|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT
|
Professional
|
Both
|
$3,913.00
|
|
|
Service Code
|
HCPCS 34702
|
| Min. Negotiated Rate |
$1,119.53 |
| Max. Negotiated Rate |
$2,868.12 |
| Rate for Payer: Aetna Commercial |
$2,315.02
|
| Rate for Payer: Aetna Medicare |
$1,796.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,315.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,487.79
|
| Rate for Payer: BCBS Complete |
$1,175.51
|
| Rate for Payer: BCBS MAPPO |
$1,727.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.96
|
| Rate for Payer: BCN Commercial |
$2,630.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,727.63
|
| Rate for Payer: Cash Price |
$3,130.40
|
| Rate for Payer: Cash Price |
$3,130.40
|
| Rate for Payer: Cofinity Commercial |
$2,315.02
|
| Rate for Payer: Cofinity Commercial |
$2,487.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,727.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,814.01
|
| Rate for Payer: Meridian Medicaid |
$1,175.51
|
| Rate for Payer: Nomi Health Commercial |
$2,073.16
|
| Rate for Payer: PACE SWMI |
$1,727.63
|
| Rate for Payer: PHP Commercial |
$2,418.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,727.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,119.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,543.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,868.12
|
| Rate for Payer: Priority Health Medicare |
$1,727.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,868.12
|
| Rate for Payer: Priority Health SBD |
$2,868.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,727.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,727.63
|
| Rate for Payer: UHCCP Medicaid |
$1,119.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,799.98
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT
|
Professional
|
Both
|
$3,166.00
|
|
|
Service Code
|
HCPCS 34705
|
| Min. Negotiated Rate |
$950.83 |
| Max. Negotiated Rate |
$2,747.37 |
| Rate for Payer: Aetna Commercial |
$1,957.42
|
| Rate for Payer: Aetna Medicare |
$1,519.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,957.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,103.49
|
| Rate for Payer: BCBS Complete |
$998.37
|
| Rate for Payer: BCBS MAPPO |
$1,460.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,747.37
|
| Rate for Payer: BCN Commercial |
$2,174.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,460.76
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Cofinity Commercial |
$1,957.42
|
| Rate for Payer: Cofinity Commercial |
$2,103.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,460.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,533.80
|
| Rate for Payer: Meridian Medicaid |
$998.37
|
| Rate for Payer: Nomi Health Commercial |
$1,752.91
|
| Rate for Payer: PACE SWMI |
$1,460.76
|
| Rate for Payer: PHP Commercial |
$2,045.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,460.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$950.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,371.93
|
| Rate for Payer: Priority Health Medicare |
$1,460.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,371.93
|
| Rate for Payer: Priority Health SBD |
$2,371.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,460.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,460.76
|
| Rate for Payer: UHCCP Medicaid |
$950.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,456.36
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT
|
Professional
|
Both
|
$4,840.00
|
|
|
Service Code
|
HCPCS 34706
|
| Min. Negotiated Rate |
$1,419.65 |
| Max. Negotiated Rate |
$3,535.04 |
| Rate for Payer: Aetna Commercial |
$2,928.93
|
| Rate for Payer: Aetna Medicare |
$2,273.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,928.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,147.51
|
| Rate for Payer: BCBS Complete |
$1,490.63
|
| Rate for Payer: BCBS MAPPO |
$2,185.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,686.93
|
| Rate for Payer: BCN Commercial |
$3,239.93
|
| Rate for Payer: BCN Medicare Advantage |
$2,185.77
|
| Rate for Payer: Cash Price |
$3,872.00
|
| Rate for Payer: Cash Price |
$3,872.00
|
| Rate for Payer: Cofinity Commercial |
$2,928.93
|
| Rate for Payer: Cofinity Commercial |
$3,147.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,185.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,295.06
|
| Rate for Payer: Meridian Medicaid |
$1,490.63
|
| Rate for Payer: Nomi Health Commercial |
$2,622.92
|
