|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 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 |
$226.58
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| 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
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$172.05 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna American Axle |
$302.25
|
| Rate for Payer: Aetna Commercial |
$395.25
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.25
|
| 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 |
$372.00
|
| 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: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| 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: 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 |
$395.25
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$395.25
|
| 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 |
$302.25
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$292.95
|
| 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 |
$172.05
|
| Rate for Payer: VA VA |
$1,580.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$243.09 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna American Axle |
$427.05
|
| Rate for Payer: Aetna Commercial |
$558.45
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.05
|
| 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 |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Commercial |
$565.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$591.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.75
|
| 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 |
$558.45
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$558.45
|
| 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 |
$427.05
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$413.91
|
| 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 |
$243.09
|
| Rate for Payer: VA VA |
$1,580.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$238.04 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$318.97
|
| Rate for Payer: Aetna Medicare |
$247.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.97
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS MAPPO |
$238.04
|
| Rate for Payer: BCN Medicare Advantage |
$238.04
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$342.78
|
| Rate for Payer: Cofinity Commercial |
$318.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.94
|
| Rate for Payer: Nomi Health Commercial |
$285.65
|
| Rate for Payer: PACE SWMI |
$238.04
|
| Rate for Payer: PHP Commercial |
$333.26
|
| Rate for Payer: PHP Medicare Advantage |
$238.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health Medicare |
$238.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.04
|
| Rate for Payer: UHC Medicare Advantage |
$238.04
|
| Rate for Payer: UMR Bronson Commercial |
$302.22
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$289.08 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna American Axle |
$427.05
|
| Rate for Payer: Aetna Commercial |
$558.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.05
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Commercial |
$565.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Healthscope Commercial |
$591.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: PHP Commercial |
$558.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health SBD |
$413.91
|
| Rate for Payer: UMR Bronson Commercial |
$289.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
11406
|
| Min. Negotiated Rate |
$238.04 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$318.97
|
| Rate for Payer: Aetna Medicare |
$247.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.97
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS MAPPO |
$238.04
|
| Rate for Payer: BCN Medicare Advantage |
$238.04
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$318.97
|
| Rate for Payer: Cofinity Commercial |
$342.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.94
|
| Rate for Payer: Nomi Health Commercial |
$285.65
|
| Rate for Payer: PACE SWMI |
$238.04
|
| Rate for Payer: PHP Commercial |
$333.26
|
| Rate for Payer: PHP Medicare Advantage |
$238.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health Medicare |
$238.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.04
|
| Rate for Payer: UHC Medicare Advantage |
$238.04
|
| Rate for Payer: UMR Bronson Commercial |
$302.22
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$167.47
|
| Rate for Payer: Aetna Medicare |
$129.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.47
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$124.98
|
| Rate for Payer: BCN Medicare Advantage |
$124.98
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$179.97
|
| Rate for Payer: Cofinity Commercial |
$167.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.23
|
| Rate for Payer: Nomi Health Commercial |
$149.98
|
| Rate for Payer: PACE SWMI |
$124.98
|
| Rate for Payer: PHP Commercial |
$174.97
|
| Rate for Payer: PHP Medicare Advantage |
$124.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$124.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.98
|
| Rate for Payer: UHC Medicare Advantage |
$124.98
|
| Rate for Payer: UMR Bronson Commercial |
$127.88
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
11441
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$167.47
|
| Rate for Payer: Aetna Medicare |
$129.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.47
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$124.98
|
| Rate for Payer: BCN Medicare Advantage |
$124.98
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$167.47
|
| Rate for Payer: Cofinity Commercial |
$179.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.23
|
| Rate for Payer: Nomi Health Commercial |
$149.98
|
| Rate for Payer: PACE SWMI |
$124.98
|
| Rate for Payer: PHP Commercial |
$174.97
|
| Rate for Payer: PHP Medicare Advantage |
$124.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$124.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.98
|
| Rate for Payer: UHC Medicare Advantage |
$124.98
|
| Rate for Payer: UMR Bronson Commercial |
$127.88
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$122.32 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Aetna American Axle |
$180.70
|
| Rate for Payer: Aetna Commercial |
$236.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.70
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$194.60
|
| Rate for Payer: Cofinity Commercial |
$239.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Healthscope Commercial |
$250.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: PHP Commercial |
$236.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health SBD |
$175.14
|
| Rate for Payer: UMR Bronson Commercial |
$122.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$102.86 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna American Axle |
$180.70
|
| Rate for Payer: Aetna Commercial |
$236.30
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.70
|
| 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 |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$194.60
|
| Rate for Payer: Cofinity Commercial |
$239.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$250.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.50
|
| 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 |
$236.30
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$236.30
|
| 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 |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$175.14
|
| 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 |
$102.86
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$155.32 |
| Max. Negotiated Rate |
$317.70 |
| Rate for Payer: Aetna American Axle |
$229.45
|
| Rate for Payer: Aetna Commercial |
$300.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.45
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$303.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.40
|
| Rate for Payer: Healthscope Commercial |
$317.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.05
|
| Rate for Payer: PHP Commercial |
$300.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health SBD |
$222.39
|
| Rate for Payer: UMR Bronson Commercial |
$155.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.75
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$138.77 |
| Max. Negotiated Rate |
$229.45 |
| Rate for Payer: Aetna Commercial |
$185.95
|
| Rate for Payer: Aetna Medicare |
$144.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.95
|
| Rate for Payer: BCBS Complete |
$141.20
|
| Rate for Payer: BCBS MAPPO |
$138.77
|
| Rate for Payer: BCN Medicare Advantage |
$138.77
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$199.83
|
| Rate for Payer: Cofinity Commercial |
$185.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.71
|
| Rate for Payer: Nomi Health Commercial |
$166.52
|
| Rate for Payer: PACE SWMI |
