
|
| Rate for Payer: PACE SWMI |
$157.35
|
| Rate for Payer: PHP Commercial |
$220.29
|
| Rate for Payer: PHP Medicare Advantage |
$157.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health Medicare |
$157.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.35
|
| Rate for Payer: UHC Medicare Advantage |
$157.35
|
| Rate for Payer: UMR Bronson Commercial |
$213.90
|
|