| Rate for Payer: PACE SWMI |
$2,185.77
|
| Rate for Payer: PHP Commercial |
$3,060.08
|
| Rate for Payer: PHP Medicare Advantage |
$2,185.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,419.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,146.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,535.04
|
| Rate for Payer: Priority Health Medicare |
$2,185.77
|
| Rate for Payer: Priority Health Narrow Network |
$3,535.04
|
| Rate for Payer: Priority Health SBD |
$3,535.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,185.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,185.77
|
| Rate for Payer: UHCCP Medicaid |
$1,419.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,226.40
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT
|
Professional
|
Both
|
$2,917.00
|
|
|
Service Code
|
HCPCS 34703
|
| Min. Negotiated Rate |
$855.62 |
| Max. Negotiated Rate |
$2,308.14 |
| Rate for Payer: Aetna Commercial |
$1,761.51
|
| Rate for Payer: Aetna Medicare |
$1,367.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,892.97
|
| Rate for Payer: BCBS Complete |
$898.40
|
| Rate for Payer: BCBS MAPPO |
$1,314.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,308.14
|
| Rate for Payer: BCN Commercial |
$1,960.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,314.56
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cofinity Commercial |
$1,761.51
|
| Rate for Payer: Cofinity Commercial |
$1,892.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,314.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,380.29
|
| Rate for Payer: Meridian Medicaid |
$898.40
|
| Rate for Payer: Nomi Health Commercial |
$1,577.47
|
| Rate for Payer: PACE SWMI |
$1,314.56
|
| Rate for Payer: PHP Commercial |
$1,840.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,314.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,896.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,133.15
|
| Rate for Payer: Priority Health Medicare |
$1,314.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,133.15
|
| Rate for Payer: Priority Health SBD |
$2,133.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,314.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,314.56
|
| Rate for Payer: UHCCP Medicaid |
$855.62
|
| Rate for Payer: UMR Bronson Commercial |
$1,341.82
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT
|
Professional
|
Both
|
$2,414.00
|
|
|
Service Code
|
HCPCS 34707
|
| Min. Negotiated Rate |
$725.48 |
| Max. Negotiated Rate |
$2,209.35 |
| Rate for Payer: Aetna Commercial |
$1,491.27
|
| Rate for Payer: Aetna Medicare |
$1,157.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,602.56
|
| Rate for Payer: BCBS Complete |
$761.75
|
| Rate for Payer: BCBS MAPPO |
$1,112.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.35
|
| Rate for Payer: BCN Commercial |
$1,662.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,112.89
|
| Rate for Payer: Cash Price |
$1,931.20
|
| Rate for Payer: Cash Price |
$1,931.20
|
| Rate for Payer: Cofinity Commercial |
$1,491.27
|
| Rate for Payer: Cofinity Commercial |
$1,602.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,112.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,168.53
|
| Rate for Payer: Meridian Medicaid |
$761.75
|
| Rate for Payer: Nomi Health Commercial |
$1,335.47
|
| Rate for Payer: PACE SWMI |
$1,112.89
|
| Rate for Payer: PHP Commercial |
$1,558.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,112.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$725.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,569.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,803.95
|
| Rate for Payer: Priority Health Medicare |
$1,112.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,803.95
|
| Rate for Payer: Priority Health SBD |
$1,803.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,112.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,112.89
|
| Rate for Payer: UHCCP Medicaid |
$725.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,110.44
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT
|
Professional
|
Both
|
$3,899.00
|
|
|
Service Code
|
HCPCS 34708
|
| Min. Negotiated Rate |
$1,134.44 |
| Max. Negotiated Rate |
$2,827.72 |
| Rate for Payer: Aetna Commercial |
$2,345.95
|
| Rate for Payer: Aetna Medicare |
$1,820.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,345.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,521.02
|
| Rate for Payer: BCBS Complete |
$1,191.16
|
| Rate for Payer: BCBS MAPPO |