$138.77
|
| Rate for Payer: PHP Commercial |
$194.28
|
| Rate for Payer: PHP Medicare Advantage |
$138.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health Medicare |
$138.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.77
|
| Rate for Payer: UHC Medicare Advantage |
$138.77
|
| Rate for Payer: UMR Bronson Commercial |
$162.38
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$138.77 |
| Max. Negotiated Rate |
$229.45 |
| Rate for Payer: Aetna Commercial |
$185.95
|
| Rate for Payer: Aetna Medicare |
$144.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.95
|
| Rate for Payer: BCBS Complete |
$141.20
|
| Rate for Payer: BCBS MAPPO |
$138.77
|
| Rate for Payer: BCN Medicare Advantage |
$138.77
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$185.95
|
| Rate for Payer: Cofinity Commercial |
$199.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.71
|
| Rate for Payer: Nomi Health Commercial |
$166.52
|
| Rate for Payer: PACE SWMI |
$138.77
|
| Rate for Payer: PHP Commercial |
$194.28
|
| Rate for Payer: PHP Medicare Advantage |
$138.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health Medicare |
$138.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.77
|
| Rate for Payer: UHC Medicare Advantage |
$138.77
|
| Rate for Payer: UMR Bronson Commercial |
$162.38
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna American Axle |
$229.45
|
| Rate for Payer: Aetna Commercial |
$300.05
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.45
|
| 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 |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$303.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$317.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.75
|
| 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 |
$300.05
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$300.05
|
| 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 |
$229.45
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$222.39
|
| 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 |
$130.61
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.75
|
|
|
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
|
| 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: Aetna New Business (MI Preferred) |
$244.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.97
|
| 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 Commercial |
$238.18
|
| Rate for Payer: PHP Medicare Advantage |
$170.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$170.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.13
|
| Rate for Payer: UHC Medicare Advantage |
$170.13
|
| Rate for Payer: UMR Bronson Commercial |
$206.54
|
|
|
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 |
$166.13 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna American Axle |
$291.85
|
| Rate for Payer: Aetna Commercial |
$381.65
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.85
|
| 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 |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$314.30
|
| Rate for Payer: Cofinity Commercial |
$386.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$404.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.75
|
| 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 |
$381.65
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$381.65
|
| 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 |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$282.87
|
| 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 |
$166.13
|
| Rate for Payer: VA VA |
$1,580.19
|
| 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
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$197.56 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Aetna American Axle |
$291.85
|
| Rate for Payer: Aetna Commercial |
$381.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.85
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$314.30
|
| Rate for Payer: Cofinity Commercial |
$386.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.20
|
| Rate for Payer: Healthscope Commercial |
$404.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.65
|
| Rate for Payer: PHP Commercial |
$381.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health SBD |
$282.87
|
| Rate for Payer: UMR Bronson Commercial |
$197.56
|
| 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: Aetna New Business (MI Preferred) |
$244.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.97
|
| 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 |
$227.97
|
| Rate for Payer: Cofinity Commercial |
$244.99
|
| 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 Commercial |
$238.18
|
| Rate for Payer: PHP Medicare Advantage |
$170.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$170.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.13
|
| Rate for Payer: UHC Medicare Advantage |
$170.13
|
| Rate for Payer: UMR Bronson Commercial |
$206.54
|
|
|
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 |
$213.49 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna American Axle |
$375.05
|
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.05
|
| 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 |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$403.90
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.75
|
| 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 |
$490.45
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$490.45
|
| 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 |
$375.05
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$363.51
|
| 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 |
$213.49
|
| Rate for Payer: VA VA |
$1,580.19
|
| 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
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$253.88 |
| Max. Negotiated Rate |
$519.30 |
| Rate for Payer: Aetna American Axle |
$375.05
|
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.05
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$403.90
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: PHP Commercial |
$490.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health SBD |
$363.51
|
| Rate for Payer: UMR Bronson Commercial |
$253.88
|
| 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
|
| 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: Aetna New Business (MI Preferred) |
$311.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.82
|
| 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 Commercial |
$302.79
|
| Rate for Payer: PHP Medicare Advantage |
$216.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health Medicare |
$216.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.28
|
| Rate for Payer: UHC Medicare Advantage |
$216.28
|
| Rate for Payer: UMR Bronson Commercial |
$265.42
|
|
|
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: Aetna New Business (MI Preferred) |
$311.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.82
|
| 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 |
$289.82
|
| Rate for Payer: Cofinity Commercial |
$311.44
|
| 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 Commercial |
$302.79
|
| Rate for Payer: PHP Medicare Advantage |
$216.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health Medicare |
$216.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.28
|
| Rate for Payer: UHC Medicare Advantage |
$216.28
|
| Rate for Payer: UMR Bronson Commercial |
$265.42
|
|
|
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: Aetna New Business (MI Preferred) |
$2,833.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,636.54
|
| 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 Commercial |
$2,754.60
|
| 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 |
$1,967.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,967.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,967.57
|
| Rate for Payer: UMR Bronson Commercial |
$3,672.64
|
|
|
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: Aetna New Business (MI Preferred) |
$1,359.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.09
|
| 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 Commercial |
$1,321.74
|
| 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 |
$944.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$944.10
|
| Rate for Payer: UHC Medicare Advantage |
$944.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,063.06
|
|
|
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: Aetna New Business (MI Preferred) |
$494.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.77
|
| 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 Commercial |
$480.35
|
| Rate for Payer: PHP Medicare Advantage |
$343.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.60
|
| Rate for Payer: Priority Health Medicare |
$343.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.11
|
| Rate for Payer: UHC Medicare Advantage |
$343.11
|
| Rate for Payer: UMR Bronson Commercial |
$471.04
|
|