$1,750.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,929.88
|
| Rate for Payer: BCN Commercial |
$2,587.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,750.71
|
| Rate for Payer: Cash Price |
$3,119.20
|
| Rate for Payer: Cash Price |
$3,119.20
|
| Rate for Payer: Cofinity Commercial |
$2,345.95
|
| Rate for Payer: Cofinity Commercial |
$2,521.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,750.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,838.25
|
| Rate for Payer: Meridian Medicaid |
$1,191.16
|
| Rate for Payer: Nomi Health Commercial |
$2,100.85
|
| Rate for Payer: PACE SWMI |
$1,750.71
|
| Rate for Payer: PHP Commercial |
$2,450.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,750.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,134.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,534.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,827.72
|
| Rate for Payer: Priority Health Medicare |
$1,750.71
|
| Rate for Payer: Priority Health Narrow Network |
$2,827.72
|
| Rate for Payer: Priority Health SBD |
$2,827.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,750.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,750.71
|
| Rate for Payer: UHCCP Medicaid |
$1,134.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,793.54
|
|
|
PR EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH
|
Professional
|
Both
|
$8,245.00
|
|
|
Service Code
|
HCPCS 33880
|
| Min. Negotiated Rate |
$649.81 |
| Max. Negotiated Rate |
$5,359.25 |
| Rate for Payer: Aetna Commercial |
$2,291.68
|
| Rate for Payer: Aetna Medicare |
$1,778.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,291.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,462.70
|
| Rate for Payer: BCBS Complete |
$1,169.24
|
| Rate for Payer: BCBS MAPPO |
$1,710.21
|
| Rate for Payer: BCBS Trust/PPO |
$649.81
|
| Rate for Payer: BCN Commercial |
$2,552.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,710.21
|
| Rate for Payer: Cash Price |
$6,596.00
|
| Rate for Payer: Cash Price |
$6,596.00
|
| Rate for Payer: Cofinity Commercial |
$2,291.68
|
| Rate for Payer: Cofinity Commercial |
$2,462.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,710.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,795.72
|
| Rate for Payer: Meridian Medicaid |
$1,169.24
|
| Rate for Payer: Nomi Health Commercial |
$2,052.25
|
| Rate for Payer: PACE SWMI |
$1,710.21
|
| Rate for Payer: PHP Commercial |
$2,394.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,710.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,113.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,359.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,779.31
|
| Rate for Payer: Priority Health Medicare |
$1,710.21
|
| Rate for Payer: Priority Health Narrow Network |
$2,779.31
|
| Rate for Payer: Priority Health SBD |
$2,779.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,710.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.21
|
| Rate for Payer: UHCCP Medicaid |
$1,113.56
|
| Rate for Payer: UMR Bronson Commercial |
$3,792.70
|
|
|
PR EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN
|
Professional
|
Both
|
$5,504.00
|
|
|
Service Code
|
HCPCS 33881
|
| Min. Negotiated Rate |
$924.53 |
| Max. Negotiated Rate |
$3,577.60 |
| Rate for Payer: Aetna Commercial |
$1,967.96
|
| Rate for Payer: Aetna Medicare |
$1,527.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,967.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,114.83
|
| Rate for Payer: BCBS Complete |
$1,004.41
|
| Rate for Payer: BCBS MAPPO |
$1,468.63
|
| Rate for Payer: BCBS Trust/PPO |
$924.53
|
| Rate for Payer: BCN Commercial |
$2,187.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,468.63
|
| Rate for Payer: Cash Price |
$4,403.20
|
| Rate for Payer: Cash Price |
$4,403.20
|
| Rate for Payer: Cofinity Commercial |
$1,967.96
|
| Rate for Payer: Cofinity Commercial |
$2,114.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,468.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,542.06
|
| Rate for Payer: Meridian Medicaid |
$1,004.41
|
| Rate for Payer: Nomi Health Commercial |
$1,762.36
|
| Rate for Payer: PACE SWMI |
$1,468.63
|
| Rate for Payer: PHP Commercial |
$2,056.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,468.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,577.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,387.37
|
| Rate for Payer: Priority Health Medicare |
$1,468.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,387.37
|
| Rate for Payer: Priority Health SBD |
$2,387.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,468.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,468.63
|
| Rate for Payer: UHCCP Medicaid |
$956.58
|
| Rate for Payer: UMR Bronson Commercial |
$2,531.84
|
|
|
PR EVASC RPR ILAC ART BIFUR ENDGRFT CATHJ RS&I UNI
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
HCPCS 0254T
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$623.35 |
| Rate for Payer: Aetna Medicare |
$479.50
|
| Rate for Payer: BCBS Complete |
$383.60
|
| Rate for Payer: Cash Price |
$767.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.35
|
| Rate for Payer: UMR Bronson Commercial |
$441.14
|
|
|
PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 34718
|
| Min. Negotiated Rate |
$770.63 |
| Max. Negotiated Rate |
$1,924.14 |
| Rate for Payer: Aetna Commercial |
$1,587.52
|
| Rate for Payer: Aetna Medicare |
$1,232.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,587.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,706.00
|
| Rate for Payer: BCBS Complete |
$809.16
|
| Rate for Payer: BCBS MAPPO |
$1,184.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.62
|
| Rate for Payer: BCN Commercial |
$1,758.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.72
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Cofinity Commercial |
$1,587.52
|
| Rate for Payer: Cofinity Commercial |
$1,706.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.96
|
| Rate for Payer: Meridian Medicaid |
$809.16
|
| Rate for Payer: Nomi Health Commercial |
$1,421.66
|
| Rate for Payer: PACE SWMI |
$1,184.72
|
| Rate for Payer: PHP Commercial |
$1,658.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$770.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,924.14
|
| Rate for Payer: Priority Health Medicare |
$1,184.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,924.14
|
| Rate for Payer: Priority Health SBD |
$1,924.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,184.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.72
|
| Rate for Payer: UHCCP Medicaid |
$770.63
|
| Rate for Payer: UMR Bronson Commercial |
$994.52
|
|
|
PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 34717
|
| Min. Negotiated Rate |
$274.77 |
| Max. Negotiated Rate |
$1,145.35 |
| Rate for Payer: Aetna Commercial |
$568.63
|
| Rate for Payer: Aetna Medicare |
$441.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.06
|
| Rate for Payer: BCBS Complete |
$288.51
|
| Rate for Payer: BCBS MAPPO |
$424.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.35
|
| Rate for Payer: BCN Commercial |
$629.42
|
| Rate for Payer: BCN Medicare Advantage |
$424.35
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$568.63
|
| Rate for Payer: Cofinity Commercial |
$611.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$424.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.57
|
| Rate for Payer: Meridian Medicaid |
$288.51
|
| Rate for Payer: Nomi Health Commercial |
$509.22
|
| Rate for Payer: PACE SWMI |
$424.35
|
| Rate for Payer: PHP Commercial |
$594.09
|
| Rate for Payer: PHP Medicare Advantage |
$424.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.58
|
| Rate for Payer: Priority Health Medicare |
$424.35
|
| Rate for Payer: Priority Health Narrow Network |
$686.58
|
| Rate for Payer: Priority Health SBD |
$686.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$424.35
|
| Rate for Payer: UHC Medicare Advantage |
$424.35
|
| Rate for Payer: UHCCP Medicaid |
$274.77
|
| Rate for Payer: UMR Bronson Commercial |
$372.14
|
|
|
PR EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK
|
Professional
|
Both
|
$3,336.00
|
|
|
Service Code
|
HCPCS 61623
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$2,168.40 |
| Rate for Payer: Aetna Commercial |
$756.03
|
| Rate for Payer: Aetna Medicare |
$586.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$756.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.45
|
| Rate for Payer: BCBS Complete |
$386.91
|
| Rate for Payer: BCBS MAPPO |
$564.20
|
| Rate for Payer: BCBS Trust/PPO |
$124.15
|
| Rate for Payer: BCN Commercial |
$838.57
|
| Rate for Payer: BCN Medicare Advantage |
$564.20
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cofinity Commercial |
$812.45
|
| Rate for Payer: Cofinity Commercial |
$756.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.41
|
| Rate for Payer: Meridian Medicaid |
$386.91
|
| Rate for Payer: Nomi Health Commercial |
$677.04
|
| Rate for Payer: PACE SWMI |
$564.20
|
| Rate for Payer: PHP Commercial |
$789.88
|
| Rate for Payer: PHP Medicare Advantage |
$564.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,168.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$980.47
|
| Rate for Payer: Priority Health Medicare |
$564.20
|
| Rate for Payer: Priority Health Narrow Network |
$980.47
|
| Rate for Payer: Priority Health SBD |
$980.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.20
|
| Rate for Payer: UHC Medicare Advantage |
$564.20
|
| Rate for Payer: UHCCP Medicaid |
$368.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,534.56
|
|
|
PR EWHO RIGID W/O JNTS CF
|
Professional
|
Both
|
$699.00
|
|
|
Service Code
|
HCPCS L3763
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$646.68 |
| Rate for Payer: BCBS Complete |
$279.60
|
| Rate for Payer: BCN Commercial |
$646.68
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.35
|
| Rate for Payer: UMR Bronson Commercial |
$321.54
|
|
|
PR EWHO W/JOINT(S) CF
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS L3764
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$676.76 |
| Rate for Payer: BCBS Complete |
$292.40
|
| Rate for Payer: BCN Commercial |
$676.76
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.15
|
| Rate for Payer: UMR Bronson Commercial |
$336.26
|
|
|
PR EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM
|
Professional
|
Both
|
$2,379.00
|
|
|
Service Code
|
HCPCS 44110
|
| Min. Negotiated Rate |
$545.71 |
| Max. Negotiated Rate |
$1,643.01 |
| Rate for Payer: Aetna Commercial |
$1,100.45
|
| Rate for Payer: Aetna Medicare |
$854.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.45
|
| Rate for Payer: BCBS Complete |
$573.00
|
| Rate for Payer: BCBS MAPPO |
$821.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.01
|
| Rate for Payer: BCN Commercial |
$1,234.88
|
| Rate for Payer: BCN Medicare Advantage |
$821.23
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cofinity Commercial |
$1,100.45
|
| Rate for Payer: Cofinity Commercial |
$1,182.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.29
|
| Rate for Payer: Meridian Medicaid |
$573.00
|
| Rate for Payer: Nomi Health Commercial |
$985.48
|
| Rate for Payer: PACE SWMI |
$821.23
|
| Rate for Payer: PHP Commercial |
$1,149.72
|
| Rate for Payer: PHP Medicare Advantage |
$821.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$545.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,546.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,523.10
|
| Rate for Payer: Priority Health Medicare |
$821.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,523.10
|
| Rate for Payer: Priority Health SBD |
$1,523.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.23
|
| Rate for Payer: UHC Medicare Advantage |
$821.23
|
| Rate for Payer: UHCCP Medicaid |
$545.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,094.34
|
|
|
PR EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE
|
Professional
|
Both
|
$3,605.00
|
|
|
Service Code
|
HCPCS 44111
|
| Min. Negotiated Rate |
$266.79 |
| Max. Negotiated Rate |
$2,343.25 |
| Rate for Payer: Aetna Commercial |
$1,266.86
|
| Rate for Payer: Aetna Medicare |
$983.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,361.40
|
| Rate for Payer: BCBS Complete |
$659.32
|
| Rate for Payer: BCBS MAPPO |
$945.42
|
| Rate for Payer: BCBS Trust/PPO |
$266.79
|
| Rate for Payer: BCN Commercial |
$1,435.25
|
| Rate for Payer: BCN Medicare Advantage |
$945.42
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cofinity Commercial |
$1,266.86
|
| Rate for Payer: Cofinity Commercial |
$1,361.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.69
|
| Rate for Payer: Meridian Medicaid |
$659.32
|
| Rate for Payer: Nomi Health Commercial |
$1,134.50
|
| Rate for Payer: PACE SWMI |
$945.42
|
| Rate for Payer: PHP Commercial |
$1,323.59
|
| Rate for Payer: PHP Medicare Advantage |
$945.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,343.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,748.62
|
| Rate for Payer: Priority Health Medicare |
$945.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,748.62
|
| Rate for Payer: Priority Health SBD |
$1,748.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.42
|
| Rate for Payer: UHC Medicare Advantage |
$945.42
|
| Rate for Payer: UHCCP Medicaid |
$627.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,658.30
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$98.56 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna American Axle |
$145.60
|
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$141.12
|
| Rate for Payer: UMR Bronson Commercial |
$98.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
11440
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$169.24 |
| Rate for Payer: Aetna Commercial |
$134.13
|
| Rate for Payer: Aetna Medicare |
$104.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.14
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS MAPPO |
$100.10
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$169.24
|
| Rate for Payer: BCN Medicare Advantage |
$100.10
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$144.14
|
| Rate for Payer: Cofinity Commercial |
$134.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.10
|
| Rate for Payer: Meridian Medicaid |
$72.91
|
| Rate for Payer: Nomi Health Commercial |
$120.12
|
| Rate for Payer: PACE SWMI |
$100.10
|
| Rate for Payer: PHP Commercial |
$140.14
|
| Rate for Payer: PHP Medicare Advantage |
$100.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.29
|
| Rate for Payer: Priority Health Medicare |
$100.10
|
| Rate for Payer: Priority Health Narrow Network |
$146.29
|
| Rate for Payer: Priority Health SBD |
$146.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.10
|
| Rate for Payer: UHC Medicare Advantage |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$69.44
|
| Rate for Payer: UMR Bronson Commercial |
$103.04
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna American Axle |
$145.60
|
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$727.88
|
| Rate for Payer: BCN Commercial |
$727.88
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$141.12
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.72
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$100.65
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: UMR Bronson Commercial |
$82.88
|
| Rate for Payer: VA VA |
$689.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 11440
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$169.24 |
| Rate for Payer: Aetna Commercial |
$134.13
|
| Rate for Payer: Aetna Medicare |
$104.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.14
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS MAPPO |
$100.10
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$169.24
|
| Rate for Payer: BCN Medicare Advantage |
$100.10
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$134.13
|
| Rate for Payer: Cofinity Commercial |
$144.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.10
|
| Rate for Payer: Meridian Medicaid |
$72.91
|
| Rate for Payer: Nomi Health Commercial |
$120.12
|
| Rate for Payer: PACE SWMI |
$100.10
|
| Rate for Payer: PHP Commercial |
$140.14
|
| Rate for Payer: PHP Medicare Advantage |
$100.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.29
|
| Rate for Payer: Priority Health Medicare |
$100.10
|
| Rate for Payer: Priority Health Narrow Network |
$146.29
|
| Rate for Payer: Priority Health SBD |
$146.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.10
|
| Rate for Payer: UHC Medicare Advantage |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$69.44
|
| Rate for Payer: UMR Bronson Commercial |
$103.04
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
HCPCS 11446
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$536.90 |
| Rate for Payer: Aetna Commercial |
$407.40
|
| Rate for Payer: Aetna Medicare |
$316.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.80
|
| Rate for Payer: BCBS Complete |
$215.83
|
| Rate for Payer: BCBS MAPPO |
$304.03
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$449.99
|
| Rate for Payer: BCN Medicare Advantage |
$304.03
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cofinity Commercial |
$407.40
|
| Rate for Payer: Cofinity Commercial |
$437.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.23
|
| Rate for Payer: Meridian Medicaid |
$215.83
|
| Rate for Payer: Nomi Health Commercial |
$364.84
|
| Rate for Payer: PACE SWMI |
$304.03
|
| Rate for Payer: PHP Commercial |
$425.64
|
| Rate for Payer: PHP Medicare Advantage |
$304.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.30
|
| Rate for Payer: Priority Health Medicare |
$304.03
|
| Rate for Payer: Priority Health Narrow Network |
$430.30
|
| Rate for Payer: Priority Health SBD |
$430.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$304.03
|
| Rate for Payer: UHC Medicare Advantage |
$304.03
|
| Rate for Payer: UHCCP Medicaid |
$205.55
|
| Rate for Payer: UMR Bronson Commercial |
$379.96
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 11420
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$150.39 |
| Rate for Payer: Aetna Commercial |
$104.45
|
| Rate for Payer: Aetna Medicare |
$81.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.25
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$77.95
|
| Rate for Payer: BCBS Trust/PPO |
$100.72
|
| Rate for Payer: BCN Commercial |
$150.39
|
| Rate for Payer: BCN Medicare Advantage |
$77.95
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$112.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.85
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Nomi Health Commercial |
$93.54
|
| Rate for Payer: PACE SWMI |
$77.95
|
| Rate for Payer: PHP Commercial |
$109.13
|
| Rate for Payer: PHP Medicare Advantage |
$77.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.97
|
| Rate for Payer: Priority Health Medicare |
$77.95
|
| Rate for Payer: Priority Health Narrow Network |
$111.97
|
| Rate for Payer: Priority Health SBD |
$111.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.95
|
| Rate for Payer: UHC Medicare Advantage |
$77.95
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
| Rate for Payer: UMR Bronson Commercial |
$93.38
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
11421
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$138.19
|
| Rate for Payer: Aetna Medicare |
$107.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.51
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS MAPPO |
$103.13
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$188.87
|
| Rate for Payer: BCN Medicare Advantage |
$103.13
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$138.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.29
|
| Rate for Payer: Meridian Medicaid |
$74.02
|
| Rate for Payer: Nomi Health Commercial |
$123.76
|
| Rate for Payer: PACE SWMI |
$103.13
|
| Rate for Payer: PHP Commercial |
$144.38
|
| Rate for Payer: PHP Medicare Advantage |
$103.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.55
|
| Rate for Payer: Priority Health Medicare |
$103.13
|
| Rate for Payer: Priority Health Narrow Network |
$148.55
|
| Rate for Payer: Priority Health SBD |
$148.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.13
|
| Rate for Payer: UHC Medicare Advantage |
$103.13
|
| Rate for Payer: UHCCP Medicaid |
$70.50
|
| Rate for Payer: UMR Bronson Commercial |
$120.06
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$96.57 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna American Axle |
$169.65
|
| Rate for Payer: Aetna Commercial |
$221.85
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$727.88
|
| Rate for Payer: BCN Commercial |
$727.88
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$182.70
|
| Rate for Payer: Cofinity Commercial |
$224.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$234.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.75
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.85
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$221.85
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$164.43
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.27
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$103.88
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: UMR Bronson Commercial |
$96.57
|
| Rate for Payer: VA VA |
$689.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 11421
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$138.19
|
| Rate for Payer: Aetna Medicare |
$107.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.51
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS MAPPO |
$103.13
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$188.87
|
| Rate for Payer: BCN Medicare Advantage |
$103.13
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$138.19
|
| Rate for Payer: Cofinity Commercial |
$148.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.29
|
| Rate for Payer: Meridian Medicaid |
$74.02
|
| Rate for Payer: Nomi Health Commercial |
$123.76
|
| Rate for Payer: PACE SWMI |
$103.13
|
| Rate for Payer: PHP Commercial |
$144.38
|
| Rate for Payer: PHP Medicare Advantage |
$103.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.55
|
| Rate for Payer: Priority Health Medicare |
$103.13
|
| Rate for Payer: Priority Health Narrow Network |
$148.55
|
| Rate for Payer: Priority Health SBD |
$148.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.13
|
| Rate for Payer: UHC Medicare Advantage |
$103.13
|
| Rate for Payer: UHCCP Medicaid |
$70.50
|
| Rate for Payer: UMR Bronson Commercial |
$120.06
|
|
